Diabetes Management For Low-Income Patients in Los Angeles: Two Strategies Improved Disease Control in the Short Term

Peter J. Huckfeldt, RAND Corporation
Daniella Meeker, RAND Corporation
Anne Peters, University of Southern California
Jeffrey J. Guterman, Los Angeles County Department of Health Services
Guillermo Diaz Jr., QueensCare Family Clinics
Dana P. Goldman, University of Southern California

Abstract

Health care providers serving vulnerable patients in Los Angeles have developed programs intended to increase diabetes control through more-intensive patient education and engagement. We examined two programs, the first using a short-term intensive intervention by a care team including nurses and a specialist, and the second integrating case management and clinical pharmacy programs into primary care in a community clinic. We show evidence that both models improved short-term disease control, as measured by reductions in HbA1c and low-density lipoprotein (sometimes referred to as “bad” cholesterol). However, integrating case management and clinical pharmacy programs into a primary care setting was less labor-intensive and potentially less expensive than the care team intervention. The challenge is to understand the essential aspects of these interventions; refine their design so that they are more cost-effective and fiscally feasible; and identify long-term health and cost effects.