Quality, cost and outcome of the coordinated management of type 2 diabetic patients in a healthcare network

Abstract

Aim: To assess the quality and costs of treating patients with type 2 diabetes in a network compared with the usual treatment process in 2005 in the Provence-Alpes- Côte d'Azur region.Methods: Two groups of patients were compared. The experimental group was made up of patients included in the network and the control group of diabetic patients living in the same geographical area as those in the network. Treatment quality was defined by conformity to the professional treatment practices for type 2 diabetes according to the criteria of the French National Authority for Health reference standard (Haute Autorité de Santé). Regarding costs, the French national health insurance system's calculation method was adopted.Results: The study involved a sample of 828 patients. The 414 patients of the network group were followed up more fully over the year than the 414 patients of the control group: three glycated haemoglobin assays (56.4% vs 46.9 % of patients), a lipid control test (80.0% vs 65.0%), testing for microalbuminuria (61.7% vs 27.3%), an ophthalmologic examination (59.4%vs 40.8%), an electrocardiogram (87.5% vs 75.1%), and a dental examination (41.9% vs 32.9%). Patients from the network group presented a higher average outpatient cost than the control group (2,666 vs 2,289 Euro; p = 0.022) and a lower average inpatient cost than the control group (1,462 vs 2,134 Euro; p = 0.04).There was no significant difference between the total treatment costs of the two groups.Conclusion: The level of conformity of professional treatment practices for type 2 diabetes was higher in the network, without a reduction in costs in comparison with the usual treatment process