Benefit evaluation of the clinical collaborative path for diabetes mellitus used in Okayama Prefecture

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  • Tone Atsuhito
    Okayama University Hospital, Diabetes Center
  • Hida Kazuyuki
    National Hospital Organization, Okayama Medical Center, Department of Diabetes & Metabolism
  • Omori Nobuhiko
    National Hospital Organization, Okayama Kanagawa Hospital
  • Nakatou Tatsuaki
    Okayama Saiseikai General Hospital, Diabetes Center
  • Shikata Kenichi
    Okayama University Hospital, Diabetes Center Okayama University Hospital, Center for Innovative Clinical Medicine
  • Wada Jun
    Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of medicine Dentistry and Pharmaceutical Sciences

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  • 岡山県内統一糖尿病地域連携クリティカルパスの意義と医療連携促進による機能分化についての検討
  • オカヤマ ケンナイ トウイツ トウニョウビョウ チイキ レンケイ クリティカルパス ノ イギ ト イリョウ レンケイ ソクシン ニ ヨル キノウ ブンカ ニ ツイテ ノ ケントウ

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Abstract

<p>We evaluated the clinical collaborative path for diabetes mellitus used in Okayama Prefecture. Total of 324 patients (mean age：60±9 yrs, duration of diabetes：8.5±8.9 yrs, HbA1c：9.4±2.2 %), using the diabetic critical path in Okayama Medical Center, were tested. They were followed up in Okayama Medical Center every six months for re-evaluation of diabetic complications and therapeutic strategies. The HbA1c levels were 7.0-7.2% in 6 to 60 months from induction of the critical path. In 81 cases, the critical path was finished because of good clinical course. The mean HbA1c levels was 6.3±0.6% at finish time in them.</p><p>According to the latest data, the frequency of multiple daily injections (MDI) was decreased (26% to 18%) and the frequency of oral antidiabetic agents (OAD), diet therapy and GLP-1 receptor analogs were increased (46% to 50%, 5% to 7%, 1% to 5%, respectively) compared to those at the induction of the critical path. Especially in 81 patients in whom the critical path was finished because of good clinical course, the frequency of MDI was significantly decreased (16% to 5%) and the frequency of OAD and diet therapy were increased (67% to 72%, 4% to 8%, respectively), suggesting that the diabetic treatment was stepped down while the inter-regional cooperative therapy is maintained.</p><p>The clinical collaborative path is useful as a tool to initiate collaborative management for diabetes mellitus between hospitals and clinics. Development of inter-regional cooperation results in promoting role-sharing and function differentiation in hospitals and clinics.</p>

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