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Why Transform

Objective of Section

To explain why health care professionals and practices should consider redesigning diabetes care delivery.

Key Concepts

  1. With more than 100 million people with diabetes and prediabetes, there is an urgent need to redesign existing models of diabetes care delivery in the United States.
  2. Health care reform is driving a shift from fee-for-service payment models to value-driven payment structures based on improving outcomes, enhancing the patient experience and reducing costs. 
  3. Redesigning how diabetes care is coordinated and delivered provides benefits to health care practices by preparing them for changing reimbursement models and by building a more satisfied and effective diabetes care delivery team.


For many patients and families across the United States (U.S.), accessing health care can be intimidating, confusing and expensive.1 Improving health care delivery requires expanding access to care while reengineering the current delivery system to provide consistently high-quality care at lower costs.2 Throughout the U.S., discussion of health care reform recognizes that successful reform requires a shift in emphasis from highly specialized care centers to primary care settings that increase care coordination, emphasize prevention and ongoing support, and enhance collaboration between multidisciplinary teams.3 Primary care practices provide a critical leverage point for improving clinical outcomes in communities across the U.S. Significant improvement requires a redesign of existing models of primary diabetes care delivery and a ‘transformation’ in practice.4,5,6

Improved coordination and better communication through team-based care has long been recognized as an essential component of high quality diabetes care.7 As diabetes education increasingly moves out of hospitals into community-based settings, new models of ambulatory care delivery have been proposed that provide new services and offer new resources that promote effectiveness of the diabetes care team, improve clinical outcomes, and enhance patient satisfaction. New approaches that enhance community-based support and promote prevention provide a promising step for improving the delivery of diabetes care in out-patient settings.

The Practice Transformation for Physicians and Health Care Teams website presents an evidence-based and considered approach to key components of practice redesign that can be introduced into community primary care, assisted living, long-term care, home care and a wide variety of health care settings to improve the delivery of patient-centered diabetes care. Health care professionals from a wide variety of disciplines have joined with the National Diabetes Education Program (NDEP), a joint program of the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), to present information that has been widely accepted to improve the clinical outcomes of diabetes in the U.S.

The Practice Transformation website provides an open access resource for tools and materials for health care professionals undergoing practice redesign associated with health care reform. It provides authoritative information about models and processes of care delivery that can enhance the quality of diabetes care and correspond with national standards and performance initiatives.

The Practice Transformation website presents and explains methods of team-based care with the strongest evidence from practical trials and demonstrations for improving quality, increasing patient satisfaction, and reducing cost. A growing health care team increasingly involves contributions from nursing, education, nutrition, physical activity, pharmacy, podiatry, dentistry, ophthalmology, and mental and behavioral health. The site provides education, examples, and videos for developing collaborative team approaches that promote communication, diminish cultural barriers, and support a common understanding of a patient’s needs. Information on the site reflects emerging evidence, better approaches, and improvements in care.


1. National Quality Forum. Measuring Affordability from the Patient’s Perspective. 2015:1-19. Available at: http://www.qualityforum.org/Publications/2014/09/Measuring_Affordability_from_the_Patient_s_Perspective.aspx.
2. Committee on Quality of Health Care in America Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, D.C.: National Academy Press; 2001. 364 p.
3. Berwick D, Nolan T, Whittington J. The Triple Aim: Care, Health, And Cost. Health Affairs. 2008;27(3):759-769. doi:10.1377/hlthaff.27.3.759.
4. Shojania KG, McDonald KM, Wachter RM, Owens DK. Closing The Quality Gap: A Critical Analysis of Quality Improvement Strategies, Volume 1—Series Overview and Methodology. Technical Review 9 (Contract No. 290-02-0017 to the Stanford University–UCSF Evidence based Practices Center). AHRQ Publication No. 04-0051-1. Rockville, MD: Agency for Healthcare Research and Quality. August 2004.
5. Rittenhouse DR, Shortell SM. The patient-centered medical home: will it stand the test of health reform?. JAMA. 2009;301(19):2038-40.
6. Peterson KA, Brown MT, Warren-boulton E. Responding to the challenges of primary diabetes care through the national diabetes education program. Diabetes Care. 2015;38(3):343-4.
7. Etzwiler DD. Chronic Care: A Need in Search of a System. Diabetes Education. 1997 Jan 1;23(5):569–73. Available from: http://tde.sagepub.com/cgi/doi/10.1177/014572179702300509

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