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Quality Improvement Effort Pays Off in Diabetes Care

Spending money to improve diabetes care at federally qualified community health centers is a sound investment, according to one of the first studies to examine the clinical and economic impact of quality improvement on diabetes care.

In the June 2007 issue of Health Services Research, a University of Chicago-based research team reports that a relatively inexpensive national effort to improve the process of care at selected clinics was able to make enough difference in its first four years that, if sustained, it could reduce patients' lifetime risk of blindness, end-stage kidney disease and coronary artery diseaseall common complications of diabetes.

At a cost of less than $500 per patient each year, this modest quality improvement effort is projected to reduce the incidence of major complications, such as end-stage renal disease, which can cost $44,000 per patient each year.

"In this setting, we found that the economic value of improving the delivery of existing diabetes care was roughly equal to the benefits of developing a new treatment, such as a novel diagnostic technology or a better drug," said study author Elbert Huang, MD, assistant professor of medicine at the University of Chicago. "A small investment in upgrading the delivery of health care brought about a substantial improvement in health that justified the costs of the program."

"Unfortunately," he added, "the people who make such financial investments are not the people who directly benefit from them."

Federally qualified community health centers (FQHCs) routinely lose money on health care improvement programs. The added costs are borne by the health centers and by state and federal government programs; the benefits accrue to society. "Cost-effective medicine," Huang said, "depends entirely on an ongoing societal commitment to providing chronic care for vulnerable patients."

The researchers studied how diabetes care ch
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