BACKGROUND: Diabetes in particular presents an ideal opportunity for the
incorporation of information technology (IT) in the provision of care.
The disease is highly prevalent in managed care populations, is
frequently associated with comorbid conditions, and requires multiple
medications in its management. Furthermore, effective diabetes care
involves the monitoring of several measures of disease control, such as
hemoglobin A1c (A1c) and lipid levels, by several different levels of
providers, such as physicians, nurse practitioners, physician
assistants, pharmacists, and dieticians. All of these factors combined
make diabetes an opportune disease state for a case study of the
implementation of health information technology (HIT) in managed care.
OBJECTIVE: To review practical applications of HIT for improving the
delivery of care in diabetes management.
SUMMARY: Between 1990 and 2002, the incidence of type 2 diabetes
increased by 61% in the United States. The total costs associated with
diabetes have been increasing since the late 1970s as well, with a more
dramatic rise over the last 10 years. In fact, the total cost of
diabetes in the United States will approach $200 billion per year by
the year 2020.
In order to improve diabetes management efforts nation wide, the goal of
glucose-lowering therapy has been recommended to lower the hemoglobin
A1c (A1c) to < 7% and keep it below that level long term. Other
measures beyond A1c levels have also been identified as being important
components to effective diabetes management and incorporated into
national treatment recommendations, providing an ideal opportunity for
the incorporation of HIT interventions. These interventions have been
aimed at 3 different groups of stakeholders in managed care: payers,
providers, and patients.
CONCLUSIONS: While uncontrolled diabetes remains a major concern in
managed care from both a health and a cost perspective, implementation
of information technology enabled diabetes management (ITDM) has
demonstrated significant potential for improving processes of care,
preventing the development of diabetic complications, and generating
cost savings. ITDM improves the synthesis of information, the delivery
of knowledge, and the efficiency of communication, allowing for
coordination of care across delivery teams. Of the existing technologies
targeting providers, patients, and payers, provider-centered
interventions, such as diabetes registries currently show the most
potential for benefit in improving outcomes and reducing costs.
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