More Efficient Care of Diabetic Patients in a County-Hospital Setting

Abstract

Before 1969 the diabetes section at the Los Angeles County University of Southern California Medical Center, serving some 6000 medically indigent patients, averaged one hospital admission annually for two out of every three patients coming to its clinics. Two new programs, a telephone-answering service and the implementation of a policy to screen all candidates for admission by either a nurse clinical practitioner or a resident of the diabetes service, have served to reduce the annual admission rate of clinic patients to approximately one in five. In the process, emergency-room visits by the clinic population have been markedly reduced, and such preventable admissions as diabetic coma have been reduced by 2/3. Potential cost savings of between $1.7 million and $3.4 million have been projected for the diabetes service. Programs of this type have implications for reducing the cost of health-care delivery to the chronically ill.