Association between frequency of telephonic contact and clinical testing for a large, geographically diverse diabetes disease management population

Diabetes disease management (DM) programs strive to promote healthy behaviors, including obtaining hemoglobin A1c (A1c) and low-density lipoprotein (LDL) tests as part of standards of care. The purpose of this study was to examine the relationship between frequency of telephonic contact and A1c and LDL testing rates. A total of 245,668 members continuously enrolled in diabetes DM programs were evaluated for performance of an A1c or LDL test during their first 12 months in the programs. The association between the number of calls a member received and clinical testing rates was examined. Members who received four calls demonstrated a 24.1% and 21.5% relative increase in A1c and LDL testing rates, respectively, compared to members who received DM mailings alone. Response to the telephonic intervention as part of the diabetes DM programs was influenced by member characteristics including gender, age, and disease burden. For example, females who received four calls achieved a 27.7% and 23.6% increase in A1c and LDL testing, respectively, compared to females who received mailings alone; by comparison, males who were called achieved 21.2% and 19.9% relative increase in A1c and LDL testing, respectively, compared to those who received mailings alone. This study demonstrates a positive association between frequency of telephonic contact and increased performance of an A1c or LDL test in a large, diverse diabetes population participating in DM programs. The impact of member characteristics on the responsiveness to these programs provides DM program designers with knowledge for developing strategies to promote healthy behaviors and improve diabetes outcomes

A focused telephonic nursing intervention delivers improved adherence to A1c testing

Compliance with hemoglobin A1c (A1c) testing is suboptimal despite the clear national recommendations and guidelines established for care of patients with diabetes. Recent studies have demonstrated a relationship between participation in a diabetes disease management (DM) program and improved adherence to A1c testing. A focused intervention study was initiated to investigate the ability of a DM program to drive improvement in A1c testing. A cohort of 36,327 members experienced a statistically significant increase (29%) in A1c testing while participating in the 6-month focused intervention. This finding demonstrated that a focused DM intervention is able to deliver improvement in a clinical process metric critical for managing patients with diabetes, thereby reducing their risk of disease exacerbation

Abstract 335: Population Well-being and Cardiovascular Disease

Background: Increasingly, policies and payment structures are holding health care systems accountable for the health of their population, refocusing attention on community attributes that influence health. However, the complex and contextual aspects of a community make it challenging to know which community attributes may affect the health risk of individuals. Methods: We investigated the relationship of CVD prevalence and risk factors with a novel index of well-being, the Gallup-Healthways Well-being Index (GHWBI, 2010), consisting of 55 survey responses organized into 6 domains: life evaluation ( LE ); emotional health (EH) ; work environment (WE) ; physical health (PH) ; healthy behaviors (HB) ; and basic access [to food, shelter, and health care] (BA) . Individuals &gt;18y were randomly selected for telephone survey (n=348,846). Overall index and domain scores were made available to us aggregated to the Congressional District (CD) level. Prevalence of heart disease, stroke, hypertension, and diabetes, as well as CV health (absence of these factors), were determined using the 2011 Behavioral Risk Factor Surveillance System (BRFSS) sub-group study (224 counties). We linked datasets by assigning average BRFSS item responses at the county level to county zip codes; we then re-aggregated to CD and weighted by zip code. We used weighted linear regression to assess: (1) rates of CVD/CV health across GHWBI quintiles, and (2) independent effects of the 6 GHWBI domains on CVD/CV health, reported as t-scores. Because the PH domain included survey items related to CVD, we repeated this analysis excluding PH as an independent variable. Results: Higher CD well-being scores (n=316 CDs) were associated with lower prevalence of CVD and higher rates of CV health (Table). Independent effects of the GHWBI domains revealed inverse associations between CVD and HB , and heart disease and LE . CV health was positively associated with EH and BA, but negatively associated with HB . Excluding PH from this analysis did not meaningfully affect the results. Discussion: Population well-being is associated with reduced CVD and improved CV health, even at the CD level. Future research should investigate these relationships within smaller more homogeneous community populations, in order to identify targets for intervention. </jats:p

The Impact of a Proactive Chronic Care Management Program on Hospital Admission Rates in a German Health Insurance Society

Hospital admissions are the source of significant health care expenses, although a large proportion of these admissions can be avoided through proper management of chronic disease. In the present study, we evaluate the impact of a proactive chronic care management program for members of a German insurance society who suffer from chronic disease. Specifically, we tested the impact of nurse-delivered care calls on hospital admission rates. Study participants were insured individuals with coronary artery disease, heart failure, diabetes, or chronic obstructive pulmonary disease who consented to participate in the chronic care management program. Intervention (n = 17,319) and Comparison (n = 5668) groups were defined based on records of participating (or not participating) in telephonic interactions. Changes in admission rates were calculated from the year prior to (Base) and year after program commencement. Comparative analyses were adjusted for age, sex, region of residence, and disease severity (stratification of 3 [least severe] to 1 [most severe]). Overall, the admission rate in the Intervention group decreased by 6.2% compared with a 14.9% increase in the Comparison group (P < 0.001). The overall decrease in admissions for the Intervention group was driven by risk stratification levels 2 and 1, for which admissions decreased by 8.2% and 14.2% compared to Comparison group increases of 12.1% and 7.9%, respectively. Additionally, Intervention group admissions decreased as the number of calls increased (P = 0.004), indicating a dose-response relationship. These findings indicate that proactive chronic care management care calls can help reduce hospital admissions among German health insurance members with chronic disease. (Population Health Management 2010;13:339–345