Background: Hypertension and diabetes are common comorbidities frequently managed by primary care physicians. Poorly controlled cases of these conditions can lead to increased healthcare resource utilization. We conducted a prospective pilot study involving high-risk patients with hypertension and diabetes to evaluate whether a multidisciplinary team approach could lead to improved clinical outcomes and reduced healthcare resource utilization over a 12-month period.
Methods: Diabetic patients with HbA1c >9.0% and hypertensive patients were enrolled and stratified by hypertension severity (pre, stage 1, high-risk; high-risk defined as systolic blood pressure (SBP) >150/90 mmHg). A multidisciplinary team managed both cohorts. Hypertensive patients received home monitoring, remote tracking, frequent follow-ups, medication adjustments, and lifestyle counseling focused on diet, exercise, and smoking cessation. Statin use was regularly assessed. Diabetic patients had quarterly HbA1c monitoring, medication optimization, and nutritional counseling. Primary outcomes were changes in blood pressure and HbA1c, while secondary outcomes included the number of Emergency Department (ED) discharges and hospital length of stay (LOS). Subgroup analyses were conducted based on payer index (private, government, uninsured) to assess the impact of socioeconomic factors on clinical outcomes. A p-value of less than 0.05 was considered statistically significant.
Results: A total of 490 patients were included in the study: 240 hypertensive patients and 250 diabetic patients. In the hypertensive cohort, significant improvements in blood pressure were observed by Quarter 4, particularly in the high-risk hypertension group, where SBP decreased from 162±10 mmHg to 145±18 mmHg (p< 0.0001) and diastolic blood pressure (DBP) decreased from 99±8 mmHg to 88±11 mmHg (p< 0.0001). Despite improvements in blood pressure, there was a notable increase in healthcare utilization, with ED discharges rising from 177 to 284 and hospital LOS increasing from 367 to 777 days across all hypertensive groups. The subgroup analysis revealed no significant difference in outcomes based on payer index.In the diabetes cohort, patients experienced a significant reduction in HbA1c levels, with the mean HbA1c decreasing from 11.0%±1.4 to 8.5%±2.3 (p< 0.001) by Quarter 4. This improvement was associated with a 28% reduction in ED discharges (from 247 to 179) and a 61% decrease in inpatient LOS (from 1287 to 496 days). Subgroup analysis revealed that patients with private insurance experienced a greater reduction in HbA1c (from 10.8%±1.2 to 7.7%±2.2, p< 0.0001) and shorter inpatient stays (from 386 to 36 days) compared to those with government insurance or no insurance. Patients with government insurance also saw significant reductions in HbA1c (from 11.5%±1.7 to 8.8%±2.2, p< 0.0001) and LOS, though the improvements were not as pronounced as those observed in the privately insured group. Uninsured patients experienced similar HbA1c improvements (from 10.7%±1.2 to 8.7%±2.4, p< 0.0001) but demonstrated less reduction in hospital LOS.
Conclusions: This study suggests that a structured, multidisciplinary intervention in an outpatient setting can improve blood pressure and glycemic control in high-risk patients with hypertension and diabetes. These improvements, particularly among diabetic patients, were associated with reduced healthcare resource utilization, including fewer ED visits and shorter inpatient stays.
