Since 1963 a network of nurse-operated, physician-backed decentralized clinics has provided continuing care for more than 5000 diabetic patients referred from the medical center clinics. Protocols that provide therapy goals and management details are used by the nurses and nutritionists in this network. To reduce fragmentation of care, intercurrent illnesses as well as other chronic diseases are treated using protocols in these clinics or in the home. This study examines certain outcome data in a subset of 556 diabetic patients under continuing care over a 7-yr period in this network, with comparisons being made to care before referral. Blood glucose is maintained at comparable levels in both decentralized and hospital clinics. Blood pressure levels in hypertensive patients are maintained in a satisfactory range. Total hospitalization rates are reduced by 47%. For ketoacidosis and amputation, hospitalization is decreased by 69% compared with the experience before referral. The maintenance care costs are decreased substantially compared with costs before referral due to the less expensive ambulatory services and the reduced need for hospitalization. The data support the concept that decentralization is an effective means of providing continuing care to patients with diabetes mellitus.

Ambulatory Care↗

PubMedDate not supplied

A cohort study of mortality in two clinic populations of patients with diabetes mellitus.

Mortality rates of two cohorts of patients with diabetes mellitus are estimated and compared. The Atlanta cohort is defined as all black patients receiving care at the diabetes clinic of Grady Memorial Hospital for the first time during calendar year 1971. The Memphis cohort is defined as all black patients referred from the City of Memphis Hospital outpatient clinic to a decentralized neighborhood clinic operated by the Memphis and Shelby County Health Department during September 1969 through August 1970. The Atlanta program discontinued all prescriptions of oral hypoglycemic drugs and emphasized instead an aggressive diet therapy. The Memphis program has used diet therapy but also insulin and/or oral hypoglycemic agents according to current guidelines. The ratios of observed to expected deaths (standardized mortality ratios) were remarkably similar for the two cohorts. In both cohorts the standardized mortality ratios were greatest for the youngest patients and for those patients whose duration of illness was longest. Nine-year survival rates, estimated by the life-table method and adjusted for differences in frequency distributions of entry age and duration of diabetes, were also similar for the two cohorts.

Actuarial Analysis↗

PubMedDate not supplied

The Memphis and Atlanta continuing care programs for diabetes. II. Comparative analyses of demographic characteristics, treatment methods, and outcomes over a 9-10-year follow-up period.

A total of 1467 black patients (911 in Atlanta, 556 in Memphis) were selected (1969-70) and followed longitudinally and prospectively until death (404 patients) or through 31 December 1979, when 676 were alive and active and 387 were lost to follow-up. The women/men ratio in each cohort was 4.7/1. Women had more excess body wt than men at maximum weight and at time of diagnosis. At selection, the Atlanta cohort was older (60.2 vs 56.8 yr), had diabetes longer (7.5 vs 5.2 yr), and had a higher initial mean random plasma glucose (MRPG) level (217 vs 195 mg/dl) than the Memphis cohort. The Atlanta cohort was on sulfonylurea/phenformin therapy, which was discontinued at entry. After 9-10 yr follow-up, the MRPG level was not significantly different from the initial level in either cohort, and the Atlanta cohort level was still significantly higher (221 vs 185 mg/dl). Mean weight loss after 9-10 yr follow-up was significantly greater in Atlanta (17.7 vs 6.8 lb). Those under good control in 1979, as indicated by random plasma glucose (RPG) of less than 150 mg/dl, lost more weight (means: Atlanta, 23 lb; Memphis, 8.7 lb) than those under poor control in 1979 (RPG greater than 300 mg/dl; means: Atlanta, 14.7 lb; Memphis, 1.3 lb). In the pooled alive and active cohorts (1979), 29.1% were under good control (RPG less than 150 mg/dl); 52.9%, fair control (RPG = 150-300 mg/dl); and 18.0%, poor control (RPG greater than 300 mg/dl). Of the 639 alive and active patients, paired plasma glucose levels were less than 200 mg/dl in 207 patients in 1969-70 and less than 200 mg/dl in 322 in 1979.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMedDate not supplied

Integrating an educational program in health promotion and disease prevention into a medical school: the University of Tennessee, Memphis.

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Adult↗

PubMedDate not supplied

Inventory of knowledge and skills relating to disease prevention and health promotion.

An inventory of the knowledge and skills appropriate for the instruction of medical students in the disciplines of disease prevention and health promotion was developed by a steering committee of medical practitioners and teachers, with the input of over 70 colleagues. The inventory, which is intended as a guide for curriculum planners, defines the fundamentals of subject areas appropriate for the general education of all physicians, including the skills and knowledge related to delivery of personal disease prevention/health promotion services, quantitative methods, health services organization and delivery, and community dimensions of medical practice, as well as attitudes and philosophy.

Attitude of Health Personnel↗

PubMedDate not supplied

A method for the differentiation of male meiotic chromosome stages.

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Animals↗