"How Our Current Healthcare System Fails Patients with Type 2 Diabetes"
This may be the most important article in the medical literature on type 2 diabetes. It addresses a sad fact. While most large hospital systems in the country have quality improvement initiatives in place, most of them fail to improve health and save money. They fail to “move the needle”. They don’t change clinical and financial outcomes, but here is the curious thing. They believe they are doing as well as anyone could. but the fact is, the needle does not move. Success requires two things: a focus on high-risk conditions and evidence-based care processes consistent with best practices. This article discusses these care processes.
Very frankly, the current healthcare system does fail patients with type 2 diabetes. The aggressive goals for optimal medical treatment (OMT) for type 2 diabetes are still appropriate but a very small minority of patients achieve those goals concurrently. On average it is less than 20%. No industry would tolerate a performance like that. The reason for the failure is simple. We keep doing the same things and we expect a different result. Evidence to support care processes is just as important as the evidence for the interventions we have discussed. The approach most institutions try makes perfect sense; it just doesn’t work. “Many approaches have been tried to improve diabetes care but, with one exception, have been mostly ineffective. These include simply reminding patients about appointments; providing laboratory information on the patient to the physician, even when specific treatment recommendations for the individual patient were included; case management when the case manager could not make independent treatment decisions; education of physicians; and multifaceted quality improvement interventions in the practice setting”
So, the obvious next question is: “what does work?” Here it is in a nutshell: “The one approach that has proven to be effective is using specially trained nurses or pharmacists, under appropriate supervision, with authority to make medication changes without consulting the physician as long as the changes fell within approved treatment algorithms. In randomized clinical trials, A1C levels fell threefold more in 1,969 patients followed by nurses and pharmacists compared with 1,573 patients under usual care.” That’s it. The highest level of success comes from advanced medical home teams focused on diabetes and related conditions. Every success story I have cited uses that model. These teams identify the members with the target condition. They use protocols, information technology to support and measure care, while supporting these teams with powerful clinical and financial analytics. The team must use a payment model that supports this kind of work. Singapore has these focused teams in their primary care polyclinics and they live longer for one fourth the impact on gross domestic product. We can do this. If you “get it” and you want to move in this direction get in touch with me and we can make progress. whbester@gmail.com