The Effects of an On-Site Health Center and Care Coordination on Type-2 Diabetes Outcomes

Abstract

More than 30.3 million people in the United States (US) have diabetes with 90-95% having type-2 diabetes mellitus (T2DM). In 2017, the total costs of diabetes care were estimated at $327 billion and contributed to the $3.3 trillion in annual health care costs in the US. Of the chronic diseases, T2DM is the seventh leading cause of death in the US. Management of T2DM is complex and requires a multidisciplinary approach. The on-site health center promotes health through innovative care solutions using a patient centered model. Care coordination can potentially maximize the value of care delivery with improved health outcomes.

This scholarly project evaluated changes in T2DM outcomes at one on-site health center after enrollment into care coordination. A non-experimental, retrospective chart review was performed utilizing secondary data from health risk assessments (HRAs) and an electronic health record (EHR). The T2DM clinical variables evaluated at initial HRA and post-HRA surveys were: weight, body mass index (BMI), blood pressure (BP), blood glucose (FBS), hemoglobin A1c (HbA1c), microalbumin, low/high density lipoproteins (LDL, HDL), medication therapy with angiotensin-converting enzyme inhibitors (ACE) or angiotensin receptor blockers (ARB), and HMG-CoA reductase inhibitors (statins). Additional variables included number of health center visits, foot exams, and wellness, podiatry, and eye exam referrals.

Comparison of initial and post-HRA data were analyzed using a paired t-test. Data was used for comparison of organizational benchmarks and T2DM national standards. A total of 92 participants met the inclusion criteria. There were statistically significant improvements in HbA1c and microalbumin results. The post-HRA mean HbA1c was 7.5% (p=.045) and microalbumin was 17.8 (p=.006). There were near significant results for post-HRA mean DBP of 80.5 mmHg (p=.053) and FBS of 140.9 (p=.053). The American Diabetes Association (ADA) standards of diabetes care were met for BP control and lipid management, but not for HbA1c. Organizational benchmarks for foot exams, ACE or ARB medication therapy were met but not achieved for HbA1c. The implications to practice are on-site health centers can provide chronic disease management while potentially improving T2DM outcomes. Recommendations for further study include a cost benefit analysis of T2DM care at on-site health centers.