Consistent, Efficient, and Effective A1C Management to Goal: Novel Approaches from Kaiser Permanente Kern County, San Diego, and Northern California


R James Dudl, MD; Todd Martin, X; Benjamin Ha, MD; Richard Dlott, MD

Introduction: New Kaiser Permanente (KP) data show delaying A1C lowering from > 8% to < 7% by 1 year resulted in a 58% higher microvascular disease risk; however, KP Regions, except Northern California (NC) are not yet above HEDIS 90th percentile for the A1C < 8% metric.
Methods: A population-based care program design promoted appropriate treatment of patients with high A1Cs: in Kern County (KC) > 5.7%, in NC > 8%, and in San Diego (SD) 7% to 8%. KC ensured patients with an A1C > 5.7% received prediabetes/diabetes education and follow-up A1Cs to monitor prediabetes or diabetes status or to confirm its new diagnosis. NC and SD used processes with an accountable clinician to ensure timely, verified treatment intensification and automated A1C follow-up for every patient with A1C above goal. Clinician-level reporting was sent to managers to support performance improvement. All 3 program locations used similar diabetes “Treat-to-Target” protocols.
Results: KC’s population with diabetes increased by 11.9% vs Southern California’s of 8.1% during 1 year. SD increased A1C < 7 from 40.2% to 45.3% in 6 months. NC achieved > 90th percentile and led all KP Regions for HEDIS A1C < 8%.
Conclusion: Four features: Moving to a population-based approach, fixing clinician responsibility, promoting timely treatment intensification, and automating A1C follow-up orders were associated with the programs’ successes.

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