1. Leadership and Diabetes Outcomes: A Systematic Literature Review
Matthew G. Pearce1 OD, MPH, FAAO, Sakiko Yasuda1, MPH, BScN,
Deon V. Canyon1, PhD, MPH, DBA FACTM
1Department of Public Health Sciences, University of Hawaii at Manoa
Introduction
Methods
Results continued
Systematic literature review
PubMed, CINAHL, PsycInfo databases
Inclusion criteria
health outcomes related to type I or II diabetes
health facility leadership (clinical and/or administrative)
peer-reviewed
English
United States
Search Terms
No studies were found that considered administrative leadership and clinical outcomes
One study met all inclusion criteria8
a retrospective chart review of 157 patients receiving care from pharmacists with the ability to initiate, discontinue or adjust medications for diabetic patients
pharmacist care, as compared to baseline physician only care, improved the percentage of patients with an HBA1C value of ≤7% from 19% to 50%
for those patients with initial HBA1C ≥8.5% a mean decrease of 2.7% was noted
increase in medication use, and number of patients receiving annual foot and eye exams OR
AND
Physicians
Leadership
Outcome assessment
Diabetes
Physician executives
Health facility administrators
Nurses
Health personnel
Organization and administration
Physician-led
Physician led
Delivery of health care
Non-physician-led
Non-physician led
Nurse-led
Nurse led
Health facility administrator-led
Health facility administrator led
Vital statistics
Conclusion
Leadership is one of six health system building blocks1.2
Leadership influences the function and effectiveness of other building blocks1
Effective leadership is a key feature of successful health systems1,2,3
Poorly functioning health systems are a major cause of poor health outcomes1,3,4
Health care organizations can be considered as health “systems”
Types of Leadership
Clinical and administrative4
Physician or non-physician
Clinical leaders
licensed independent health practitioners
active in the service delivery and health workforce building blocks
direct interaction with health care consumers
advanced practice nurses, physician assistants, and pharmacists are the most prominent type of non-physician clinical leaders5
Administrative leaders
oversight and influence over all building blocks
unlikely to interact directly with patients
unless they are licensed independent health practitioners, unable to clinically supervise health care providers
There is sufficient evidence to show that patients of non-physician clinicians achieve health outcomes equal or better than patients of physicians
There is limited data on the outcomes of diabetic patients of non-physician clinicians acting as substitutes of physicians
The limits placed on this literature review, which included US diabetes studies published in the past 10 years, were too specific and limited conclusions that can be drawn from the data. The process does, however, raise five observations that bear consideration
the nature of leadership in health care organizations is understudied
concentrating solely on patient health outcomes as a measure of the effectiveness of clinical and administrative leaders in diabetes care did not allow for the differentiation of physicians and non-physicians
all health system goals should be considered as equally important outcomes in leadership research
gap in health care leadership literature on the effect of administrative leadership on patient outcomes
the question of who should provide diabetic care should shift from physician versus non-physician to generalist versus specialist
Results
References
WHO (2007) Everybody's business: Strengthening health systems to improve health outcomes: WHO's framework for action, Geneva:World Health Organization.
WHO (2010), Monitoring the building blocks of health systems: A handbook of indicators and their measurement strategies, Geneva: World Health Organization.
WHO (2000), The world health report 2000: Health systems: Improving perfromance, Geneva: World Health Organization.
Schyve, P. M. (2009), “Leadership in healthcare organizations: A guide to joint commission leadership standards”, white paper, The Governance Institute, San Diego, CA, Winter.
Laurant, M., Harmsen, M., Wollersheim, H., Grol, R., Faber, M. and Sibbald, B. (2009), “The impact of nonphysician clinicians: do they improve the quality and cost-effectiveness of health care services?”, Med Care Res Rev,Vol. 66, pp. 36S-89S.
Centers for Disease Control and Prevention (2011), “National diabetes fact sheet: National estimates and general information on diabetes and prediabetes in the United States”, Available at: (Accessed 23 February 2014)
American Diabetes Association (2013), “Economic costs of diabetes in the U.S. in 2012”, Diabetes Care, Vol. 36, pp
Kiel, P. J. and McCord, A. D. (2005), “Pharmacist impact on clinical outcomes in a diabetes disease management program via collaborative practice”, Ann Pharmacother, Vol. 39, pp
Purpose
To determine if it was possible to differentiate between physician-leaders and non-physician-leaders using diabetic patient outcomes as an end point
there are 25.8 million diabetics and 79 million pre-diabetics in the US6
cost $176 billion in direct medical costs and account for over 37.3 million outpatient visits7