The effectiveness of diabetes care management in managed care

To evaluate the effectiveness of the diabetes care management (CM) program in Kaiser Permanente Northern California (KPNC) by determining the proportion of enrollees that met program entry criteria and by comparing intermediate outcomes trajectories of enrollees versus similar patients who did not receive CM.

Observational study with propensity score matching of CM patients to control subjects.

Care management program entry criteria were assessed for 179,249 adult patients with diabetes mellitus in 2003 and were compared between CM and non-CM patients in that year. Propensity score matching was used to match CM patients with comparable non-CM controls. Preprogram and postprogram glycosylated hemoglobin (A1C), low-density lipoprotein cholesterol (LDL-C), and systolic blood pressure levels, as well as medication adherence, and treatment intensification rates of CM patients, were compared for enrollees versus controls.

Sixteen percent of CM patients were ineligible by program entry criteria. Small but statistically significant differences in A1C and LDL-C levels favoring CM patients were observed during 15 months of postprogram follow-up. Care management patients were more likely to receive treatment intensification for poorly controlled hyperglycemia, hyperlipidemia, and hypertension. Improvements in all 3 cardiovascular risk factor levels were observed for all KPNC patients with diabetes regardless of CM participation.

Eligibility guidelines for diabetes CM were not strictly adhered to in this program. Nevertheless, in a population with improving risk factor control, patients entering CM experienced slightly greater improvement.