CoChat
Sign Up
Cited by 39Diabetes Management and EducationChronic Disease Management StrategiesDiabetes Management and Research

Evaluation of a diabetes self-management program: claims analysis on comorbid illnesses, health care utilization, and cost

Open access
Turner, Ralph M, Ma, Qinli, Lorig, Kate, Greenberg, Jay, DeVries, Andrea R·2018·Journal of Medical Internet Research
DOI 10.2196/jmir.9225PMC PMC6035341

Published version of a preprint

Open this paper in CoChat — free account

Abstract

BACKGROUND: An estimated 30.3 million Americans have diabetes mellitus. The US Department of Health and Human Services created national objectives via its Healthy People 2020 initiative to improve the quality of life for people who either have or are at risk for diabetes mellitus, and hence, lower the personal and national economic burden of this debilitating chronic disease. Diabetes self-management education interventions are a primary focus of this initiative. OBJECTIVE: The aim of this study was to evaluate the impact of the Better Choices Better Health Diabetes (BCBH-D) self-management program on comorbid illness related to diabetes mellitus, health care utilization, and cost. METHODS: A propensity score matched two-group, pre-post design was used for this study. Retrospective administrative medical and pharmacy claims data from the HealthCore Integrated Research Environment were used for outcome variables. The intervention cohort included diabetes mellitus patients who were recruited to a diabetes self-management program. Control cohort subjects were identified from the HealthCore Integrated Research Environment by at least two diabetes-associated claims (International Classification of Diseases-Ninth Revision, ICD-9 250.xx) within 2 years before the program launch date (October 1, 2011-September 30, 2013) but did not participate in BCBH-D. Controls were matched to cases in a 3:1 propensity score match. Outcome measures included pre- and postintervention all-cause and diabetes-related utilization and costs. Cost outcomes are reported as least squares means. Repeated measures analyses (generalized estimating equation approach) were conducted for utilization, comorbid conditions, and costs. RESULTS: The program participants who were identified in HealthCore Integrated Research Environment claims (N=558) were matched to a control cohort of 1669 patients. Following the intervention, the self-management cohort experienced significant reductions for diabetes mellitus-associated comorbid conditions, with the postintervention disease burden being significantly lower (mean 1.6 [SD 1.6]) compared with the control cohort (mean 2.1 [SD 1.7]; P=.001). Postintervention all-cause utilization was decreased in the intervention cohort compared with controls with -40/1000 emergency department visits vs +70/1000; P=.004 and -5780 outpatient visits per 1000 vs -290/1000; P=.001. Unadjusted total all-cause medical cost was decreased by US $2207 in the intervention cohort compared with a US $338 decrease in the controls; P=.001. After adjustment for other variables through structural equation analysis, the direct effect of the BCBH-D was -US $815 (P=.049). CONCLUSIONS: Patients in the BCBH-D program experienced reduced all-cause health care utilization and costs. Direct cost savings were US $815. Although encouraging, given the complexity of the patient population, further study is needed to cross-validate the results.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.2196/jmir.9225

Cites

39 of 39 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Changes in reimbursement policies that increase diabetes self-management education and support access and utilization will result in a positive impact to beneficiaries' clinical outcomes, quality of life, health care utilization, and costs.

    “Changes in reimbursement policies that increase DSMES access and utilization will result in a positive impact to beneficiaries' clinical outcomes, quality of life, health care utilization, and costs (13,(84)(85)(86).”

    From 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes:<i>Standards of Care in Diabetes—2023</i> (2023) · cites this paper as [85]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Turner, R. M., Ma, Q., Lorig, K., Greenberg, J., & DeVries, A. R.
Affiliations
  • Carelon Research (United States) (US)
  • Stanford University (US)
  • National Council on Aging (US)
Corresponding author
Ma, Qinli
ORCID
Venue
Journal of Medical Internet Research
Publisher
JMIR Publications Inc.
Published
2018-06-22
Volume
20
Issue
6
Pages
e207
ISSN
1438-8871 (ISSN-L)
DOI
10.2196/jmir.9225
PMC
PMC6035341
OpenAlex
W2809585336
Cited by
39
References
39
Citations by year
2026: 2 · 2025: 2 · 2024: 2 · 2023: 5 · 2022: 6 · 2021: 4 · 2020: 8 · 2019: 8 · 2018: 2
FWCI
4.37
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Journal of Medical Internet Research (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
diabetes mellitus, diabetes self-management education, comorbidities, health care utilization, health care costs, emergency department visits, outpatient visits, hospitalization, cost reduction, chronic disease management, claims data, propensity score matching, Healthy People 2020, economic burden of diabetes, program evaluation
MeSH terms
Self-Management, Adult, Aged, Diabetes Mellitus, Female, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Retrospective Studies, United States, Comorbidity, Health Care Costs, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review