The effectiveness of the diabetic critical path after 10-year application in the Shibata regional cooperation

Abstract

Ten years have passed since the Shibata District Diabetes Regional Cooperation Critical Path (hereinafter referred to as the Cooperation Path) was operated between the clinic in the Shibata District, Niigata Prefecture, and Niigata Prefectural Shibata Hospital, the core hospital in the area. The progress of the cooperative path for 10 years and its results are summarized. Methods were analyzed for the number of patients recorded, changes in the number of affiliated facilities, HbA1c, the course of urinary albumin, and reasons for withdrawal from the path. From October 2008 to January 2018, 397 patients were enrolled in the path, and 189 patients were continuing the cooperation path, with a retention rate of 47.6%. There were 31 registered medical institutions, and 25 affiliated medical institutions continued with the program. Of these, 42 patients operated the cooperation path through the Internet-based cooperative system (Toki-Net), and 7 implementing medical institutions. The average age of the 189 patients continuing the coordination path was 66.9 ± 10.5 years (27-89 years), and 145 patients (76.7%) were on it for 3 years or more. Type 2 diabetes accounted for 93% of the disease types. HbA1c of continuing patients showed 6.8 ± 0.5% (NGSP value) at the time of consultation at our hospital from March to August 2016. The course of urinary albumin in 221 patients who continued for 6 months or longer in January 2013 was examined, and there was no significant deterioration in urinary albumin level in the 1-year, 2-year, and 3-year groups. Until January 2013, 103 patients had withdrawn from the cooperative path, among them 38 (37%) were due to worsening glycemic control and 29 (28%) were due to worsening complications. Through the cooperative path, maintenance of glycemic control and prevention of complications in diabetic patients were promoted. Collaboration with local medical institutions has also contributed to improving the level of diabetes care in the region.