Team Model Associated With Improved Diabetes Care Quality

The Enhanced Primary Care Diabetes (EPCD) team model was able to improve diabetes care quality for those who had access to the model, according to a study in Annals of Family Medicine. Clinicians, care team nurses, and clinical pharmacists may benefit from this model, but more research is needed.

As of 2020, there were 37.7 million people in the United States living with diabetes, most of whom receive care from their primary care physician. Care delivery models have been used in these settings to improve diabetes care quality. However, these interventions lack guidance for proper implementation. This study evaluated the EPCD and its effect in practices with an integrated health care delivery system who did or did not implement the model.

The researchers obtained data from 32 practices: 13 Mayo Clinic Rochester (MCR) practices and 19 Mayo Clinic Health System (MCHS) practices in Minnesota. Practices in family medicine, internal medicine, and pediatrics are included in MCR, and community clinics are covered in MCHS. Care teams are formed in both MCR and MHS, in which patients are assigned to a physician and that clinician’s care team.

The EPCD model was implemented between March 1 and April 30, 2019, with the included practices separated into 3 groups: 11 were EPCD staff clinician practices (had phsycians and advanced practice providers with access to the model), 19 were non-EPCD staff clinician practices (had physicians and advanced practice providers without access to the EPCD), and 2 were EPCD trainee practices (resident physicians with access to the EPCD). The researchers were analyzing what 5-component diabetes quality indicators (D5) were present in these practices after implementation of EPCD.

There were 5761 patients from the EPCD staff practices, 1887 patients from EPCD trainee practices, and 10,079 patients from the non-EPCD staff practices included in this study.

There were more patients that met the D5 composite indicator and the individual component indicators of glycemic control, tobacco abstinence, and blood pressure control before implementation in the EPCD staff group. Patients who met the D5 indicator increased from 42.9% to 45.0% (incident rate ratio [IRR], 1.005) in the EPCD staff group and from 38.9% to 42.0% (IRR, 1.011) in the EPCD trainee group post implementation. The D5 indicator decreased in the non-EPCD staff group from 36.2% to 35.5% (IRR, 0.994).

The non-EPCD group saw a decrease in the percentage of patients who met the glycemic control indicator whereas both EPCD groups met the blood pressure indicator. The EPCD staff group had an improvement in attaining the D5 composite indicator (change in IRR from 0.995 to 1.005).

The blood pressure indicator saw improvement in all 3 groups from pre- to post implementation but was more prominently found in the EPCD groups compared with the non-EPCD group. Worsening of glycemic control and tobacco-free indicators were also found in the non-EPCD group.

Significant differences in the preimplementation trends were not found in the D5 indicator when the groups were directly compared. The percentage of patients who met the indicator in the EPCD staff group indicated a more positive trend compared with the non-EPCD group (IRR, 1.013). The same was found in the EPCD trainee group wn compared with the non-EPCD group (IRR, 1.017).

There were some limitations to this study. The evaluation of the EPCD model had to be ended after 10 months of implementation due to the COVID-19 pandemic, which lead to less than 10% of the population receiving formal evaluation. In addition, all health care practices were from 1 region in the United States, which may not generalize to all parts of the country, and granular patient-level information was not an adjustable factor in this study.

The researchers concluded that the EPCD model was “a successful template that health care systems can build on to improve the quality of diabetes care they provide to patients.”

Reference

Herges JR, Matulis JC, Kessler ME, Ruehmann LL, Mara KC, McCoy RG. Evaluation of an enhanced primary care team model to improve diabetes care. Ann Fam Med. 2022;20(6):505-511. doi:10.1370/afm.2884