Blog | Thursday, September 30, 2010

Debating and dining over diabetes


There's something kind of evil about a conference that offers you delicious chocolate chunk brownies and statistics like "51% of Americans' mortality risk is due to lifestyle factors" at the same time.

But yesterday's "Diabetes Symposium: Seeing Patient-Centered Solutions to a National Epidemic," sponsored by the Jefferson School of Population Health, did have more to offer than sadism.

We heard about some innovative programs for diabetes patients that appear to be working, like Jefferson's family practice medical home and group visits. And some that haven't been so successful, like an initiative to elimiate diabetes-drug co-payments at Christiana Care in Delaware. The patients reported that the program made it easier to pay for their drugs and improved their compliance, but their A1cs hadn't budged even after a year.

Richard Wender, MD, who described the Jeff practice, offered a number of tips on the implementation of a medical home, some practical (they schedule most of their appointments 24 hours or less before) and some a little more abstract ("Create a joyful practice.").

The discussion of health care financing, especially on how to profitably convert practices to medical homes was not so joyful. "If we don't come up with a payment model, we're just kidding ourselves," said Dr. Wender. Medical directors from UnitedHealthcare and CIGNA were on hand, but they didn't have much new to offer, saying that fee-for-service is unlikely to go away anytime soon.

Robert Ratner, MD's report on the current state of evidence-based medicine was pretty gloomy, too. "Our guidelines are not being driven by data," he said, noting that although tens of thousands of randomized, controlled trials come out every year, every evidence review ends with the caveat that available evidence is too limited to draw firm conclusions. But he sees hope in the future, specifically in the hundreds of millions of dollars that the stimulus and health care reform laws will provide for comparative effectiveness research.