Evaluating concordance to American Diabetes Association standards of care for type 2 diabetes through group visits in an uninsured or inadequately insured patient population

OBJECTIVE - To evaluate the effectiveness of a managed care approach to health care delivery, group visits, in the management of uninsured or inadequately insured patients with type 2 diabetes. RESEARCH DESIGN AND METHODS - A total of 120 patients with uncontrolled type 2 diabetes were randomly assigned to receive their care in group visits or usual care for 6 months. After 6 months, concordance with 10 process-of-care indicators recommended by the American Diabetes Association (ADA) standards of care was evaluated through chart abstraction. The 10 items evaluated were up-to-date HbA_1c levels and lipid profiles, urine for microalbumin, appropriate use of ACE inhibitor or angiotensin receptor blockers, use of lipid-lowering agents where indicated, daily aspirin use, annual foot examinations, annual referrals for retinal examinations, and immunizations against streptococcal pneumonia and influenza. RESULTS - Patients who received care in group visits showed statistically significant improvement in concordance with these 10 process-of-care indicators (P < 0.001). Of the patients, 76% who received care in group visits had at least 9 of these 10 items up to date, as compared with 23% of control patients; 86% of patients in group visits had at least 8 of the 10 indicators compared with 47% of control patients. CONCLUSIONS - Group visits proved more effective in promoting concordance with ADA standards of care than usual care in the treatment of uninsured or inadequately insured patients with type 2 diabetes.