An integrated territory-hospital approach to diabetes care

Background Diabetes mellitus is a chronic illness that requires constant medical care including patient education and empowerment. Local Health Authorities (LHA)-7 of Siena (south of Tuscany Region) adopted MITO.SI, an informatics interaction and exchange of patient data between General Practitioner and Hospital Specialists to realize an integrated management of Chronic Care Model (CCM) paths. The aim of this study is to assess, from MITO.SI database, if this new organizational structure (CCM + MITO.SI) has achieved, in our LHA, the regional standards of efficacy and efficiency (by monitoring some indicators of professional appropriateness and quality). Methods The LHA-7 has 254 General Practitioners, of which 130 have joined the project MITO.SI (51,1%), about 126.000 patients (54,3%). We did a descriptive analysis through percentages or rates recorded at Tuscany Region/LHA level for each indicator. Than we used measures of Risk Ratio (RR) to verify if there were any statistically significant Tuscany/LHA differences. Results In the comparison (year 2011) between LHA-7 and Tuscany region, we observed: the hospitalization rate (per 100.000) was 26,58 (+6.69 from Tuscany), RR 1,29 (p < 0.05, CI:0,96–1,71); the percentage of patient with a year measurement of glycated haemoglobin was 64,8% (-3.9% from Tuscany), RR 0,82 (p < 0.01, CI:0,79-0,85); the percentage of patient with a screening test for diabetic retinopathy was 33,4% (+1.3% from Tuscany), RR 1,04 (p < 0.01, CI:1-1,08); the percentage of patients adherent to statin therapy was 40,01% (-2,17% from Tuscany), RR 0,93 (p < 0.01, CI:0,90-0,96); finally among the patients who use this drug, the percentage of statin not covered by patent was 52,65% (-0,01% from Tuscany), RR 0,99 (p < 0.01, CI:0,98-1) Conclusions The management of chronic diseases has shifted progressively from the hospital to the community care. To create a database containing all the information related to diabetes patients may allow the organization and management of educational activities and the integration between the various professionals involved.