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Integrated Diabetes Care pp 233–248Cite as

Diabetes Integrated Care: Are We There Yet?

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Abstract

To integrate diabetes care, indeed to ensure quality care and optimise outcomes, requires both the patient and the clinical team to be activated, knowledgeable, skilled and supported. Various ‘systems’ have now been tried in different ways to deliver these characteristics with varying outcomes. Success would deliver population benefits of reduced hospitalisation and diabetes complications, reduced societal cost (not cost shifting) and for the significant sub-groups of patients (e.g. type 1 diabetes) improved access to complex specialist care. A range of factors facilitate patient self-management including continuity of care, team working, systems to overcome barriers to care, management of co-morbidities, diabetes education and promotion of self-management, reducing costs and where needed case management. Evidence is also growing for peer support, access to health records and wider e-health interventions. On the diabetes team member side, shared electronic health records, electronic communication and defined referral pathways, guidelines and risk stratification are at the core. Keeping up to date and abreast of ongoing changes is a challenge to busy clinicians and hence clinical activity needs to be underpinned by decision support and clinician education. However, in some of the work undertaken to date, having these activities in place has been insufficient, it is clear that there has to be a milieu that minimises perverse incentives (e.g. those related to payment systems), maximises workforce flexibility (so clinician may mean a number of medical, nursing, allied health and other health-worker roles) and focuses on population outcomes. At the end of the day, diabetes integrated care requires integrated population based clinical, financial and organisational governance, with a culture that embraces flexibility and patient-focused quality care, and strong articulation with systems that activate, educate and support both patients and clinicians. Are we there yet? Our examples would say…. Nearly!

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References

  1. Hussain S, Dornhorst A. Integrated care – taking specialist medical care beyond the hospital walls. London: Royal College of Physicians; 2015.

    Google Scholar 

  2. Australian Department of Health. Evaluation report of the diabetes care project. Canberra, Australia; 2015.

    Google Scholar 

  3. Office of the Legislative Counsel. Compilation of patient protection and affordable care act 2010. Available from: http://housedocs.house.gov/energycommerce/ppacacon.pdf

  4. Randall L, Begovic J, Hudson M, Smiley D, Peng L, Pitre N, et al. Recurrent diabetic ketoacidosis in inner-city minority patients: behavioral, socioeconomic, and psychosocial factors. Diabetes Care. 2011;34(9):1891–6.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Health & Social Care Information Centre. Quality and Outcomes Framework (QOF) (2014) [05/15/2016]. Available from: http://www.hscic.gov.uk/media/15053/QOF-Publication-Consultation-Results-2014/pdf/QOF_Publication_Consultation_Results_2014.pdf

  6. Alderwick H, Ham C, Buck D. Population health systems: going beyond integrated care 2015 [05/15/2016]. Available from: http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/population-health-systems-kingsfund-feb15.pdf

  7. De Smet A, McGurk M, Vinson M. Unlocking the potential of frontline managers. New York: McKinsey & Companies; 2009. [05/15/2016]. Available from: http://www.mckinsey.com/business-functions/organization/our-insights/unlocking-the-potential-of-frontline-managers.

    Google Scholar 

  8. McKinsey & Company. How companies manage the front line today: McKinsey survey results (2010) [05/15/2016]. Available from: http://www.mckinsey.com/business-functions/organization/our-insights/how-companies-manage-the-front-line-today-mckinsey-survey-results

  9. Simmons D, Lillis S, Swan J, Haar J. Discordance in perceptions of barriers to diabetes care between patients and primary care and secondary care. Diabetes Care. 2007;30(3):490–5.

    Article  PubMed  Google Scholar 

  10. Simmons D, Wenzel H. Diabetes inpatients: a case of lose, lose, lose. Is it time to use a “diabetes-attributable hospitalization cost” to assess the impact of diabetes? Diabet Med. 2011;28(9):1123–11230.

