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Barriers and Potential Solutions to Providing Optimal Guideline-Driven Care to Patients With Diabetes in the U.S.

The cost of diabetes, driven primarily by the cost of preventable diabetes complications, will continue to increase with the epidemic rise in its prevalence in the U.S. The Diabetes Working Group (DWG), a consortium of professional organizations and individuals, was created to examine the barriers t...

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Detalles Bibliográficos
Autores principales: Vigersky, Robert A., Fitzner, Karen, Levinson, Jenifer
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Diabetes Association 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3816882/
https://www.ncbi.nlm.nih.gov/pubmed/24159181
http://dx.doi.org/10.2337/dc13-0680
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author Vigersky, Robert A.
Fitzner, Karen
Levinson, Jenifer
author_facet Vigersky, Robert A.
Fitzner, Karen
Levinson, Jenifer
author_sort Vigersky, Robert A.
collection PubMed
description The cost of diabetes, driven primarily by the cost of preventable diabetes complications, will continue to increase with the epidemic rise in its prevalence in the U.S. The Diabetes Working Group (DWG), a consortium of professional organizations and individuals, was created to examine the barriers to better diabetes care and to recommend mitigating solutions. We consolidated three sets of guidelines promulgated by national professional organizations into 29 standards of optimal care and empanelled independent groups of diabetes care professionals to estimate the minimum and maximum time needed to achieve those standards of care for each of six clinical vignettes representing typical patients seen by diabetes care providers. We used a standards-of-care economic model to compare provider costs with reimbursement and calculated “reimbursement gaps.” The reimbursement gap was calculated using the maximum and minimum provider cost estimate (reflecting the baseline- and best-case provider time estimates from the panels). The cost of guideline-driven care greatly exceeded reimbursement in almost all vignettes, resulting in estimated provider “losses” of 470,000–750,000 USD/year depending on the case mix. Such “losses” dissuade providers of diabetes care from using best practices as recommended by national diabetes organizations. The DWG recommendations include enhancements in care management, workforce supply, and payment reform.
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spelling pubmed-38168822014-11-01 Barriers and Potential Solutions to Providing Optimal Guideline-Driven Care to Patients With Diabetes in the U.S. Vigersky, Robert A. Fitzner, Karen Levinson, Jenifer Diabetes Care Review Article The cost of diabetes, driven primarily by the cost of preventable diabetes complications, will continue to increase with the epidemic rise in its prevalence in the U.S. The Diabetes Working Group (DWG), a consortium of professional organizations and individuals, was created to examine the barriers to better diabetes care and to recommend mitigating solutions. We consolidated three sets of guidelines promulgated by national professional organizations into 29 standards of optimal care and empanelled independent groups of diabetes care professionals to estimate the minimum and maximum time needed to achieve those standards of care for each of six clinical vignettes representing typical patients seen by diabetes care providers. We used a standards-of-care economic model to compare provider costs with reimbursement and calculated “reimbursement gaps.” The reimbursement gap was calculated using the maximum and minimum provider cost estimate (reflecting the baseline- and best-case provider time estimates from the panels). The cost of guideline-driven care greatly exceeded reimbursement in almost all vignettes, resulting in estimated provider “losses” of 470,000–750,000 USD/year depending on the case mix. Such “losses” dissuade providers of diabetes care from using best practices as recommended by national diabetes organizations. The DWG recommendations include enhancements in care management, workforce supply, and payment reform. American Diabetes Association 2013-11 2013-10-15 /pmc/articles/PMC3816882/ /pubmed/24159181 http://dx.doi.org/10.2337/dc13-0680 Text en © 2013 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
spellingShingle Review Article
Vigersky, Robert A.
Fitzner, Karen
Levinson, Jenifer
Barriers and Potential Solutions to Providing Optimal Guideline-Driven Care to Patients With Diabetes in the U.S.
title Barriers and Potential Solutions to Providing Optimal Guideline-Driven Care to Patients With Diabetes in the U.S.
title_full Barriers and Potential Solutions to Providing Optimal Guideline-Driven Care to Patients With Diabetes in the U.S.
title_fullStr Barriers and Potential Solutions to Providing Optimal Guideline-Driven Care to Patients With Diabetes in the U.S.
title_full_unstemmed Barriers and Potential Solutions to Providing Optimal Guideline-Driven Care to Patients With Diabetes in the U.S.
title_short Barriers and Potential Solutions to Providing Optimal Guideline-Driven Care to Patients With Diabetes in the U.S.
title_sort barriers and potential solutions to providing optimal guideline-driven care to patients with diabetes in the u.s.
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3816882/
https://www.ncbi.nlm.nih.gov/pubmed/24159181
http://dx.doi.org/10.2337/dc13-0680
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