The Diabetes Prevention Care Program

Diabetes is a common and costly chronic health condition. Afflicting slightly more than 3% of Kaiser Permanente North Carolina (KPNC) members, this condition is responsible for increased rates of myocardial infarction, stroke, kidney disease, and limb amputation. The medical management of these patients leads to dramatically higher health care costs than for nondiabetic patients. In 1995, the estimated PMPM cost per KPNC diabetic member was $315, nearly three times that of nondiabetic members. Diabetes care became a quality priority for KPNC in 1993. Over a two-year period despite several efforts to improve care, costs continued to increase. We lacked regionally accepted clinical practice management. The program is built around evidence-based clinical practice guidelines and protocols (available upon request). A diabetes registry identifies patients with diabetes risk, stratifies them, and captures relevant laboratory, pharmacy, utilization, and information regarding comorbid conditions (also available upon request). The registry is updated weekly. A primary-care-based Diabetes Care Team (DCT) works with the primary care provider, pharmacists, nutritionists, and diabetes patients to deliver coordinated, comprehensive care. A DCT consists of an RN ‘Diabetes Personal Care Coordinator’ and an LPN ‘Diabetes Self-Care Specialist.’ Since the program’s inception, statistically significant improvements have occurred in every clinical measure evaluated. KPNC now has KP Program-leading performance in retinal screening and aspirin use among patients with diabetes. We are among the top performers in smoking counseling and patient satisfaction for patients with diabetes, and provider satisfaction with the program has been exceptional. The Diabetes Prevention Care Program