Primary Care Diabetes Bundle Management: 3-Year Outcomes for Microvascular and Macrovascular Events

OBJECTIVE: To determine whether a system of care with an all-or-none bundled measure for primary-care management of diabetes mellitus reduced the risk of microvascular and macrovascular complications compared with usual care.

STUDY DESIGN: A parallel pre-post observational design was used. In 2006, a system of care for diabetes was implemented for some members of the Geisinger Health Plan. A total of 4095 primary-care patients were in the Diabetes System of Care group (DS) and compared with a propensity score–matched cohort of 4095 primary care patients not in the system of care (non-Diabetes System of Care [NDS]).

METHODS: Cumulative hazard rate was measured over a 3-year period for retinopathy, amputation, stroke, and myocardial infarction (MI).

RESULTS: The adjusted hazard ratios (HRs) for MI (HR, 0.77; 95% CI, 0.65- 0.90), stroke (HR, 0.79; CI, 0.65-0.97), and retinopathy (HR, 0.81; CI, 0.68-0.97) were all significantly lower among DS patients. The adjusted HR for major amputations (HR, 1.32; CI, 0.45-3.85) did not differ between groups, but only 17 major amputations occurred during the follow-up period. The necessary number of patients to treat in order to prevent 1 event over 3 years was 82 for MI, 178 for stroke, and 151 for retinopathy.

CONCLUSIONS: A system of care with an all-or-none bundled measure used in primary care for patients with diabetes may reduce the risk of MI, stroke, and retinopathy over a 3-year period.