University of Pittsburgh Diabetes Institute

UPMC Primary Care Physicians Improve

Outcomes for Their Patients With Diabetes

The University of Pittsburgh Medical Center’s goal as an academic medical center is to translate research findings into ever better clinical care. But that mission isn’t restricted to developing new methods and treatments: Sometimes, it’s about finding out which currently available methods work best. The idea is not to guess at the best medical practices, but to produce solid, scientific data that show what practices yield the best outcomes for patients. Such “evidence-based medicine” is practiced every day at UPMC.

By involving more than 200 primary care doctors more deeply in diabetes education and in monitoring treatment outcomes, and by offering enhanced education to diabetes patients about living with the disease, UPMC recently demonstrated improved indicators of health in these patients. This effort to improve diabetes care may serve as a model for the rest of the country. The results of UPMC’s ambitious two-year-old initiative with its Community Medicine Inc. physicians were published in the April 2004 issue of Clinical Diabetes, a publication of the American Diabetes Association.

Francis Solano Jr., MD, vice president, UPMC Physician Services, and chief medical officer of CMI, spearheaded the initiative. “This is a rather extraordinary accomplishment,” he says. “Our physicians have provided interventions on more than 15,000 patients that have exceeded outcome measures reported in the New England Journal of Medicine last year.”

In addition to the clinical component, the initiative supported increased diabetes education in the physician offices and a public awareness campaign about the dangers of the disease.

A review of 15,687 laboratory test results found that the patients’ average HbA1c, which indicates a person’s blood sugar control, was reduced to 6.97 percent — better than the national average HbA1c of 7.8 percent.

Blood pressure and cholesterol were tracked on nearly 5,000 patients. About 50 percent of these patients lowered their blood pressure below 130/80, and 71 percent saw their blood pressure drop to 140/90. “These figures are impressive because a 2002 study showed that only 65.7 percent of people with diabetes have blood pressure lower than 140/90,” says Dr. Solano.

This Focus on Diabetes initiative began with voluntary participation, with about 60 percent of CMI physicians participating in tracking and reporting data on their patients. At the end of two years, 95 percent of CMI physicians were participating.