The Cost-Effectiveness of Improving Diabetes Care in US Federally Qualified Community Health Centers

One of the longest running national quality improvement programs, the Health Disparities Collaborative (HDC), was initiated in 1998 by the Health Resources and Services Administration's Bureau of Primary Health Care with an initial focus on improving quality of diabetes care. In this study, the researchers set out to evaluate the cost-effectiveness of the Diabetes HDC program by combining data from a study of the program's effectiveness with a comprehensive simulation model of diabetes complications.

Data were collected in 1998, 2000 and 2002, and program staff members abstracted information on demographics, process of care and laboratory results from patient medical charts. The study found that multiple components of care improved from 1998 to 2002 during the implementation of the diabetes HDC. For instance, the amount of screening tests increased considerably, while cholesterol levels decreased significantly. The HDC also was found to reduce the lifetime incidence of intermediate and end-stage complications of diabetes, including renal and coronary artery disease. The improvements that produced the most health benefits were the lowering of glucose levels and the increase of ACE inhibitor prescribing. The researchers conclude that the HDC program will be cost-effective if improvements are maintained or enhanced over the lifetime of patients.