Diabetes costs the United States an estimated $174 billion annually. About two-thirds of costs arise from direct medical expenditures, and the remainder accrues from disability, work loss, and premature mortality. Associated cardiovascular comorbidities result in further mortality and morbidity; seventy-five percent (75%) of patients with diabetes also have hypertension, and heart disease is a contributing cause on 68% of diabetes-related death certificates. The cardiovascular complications of diabetes can be significantly reduced with appropriate lifestyle modification and primary and secondary preventive care; yet in the current practice environment, primary care providers find it difficult to deliver the comprehensive education and behavioral support needed to ensure adequate risk factor reduction. If patients are to receive better quality of care for this complex, chronic disease, then a model of planned care that better supports behavioral approaches to risk reduction and is integrated with the primary care practice workflow is needed. We propose to test the feasibility of Collaborative Care SupportSM (CCS), a web-based communication platform coupled with personal health guidance that enrolls adult patients who have type 2 diabetes and at least one other cardiovascular risk factor (hypertension, hyperlipidemia, and/or smoking) in a collaborative, patient-centered, behaviorally-based intervention that integrates with primary care provider workflows to improve patient activation. Previous attempts to empower patients have included disease management and self-management support, but these programs do not involve the primary care provider and are not accessible to many because of limitations their limited availability.. Because it is important that fragmented care is replaced by planned and coordinated care where possible, CCS is likely to meet with more success than traditional disease management and self-management support.
Public Health Relevance: CCS has the potential to improve the care for patients with diabetes type 2 and its co- morbidities and to be useful for other common chronic conditions, as well. Because chronic illnesses account for 75% of current health expenditures, this model of care support, scalable to primary care practices, has the potential to significantly improve the health of the population while decreasing care fragmentation. Self-funded employers and other healthcare stakeholders who traditionally purchase and/or develop disease management and self-management support programs will be targeted to purchase this innovative model of patient support.
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