    Article  CAS  PubMed  Google Scholar 

  11. Relman AS. Dealing with conflicts of interest. N Engl J Med. 1985;313(12):749–51.

    Article  CAS  PubMed  Google Scholar 

  12. Schaffer W, Holloman F. Consultation and referral between physicians in new medical prac-tice environments. Ann Intern Med. 1985;103:600–5.

    Article  CAS  PubMed  Google Scholar 

  13. Simmons D, English P, Robins P, Craig A, Rush A. Should diabetes be commissioned through multidisciplinary networks, rather than practice based commissioning? Primary Care Diabetes. 2011;5(1):39–40.

    Article  PubMed  Google Scholar 

  14. Shih A, Davis K, C SS, Gauthier A, Nuzum R, McCarthy D. Organising the U.S. Health Care Delivery System for High Performance. The Commonwealth Fund (2008) [05/12/2016]. Available from: http://www.commonwealthfund.org/usr_doc/Shih_organizingushltcaredeliverysys_1155.pdf

  15. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al. Management of hyperglycemia in type 2 diabetes, 2015: a patient-centered approach: update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2015;38(1):140–9.

    Article  PubMed  Google Scholar 

  16. Wagner EH, Austin BT, Von Korff M. Improving outcomes in chronic illness. Manag Care Q. 1996;4(2):12–25.

    CAS  PubMed  Google Scholar 

  17. Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness. Milbank Q. 1996;74(4):511–44.

    Article  CAS  PubMed  Google Scholar 

  18. Wagner EH, Bennett SM, Austin BT, Greene SM, Schaefer JK, Vonkorff M. Finding common ground: patient-centeredness and evidence-based chronic illness care. J Altern Complement Med. 2005;11 Suppl 1:S7–15.

    PubMed  Google Scholar 

  19. Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A. Improving chronic illness care: translating evidence into action. Health Aff (Millwood). 2001;20(6):64–78.

    Article  CAS  Google Scholar 

  20. Wagner EH, Glasgow RE, Davis C, Bonomi AE, Provost L, McCulloch D, et al. Quality improvement in chronic illness care: a collaborative approach. Jt Comm J Qual Improv. 2001;27(2):63–80.

    CAS  PubMed  Google Scholar 

  21. Savage MW, Dhatariya KK, Kilvert A, Rayman G, Rees JA, Courtney CH, et al. Joint British Diabetes Societies guideline for the management of diabetic ketoacidosis. Diabet Med. 2011;28(5):508–15.

    Article  CAS  PubMed  Google Scholar 

  22. Simmons D. Impact of an integrated approach to diabetes care at the Rumbalara Aboriginal Health Service. Intern Med J. 2003;33(12):581–5.

    Article  CAS  PubMed  Google Scholar 

  23. NCQA. Comprehensive diabetes care (n.d.) [05/13/2016]. Available from: http://www.ncqa.org/report-cards/health-plans/state-of-health-care-quality/2015-table-of-contents/diabetes-care

  24. Permanente K. Measuring care quality: Southern California Region. Rockville: Kaiser Permanente; 2015.

    Google Scholar 

  25. Permanente K. Measuring care quality: Northern California Region. Rockville: Kaiser Permanente; 2015.

    Google Scholar 

  26. NHS. The Information Centre. National Diabetes Audit: PCT summary. Year 2009/10 (n.d.) [05/15/2016]. Available from: http://www.hscic.gov.uk/catalogue/PUB06517/nati-diab-audi-pct-lhb-eng-scen-port-pct-rep.pdf

  27. Diabetes Specialist Centre. Pattern review and outcomes from SMBG data in primary care. An evaluatuion of communication and technology support. Diabetes Voice Summer 2014(26).

    Google Scholar 

  28. Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in Type 2 diabetes. N Engl J Med. 2008;358(24):2545–59.

    Article  Google Scholar 

  29. Huxley RR, Peters SA, Mishra GD, Woodward M. Risk of all-cause mortality and vascular events in women versus men with type 1 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol. 2015;3(3):198–206.

