Uninsured Individuals with Diabetes: Impact of Case Management on Health Outcomes

There are 1.2 million uninsured adults in the U.S. with diabetes, and 32% do not have a single source of management for their chronic condition. Of those with a source of care, over 75% reported they did not have a health professional examine their feet, and 60 percent did not have a dilated eye exam in the past year. The Marshfield Clinic, a multi-specialty clinic system, provides primary care to the indigent population in Wisconsin with the goal of facilitating access to a regular source of care. Marshfield's Family Health Center (FHC) provides standard primary care while their Community Health Access (CHA) Program provides preventive health and disease management programs.

The CHA program's goal is to assist patients in navigating the health care system more effectively, to understand the importance of preventive health and to manage chronic conditions such as diabetes through consistent contact with nurse care managers. Following an initial assessment, patients with an identified risk profile are triaged to telephonic case management which includes support to facilitate access to needed primary and specialty care, as well as self-management skill building and patient empowerment support.

To assess the effectiveness of the CHA program on diabetes outcomes, we will compare health outcomes among CHA program enrollees (n=162) and a similar group of patients with diabetes who were enrolled in the FHC program (n=529), who received mailings in addition to routine diabetes care. Clinical and quality of care outcomes related to A1C, microalbuminuria, cholesterol, and utilization patterns will be presented.