June 20, 2009
In the management of diabetes, a patient-centered multidisciplinary team has long been advocated (29) and its elements defined (30). But in practice it has been generally confined to an endocrinologist and diabetes educator(s). Many successful and innovative approaches to diabetes management that represent a hybrid between case management and the PCMH have been described and could serve as lessons for what could or does not work (31–34).
Whether the PCMH or some version of it can produce the results it promises is unclear, and effective care coordination has had problems (26). Nonetheless, as chronic care supplants acute care as the dominant driver of health care costs, there is a groundswell of opinion that the current model of physician-directed, visit centered care must be replaced.”