Evaluation of a decentralized system for chronic disease care: Seven years of observation

Observations of a publicly-financed system for the medical care of a large number of persons with chronic diseases have been made over 7 yr. The system combines decentralized, nurse-staffed neighborhood clinics, operated by a public health department, with a central referral clinic for consultations and the management of complicated problems. After 7 yr in the chronic disease program 55% of 1,004 patients with diagnoses of diabetes mellitus, hypertension, and cardiac diseases were still receiving care, 19% had died, and 26% had been lost to the program. In the 7th yr, the mean diastolic blood pressure in hypertensives was 84 mm Hg and the mean glucose in diabetics was 203 mg/dl. For the group under care, hospital days/1,000/year were 74% of the rate during the year before referral to the program and out-patient visits/1,000/year were approximately the same as before referral. However, 2/3 of the visits, formerly made to a public hospital, were now being made to neighborhood clinics. The system appears to be an effective method of providing medical services for persons who formerly used the public hospital as their source of outpatient care.