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Primary care programs with certain characteristics are more likely to help patients improve diabetes control

Controlling blood sugar levels can reduce the development of serious long-term complications in patients with diabetes. A recent survey of 170 Veterans Health Administration (VHA) medical centers and 65 community-based outpatient clinics uncovered certain primary care organizational features associated with better blood sugar control among their patients. These programs had teams that actively involved physicians in quality improvement, used electronic health information systems, had authority to respond to staffing and programmatic issues, and actively involved patients in their own care.

Supported in part by the Agency for Healthcare Research and Quality (T32 HS00079), George L. Jackson, Ph.D., M.H.A., of the Durham Veterans Affairs Medical Center, and colleagues examined data from the 1999 VHA survey along with individual patient data from the VHA Diabetes Register and VHA corporate databases. They examined the relationship between organizational characteristics and blood sugar (HbA1c) levels in 177 clinics with 82,428 patients with diabetes. Programs whose patients had significantly lower HbA1c levels were those that had more authority to establish or implement clinical policies and greater staff authority, used computerized reminders for preventive diabetes care, notified all patients of their assigned provider, hired new staff when needed, had nurses that reported only to the program, and were large academic practices. Together, these characteristics would be expected to reduce HbA1c by more than 1 percent, according to the researchers. Just a 1-percent reduction has been shown to lower the risk of diabetes-related complications and deaths by 21 percent.

See "Veterans affairs primary care organizational characteristics associated with better diabetes control," by Dr. Jackson, Elizabeth M. Yano, Ph.D., M.S.P.H., David Edelman, M.D., M.H.S., and others, in the April 2005 American Journal of Managed Care 11(4), pp. 225-237.

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