Diabetes Ten City Challenge: Final economic and clinical results

Objective: To assess the economic and clinical outcomes for the Diabetes Ten City Challenge (DTCC), a multisite community pharmacy health management program for patients with diabetes. Design: Quasiexperimental observational analysis, pre-post comparison. Setting: Employers at 10 distinct geographic sites contracting with pharmacy providers in the community setting. Participants: 573 patients with diabetes who had baseline and year 1 medical and pharmacy claims and two or more documented visits with pharmacists. Interventions: Community-based pharmacists provided patient self-management care services via scheduled consultations within a collaborative care management model. Main outcome measures: Changes in health care costs for employers and beneficiaries and key clinical measures. Results: Average total health care costs per patient per year were reduced by $1,079 (7.2%) compared with projected costs. Statistically significant improvements were observed for key clinical measures, including a mean glycosylated hemoglobin decrease from 7.5% to 7.1% (P = 0.002), a mean low-density lipoprotein cholesterol decrease from 98 to 94 mg/dL (P < 0.001), and a mean systolic blood pressure decrease from 133 to 130 mm Hg (P < 0.001) over a mean of 14.8 months of participation in the program. Between the initial visit and the end of the evaluation period, influenza vaccination rate increased from 32% to 65%, eye examination rate increased from 57% to 81%, and foot examination rate increased from 34% to 74%. Conclusion: DTCC successfully implemented an employer-funded, collaborative health management program using community-based pharmacist coaching, evidenced-based diabetes care guidelines, and self-management strategies. Positive clinical and economic outcomes were identified for 573 patients who participated in the program for at least 1 year, compared with baseline data.