HHC In Focus - Chronic Disease Management

Diabetes is a chronic disease that affects nearly 26 million Americans and is the leading cause of kidney failure, adult blindness and lower extremity amputation, and a prime contributor to heart disease and stroke.

HHC has more than 63,000 diabetic patients registered in its electronic database. All HHC clinicians use a standard evidence-based treatment protocol for patients with diabetes. By mining data from an electronic diabetes registry, a web-based tool that uses information from HHC's advanced electronic medical records system to provide a real-time "snapshot" of each diabetic patient's health status, doctors give more targeted, evidence-based treatment and can identify patients who need more support in their self management efforts.

To help diabetic patients become more active participants in their healthcare, HHC has published a Diabetes Wellness Center web site, where they can get tips and resources to get their blood sugar under control. The web site features advice from HHC doctors, nurses and nutritionists, patient success stories, healthy eating and exercise tips, access to free blood monitors, and a comprehensive list of support groups and diabetes wellness classes available in all HHC facilities.

To evaluate the effectiveness of diabetes care and the impact in helping patients keep their disease in good control, HHC measures the number of patients who have been tested for their blood sugar and the percentage of those with healthy blood sugar levels. Cholesterol and blood pressure levels are also closely monitored, since it has been recognized that controlling blood sugar alone is not enough for people with diabetes. Controlling cholesterol levels and blood pressure is crucial to preventing cardiovascular problems, including heart attacks and heart disease, which are high risk conditions for diabetics.

Shown below are the outcomes measured for diabetic patients under our care in the past five years.