Impact of behavioral adherence on clinical improvement and functional status in a diabetes disease management program.

A prospective, observational study of 1289 members completing an evidence-based diabetes management program was evaluated for clinical effectiveness and cost impact. The program consisted of direct contacts by nurse educators who worked with members to complete modules in a specific order based on the individual's readiness to change and specific standards of diabetes care behaviors lacking adherence. A total of 668 members were at HbA1c target values (HbA1c 7%) at baseline. At follow-up 899 members had either reached the target level or improved their values by 1 percentage point. At baseline, 516 members recorded normal blood pressure; at follow-up 755 members either met the target level of less than 130/80 mmHg or reduced their blood pressure by at least 10/5 mmHg. Claims data indicated that 89% (n = 233) of those who had a hospitalization in the prior year did not have a hospitalization in the program year, compared to 3% (n = 32) who did not have a hospitalization in the previous year but needed a hospital visit in the program year. There were statistically significant improvements in other health behaviors and quality of life measures. Cost avoidance was estimated at $7,402,578 for the 1289 members who completed the program and reported their results. This figure includes those who were in compliance prior to the start of the intervention. The study supported the results from large multicenter trials on diabetes management when translated to an intervention.