Team-based health care improves diabetes and chronic disease care

Chronic health conditions such as diabetes are especially costly and difficult because they require constant, comprehensive care. The day-to-day rigors of maintaining health is further compounded when such patients have multiple chronic conditions. Heart disease and diabetes are frequently linked, and either or both can increase the risk of, and be exacerbated, by depression. Social support can be a key factor.

So researchers at the University of Washington and Group Health Research Institute conducted a small randomized trial of TEAMcare, a primary care intervention that involved consistent patient monitoring and support by nurses. For the study, 214 patients with poorly controlled diabetes and/or heart disease were enrolled to receive either usual health care or the TEAMcare approach. Those receiving the intervention worked with a nurse to set realistic, step-by-step goals of reducing blood sugar, depression, and improving cardiovascular measures. Rather than shooting for potentially overly-optimistic health improvements, they worked on incremental changes.

The results? As you might expect, health measures in those receiving TEAMcare were significantly better one-year into the program compared to those receiving usual care. Patient satisfaction was also much higher.

The obvious question might be "yes, but at what cost?" TEAMcare patients received, on average, 10 in-person visits from their nurse/coach and 10 phone calls over the 12 month period. Total cost to provide the intervention over that time period: $1,224 (the average total yearly cost for such patients to the health care system is $10,000).

The authors are currently working on a formal economic analysis, but when you consider the total costs-which extend beyond health care to include quality of life, productivity and many other social and economic factors- $1224 seems like a bargain. AHRQ reported in 2002 that the average cost of a hospital stay was $17,000. At that rate, if you prevented one hospitalization among every 13 patients receiving this level of care you'd likely be ahead financially. To say nothing of the moral imperative of simply providing better care and the competitive imperative of deploying sensible and innovative health care delivery models to tackle the growing crisis in chronic disease care.

We've all heard that it takes a village to raise a child. Now here's further evidence that it takes a team to care for those suffering from diabetes, heart disease and other chronic conditions.