In 2006 the DAWN study (1) confirmed what many health care professionals and people with diabetes have known intuitively for years: that diabetes causes multiple psychosocial problems, that these issues are barriers to achieving adequate glycemic control and interfere with self-management behaviors, and that our current health care systems are not best equipped to handle and support chronic illness care.
Living with and managing diabetes is distressing and has a negative impact on many aspects of the daily lives of people with the disease, including treatment outcomes. Depression, stress or other psychological problems associated with diabetes are factors that play a role in whether treatment is adhered to and a healthy diet maintained. Long term complications as a result of poor clinical management can be avoided with a better understanding of the relationship between psychosocial well-being and diabetes control.
Patients are more likely to receive higher quality care and at the right time when treatment decisions are based on outcomes that patients care most about in the management of their diabetes.
The outcomes that matter to patients for a particular medical condition have been considered to fall into three tiers. (For more, see Michael Porter’s article “Measuring Health Outcomes: The Outcome Hierarchy,” New England Journal of Medicine, December 2010.). These are:
Tier 1: Health status achieved or retained
Tier 2: Process of recovery
Tier 3: Sustainability of health
Here’s another example of a hierarchy of needs for diabetes in which the top need is acceptance of diabetes.
Measuring the full set of outcomes that matter to patients with diabetes is essential in meeting their needs and should cover the full cycle of care, but what are those outcomes?
1. The Diabetes Attitudes, Wishes,and Needs (DAWN) Study CLINICAL DIABETES • Volume 24, Number 4, 2006
2. Measuring Health Outcomes,” Michael E. Porter, New England Journal of Medicine, December 2010
If you would like to comment as to what you consider as the outcomes that matter to people with diabetes then please use the contact form below.