Chronic Care Model for diabetes management improves diabetes care in a indigent inner-city population

Objective: To determine whether using the chronic care model (CCM) in an inner-city indigent population leads to improved metabolic measures for people with diabetes. Research Design and Methods: This was an observational case-control study of 744 diabetic patients inside the five Cincinnati Health Department clinics; 356 of those patients were treated at acute care clinics (ACC) and 388 were treated at CCM clinics during 2008 and 2009. Data was collected at the two time periods (2008 and 2009) including: Hemoglobin A1C (A1C), Low Density Lipoprotein (LDL), and Blood Pressure. Finally, demographic variables collected included: age, gender, race, weight, and height. Results: For all of the patients with paired results (n=679), the A1C levels improved from 2008 to 2009 (8.1% vs. 7.8%; decrease -0.3%, 95% CI -0.41 to -0.15, p<0.001). The largest mean decrease was seen in clinic 4 (n=152) that introduced the CCM during 2008 (decrease of -0.6% vs. -0.2%; 95% CI -0.73 to -0.12, p =0.006). The average A1C in clinic 4 decreased from 8.5% to 7.9%. The clinic that had been using the CCM since 2006 had the lowest average A1C, LDL, and Blood Pressure of all the clinics but also the lowest decrease in A1C during the study. Conclusions: The CCM appears to improve diabetes care, as measured by A1C and LDD, in a largely indigent inner-city population. The continued use of the CCM appears to maintain improvements; however, there appears to be a plateau in the effect.