865-P: Care Management Processes That Improve Diabetes Outcomes

Although previous work suggests that high performing practices focus on proactive patient outreach, the specific care management processes (CMP) that improve diabetes outcomes remain unclear. We evaluated 60 CMP from a state-wide practice survey in 2017 and 2019. Previously validated, the survey included 586 practices in 2017 (71% response, N=415) and 627 practices in 2019 (71% response, N= 445). Electronic health record data for A1c, blood pressure (BP), and lipid management were extracted for all patients with type 1 or type 2 diabetes in the practices. The longitudinal data set included 395 practices providing care to 204,745 patients. We used a longitudinal Bayesian model to correlate CMPs with A1c, systolic/diastolic BP, and probability of taking a statin. Patient outcomes were controlled for age, sex, diabetes type, insurance, comorbidity, community-level race-ethnicity, wealth, education, and income. Practices were controlled for rurality, size, FQHC status, system size, and practice-level random effects. Significance was reduced to <.01 for multiple comparisons. Although 7 CMPs significantly improved the overall diabetes performance measures for an average practice, CMPs affected individual outcomes differently. A1c improved by: 1) implementing a systematic approach to identifying and reminding patients when they were due for testing, and 2) having a nurse or care manager provide after visit follow up. BP was reduced by: 1, 2, and 3) tracking lab tests, 4) using checklists in the practice for required testing, and 5) guideline based reminders for preventive services. Statin use increased by: 5, and 6) screening for substance-abuse, and 7) a formal process for measuring performance. Together, CMPs with a statistically significant impact on performance measures accounted for a drop in average A1c in a practice from 7.39 to 7.25 (P<.01) BP from 127/75 to 121/71 (P<.01) and a 3.9% (P<.01) statin use increase. CMP 1 and 2 exemplify specific proactive patient outreach processes proven to improve diabetes care delivery.