Treating diabetes right Medical community reaches agreement

By WILLIAM K. ALCORN
VINDICATOR HEALTH WRITER
YOUNGSTOWN -- Standardized treatment guidelines, aimed at cutting diabetes death rates and the cost of treatment for the disease, have been developed by a consortium of health care entities and distributed to area health care professionals.
Because local communities are greatly affected by diabetes, setting up standardized guidelines and doctor reminders was a top priority for the group.
The treatment checklist was adapted by the local Ohio Quality Improvement Consortium (OQIC) from nationally recognized, evidence-based guidelines.
OQIC, consisting of representatives from area health care providers, insurers, physicians and other professional organizations, and the joint United Auto Workers-General Motors-International Union of Electrical Workers (UAW-GM-IUE) Delphi Community Health Care Initiatives, have joined forces to develop guidelines for local use to treat patients with chronic illnesses, such as diabetes or congestive heart failure.
"This document brings state of the art diabetes management to the fingertips of Valley doctors," said Dr. Jon Arnott, president of Premier Medical Alliance, health insurance carrier for Forum Health.
"The development of a single set of guidelines for patient care that is agreed to by physicians, hospitals, managed care organizations and employers is a major step in the right direction," Dr. Cliff Waldman, senior medical director for Humility of Mary Health Partners, said.
"Not only does it provide everyone with a clear message of what is necessary for quality medical care, it also shows that we can work together to improve the health of our community," Dr. Waldman added.
Focus on diabetes first
The consortium, started in November 2001, initially focused on the development of guidelines for the management of diabetes. The goals are to improve outcomes for all patients, not just one health plan; to promote evidence based care; and to reduce avoidable variation, Dr. Steven Richardson, chief medical officer for United Healthcare of Ohio, said.
Dr. Richardson said diabetes was chosen first by QOIC because of the community's perception that it affects the most people and costs the most money. According to the Ohio Department of Health, Trumbull, Mahoning and Columbiana counties diabetes mortality rates were higher than the state, nation and most comparison communities in 1999, the most recent year for which statistics are available.
"OQIC represents a unique and important collaboration of health care entities that rarely get together. With local hospitals, physician groups, health plans, professional organizations, employers and union representatives coming to the table to discuss ways to improve the community's health, the opportunity for truly significant change is tremendous. Patients stand to benefit dramatically from the development of a standardized approach to treating common diseases," Dr. Richardson said.
"The guidelines will help ensure that diabetic patients receive information, specific tests and examinations to improve the quality of their treatment," Dr. William McCoy, senior vice president of medical affairs at Trumbull Memorial Hospital in Warren, said.
Something as simple as a reference list for doctors, reminding them to test patients for potential health conditions, such as requiring eye and foot exams or prescribing medicines for diabetics, could dramatically improve patient outcomes, officials said.
Over the past five years, there has been a trend of acceptance of national guidelines by physicians for health care outcomes. But doctors usually get many variations from different sources. Through the OQIC, local standardized guidelines are being developed for a minimum level of care for several diseases, Dr. Richardson said.
Doctors forced to comply
The "carrot" for doctors to follow the guidelines is that all health care organizations do audits. And, if doctors follow the minimum standards and use the proper documentation, it will make their lives and the lives of the patients better, Dr. Richardson said.
Diabetics benefit greatly from modifying their exercise regimen and diet to achieve ideal body weight. Both of these activities improve control of the blood sugar and also reduce the risk of cardiovascular disease by improving blood pressure and lowering cholesterol. The OQIC guidelines will emphasize control of body weight, cholesterol and blood pressure.
By maintaining one standardized set of common clinical practice guidelines and performance measures, health plans can provide better service to their members. Another residual effect would be increased value due to more efficient delivery of health care, resulting in earlier diagnoses and shorter hospital stays.
"With the implementation of these tools we hope to help practitioners develop more effective habits in a manner that enhances the efficiency of their practice," Dr. Benjamin Hayek, medical director
for Anthem Blue Cross and Blue Shield, said.
The diabetes check list was distributed to area physicians in January. Now, the consortium is in the final stages of developing a similar set of guidelines for the treatment of congestive heart failure. Guidelines for obesity and asthma will follow, officials said.
"I think it is exciting that health plans, physicians, hospitals and other key community stake holders are working together to implement a uniform and consistent approach to treating diabetes," said Sam Shalaby, GM's director of Community Healthcare Initiatives for Northeast Ohio.
"This will provide significant improvement to the quality of care and optimize the utilization of health care resources in the Trumbull, Mahoning and Columbiana counties," Shalaby said.
"The concept of applying 'evidence-based care' consistently across a community, embraced by physicians and health plans, has the potential to improve our overall health status and improve the quality of life for all area residents," Ken Senter, Community Initiative director for UAW, said.
This was basically done to make sure that hospitals, physicians and health care plans agree on a standard set of clinical guidelines to ensure diabetics in the community are getting the best care, Shalaby said.
Physicians are now being asked to use the clinical guidelines, and next year they will be measured. Sometime down the road, OQIC may have to consider incentives, such as publishing the results to ensure adherence to the guidelines, Shalaby said.