Abstract
Background
Optimal cardiovascular risk factors control among individuals with diabetes remains
a challenge. We evaluated changes in glucose, lipid, and blood pressure control among
diabetes patients after implementation of a large-scale population management program,
known as Preventing Heart Attacks and Strokes Everyday, at Kaiser Permanente Northern
California (KPNC), during 2004-2013.
Methods
We used National Committee for Quality Assurance Healthcare Effectiveness Data and
Information Set cut points to identify prevalence of poor glycemic (hemoglobin A1c > 9%)
control, good lipid control (low-density lipoprotein cholesterol < 100 mg/dL), and
good blood pressure control (blood pressure < 140/90 mm Hg) in each year (N range
= 98,345 to 122,177 over the entire period). We assessed trends in risk factor control
based on Joinpoint regression and average annual percentage change (AAPC) compared
with published National Committee for Quality Assurance Healthcare Effectiveness Data
and Information Set commercial rates.
Results
We found that the prevalence of poor glycemic control (hemoglobin A1c > 9%) declined
in both KPNC and nationally, but was statistically significant only in KPNC (AAPC
= −4.8; P < .05). The prevalence of good lipid control (low-density lipoprotein cholesterol < 100 mg/dL)
increased significantly in KPNC (47% to 71%; AAPC = +4.3; P < .05), but there was no significant improvement nationally (40% to 44%; AAPC = +1.4;
P = .2). The prevalence of blood pressure control (<140/90 mm Hg) was higher in KPNC
(77% to 82%; AAPC = +1.1; P < .05) versus nationally (57% to 62%; AAPC = +1.9; P < .05) during the reported years 2007-2013.
Conclusions
Relative to national benchmarks, a substantially greater improvement in risk factor
control among adults with diabetes was observed after implementation of a comprehensive
population management program.
Keywords
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Article Info
Publication History
Published online: March 22, 2018
Footnotes
Funding: This project was supported by funding from a Kaiser Permanente Northern California Community Benefit grant. The funding sources had no role in study design, data collection, data analysis, data interpretation, or writing of the report.
Conflict of Interest: None.
Authorship: All authors had access to the data and had a role in writing the manuscript.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