    Article  PubMed  Google Scholar 

  30. Coulter A, Roberts S, Dixon A. Delivering better services for people with long term conditions. Building the house of care. London: The King’s Fund; 2013.

    Google Scholar 

  31. Pringle M, Stewart-Evans C, Coupland C, Williams I, Allison S, Sterland J. Influences on control in diabetes mellitus: patient, doctor, practice, or delivery of care? BMJ Br Med J. 1993;306(6878):630–4.

    Article  CAS  Google Scholar 

  32. Cebolla Garrofé B, Björnberg A, Yung Phang A. Euro diabetes index 2014. Health Consumer Powerhouse Ltd; 2014.

    Google Scholar 

  33. Davis K, Stremikis K, Schoen C, Squires D. Mirror. Mirror on the wall, update: how the U.S. Health Care System compares internationally. The Commonwealth Fund; 2014.

    Google Scholar 

  34. Tricco AC, Ivers NM, Grimshaw JM, Moher D, Turner L, Galipeau J, et al. Effectiveness of quality improvement strategies on the management of diabetes: a systematic review and meta-analysis. Lancet. 2012;379(9833):2252–61.

    Article  PubMed  Google Scholar 

  35. Piwernetz K. DIABCARE Quality Network in Europe – a model for quality management in chronic diseases. Int Clin Psychopharmacol. 2001;16 Suppl 3:S5–13.

    Article  PubMed  Google Scholar 

  36. US Department of Health & Human Services. EHR Incentives & Certification [05/24/2016]. Available from: https://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives

  37. Kings’ Fund. Consultancy report: partnership for sustainable health care development: options paper for approaches to governance and clinical governance for an integrated care approach to diabetes. Final report. London; October 2010.

    Google Scholar 

  38. Simmons D, Peng A, Cecil A, Gatland B. The personal costs of diabetes: a significant barrier to care in South Auckland. N Z Med J. 1999;112(1097):383–285.

    CAS  PubMed  Google Scholar 

  39. International Diabetes Federation Europe. Access to quality medicines and medical devices for diabetes care in Europe; 2013.

    Google Scholar 

  40. OECD – OECD. Stat. Income distribution and poverty: median disposable income at current prices (n.d.) [05/12/2016]. Available from: http://stats.oecd.org/Index.aspx?DataSetCode=IDD

  41. Simmons D, Hartnell S, Watts J, Ward C, Davenport K, Gunn E, et al. Effectiveness of a multidisciplinary team approach to the prevention of readmission for acute glycaemic events. Diabet Med. 2015;32(10):1361–7.

    Article  CAS  PubMed  Google Scholar 

  42. Murray NJ, Gasper AV, Irvine L, Scarpello TJ, Sampson MJ. A motivational peer support program for type 2 diabetes prevention delivered by people with type 2 diabetes: the UEA-IFG feasibility study. Diabetes Educ. 2012;38(3):366–76.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. School of Medicine, Western Sydney University, Sydney, New South Wales, Australia

    David Simmons

  2. Health Economist, Konstanz, Germany

    Helmut Wenzel

  3. Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, FL, USA

    Janice C. Zgibor

Authors
  1. David Simmons
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  2. Helmut Wenzel
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  3. Janice C. Zgibor
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Correspondence to David Simmons .

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Editors and Affiliations

  1. School of Medicine, Western Sydney University, Sydney, New South Wales, Australia

    David Simmons

  2. Health Economist, Konstanz, Germany

    Helmut Wenzel

  3. Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida, Tampa, Florida, USA

    Janice C. Zgibor

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Simmons, D., Wenzel, H., Zgibor, J.C. (2017). Diabetes Integrated Care: Are We There Yet?. In: Simmons, D., Wenzel, H., Zgibor, J. (eds) Integrated Diabetes Care. Springer, Cham. https://doi.org/10.1007/978-3-319-13389-8_15

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  • DOI: https://doi.org/10.1007/978-3-319-13389-8_15

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