Labor characteristics and program costs of a successful diabetes disease management program.

BACKGROUND: Organizations have invested in disease management programs to improve quality and to reduce costs, but little is known about the labor characteristics and the program costs necessary to implement a program. OBJECTIVE: To examine the labor characteristics and the program costs of a successful diabetes disease management program. STUDY DESIGN: We performed a labor and cost analysis within a randomized controlled trial of a primary care-based diabetes disease management intervention. METHODS: Participants included 217 patients with type 2 diabetes mellitus and poor glycemic control (glycosylated hemoglobin levels, > or = 8.0%). The intervention group received 12 months of intensive management from clinical pharmacists and a diabetes care coordinator who provided education, applied algorithms for medication management, and addressed barriers to care. The control group attended a single session led by pharmacists, followed by usual care from their primary providers. The process outcomes included the number of patient care-related activities, time spent per patient, and number of drug titrations or additions. The program costs were calculated based on Bureau of Labor Statistics wage data using a sensitivity analysis. RESULTS: The disease management team performed a mean of 4.0 care-related activities for a mean of 38.6 minutes per patient per month for intervention patients and performed a mean of 1.1 care-related activities for a mean of 10.7 minutes per patient per month for control patients (P < .001). Intervention patients had a median of 7 drug titrations or additions during the study. The incremental program cost for the intervention was 36.97 dollars (sensitivity analysis, 6.22 dollars-88.56 dollars) per patient per month. CONCLUSION: A successful diabetes disease management program can be integrated into an academic clinic for modest labor and cost.

Duke Scholars

Author Michael Patrick Pignone Medicine, General Internal Medicine