Chronic Care Clinics for Diabetes in Primary Care

• Published in: Diabetes care Vol. 24; no. 4; pp. 695 - 700
• Main Authors: Wagner, Edward H., Grothaus, Louis C., Sandhu, Nirmala, Galvin, Mary Sue, McGregor, Mary, Artz, Karen, Coleman, Eric A.
• Format: Journal Article
• Language: English
• Published: American Diabetes Association 01-04-2001
• Subjects: Care and treatment; Diabetes; Diabetics; Education; Group counseling; Health aspects; Medicine, Preventive; Preventive health services; United States
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.24.4.695

Chronic Care Clinics for Diabetes in Primary Care
A system-wide randomized trial
Edward H. Wagner , MD, MPH ,
Louis C. Grothaus , MS ,
Nirmala Sandhu , MPH ,
Mary Sue Galvin , RN, MN ,
Mary McGregor , RN, MN ,
Karen Artz , RN, MS and
Eric A. Coleman , MD, MPH
W.A. MacColl Institute for Healthcare Innovation, Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle,
Washington
Abstract
OBJECTIVE —To evaluate the impact of primary care group visits (chronic care clinics) on the process and outcome of care for diabetic
patients.
RESEARCH DESIGN AND METHODS —We evaluated the intervention in primary care practices randomized to intervention and control groups in a large-staff model
health maintenance organization (HMO). Patients included diabetic patients ≥30 years of age in each participating primary
care practice, selected at random from an automated diabetes registry. Primary care practices were randomized within clinics
to either a chronic care clinic (intervention) group or a usual care (control) group. The intervention group conducted periodic
one-half day chronic care clinics for groups of ∼8 diabetic patients in their respective doctor’s practice. Chronic care clinics
consisted of standardized assessments; visits with the primary care physician, nurse, and clinical pharmacist; and a group
education/peer support meeting. We collected self-report questionnaires from patients and data from administrative systems.
The questionnaires were mailed, and telephoned interviews were conducted for nonrespondents, at baseline and at 12 and 24
months; we queried the process of care received, the satisfaction with care, and the health status of each patient. Serum
cholesterol and HbA 1c levels and health care use and cost data was collected from HMO administrative systems.
RESULTS —In an intention-to-treat analysis at 24 months, the intervention group had received significantly more recommended preventive
procedures and helpful patient education. Of five primary health status indicators examined, two (SF-36 general health and
bed disability days) were significantly better in the intervention group. Compared with control patients, intervention patients
had slightly more primary care visits, but significantly fewer specialty and emergency room visits. Among intervention participants,
we found consistently positive associations between the number of chronic care clinics attended and a number of outcomes,
including patient satisfaction and HbA 1c levels.
CONCLUSIONS —Periodic primary care sessions organized to meet the complex needs of diabetic patients improved the process of diabetes
care and were associated with better outcomes.
GHC, Group Health Cooperative
HMO, health maintenance organization
Footnotes
Address correspondence and reprint requests to Edward H. Wagner, M.D., M.P.H., Center for Health Studies, Group Health Cooperative,
1730 Minor Ave., Suite 1290, Seattle, WA 98101. E-mail: wagner.e{at}ghc.org .
Received for publication 27 June 2000 and accepted in revised form 7 November 2000.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.