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Forum Three: Changes in the U.S. Health Care System That Would Facilitate Improved Care for Non-Insulin-dependent Diabetes Mellitus

Roland G. Hiss, MD; and Sheldon Greenfield, MD
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From the University of Michigan Medical Center, Ann Arbor, Michigan; and the New England Medical Center, Boston, Massachusetts. Note: This article is one of a series of articles comprising an Annals of Internal Medicine supplement entitled “Risks and Benefits of Intensive Management in Non-Insulin-dependent Diabetes Mellitus: The Fifth Regenstrief Conference.” To view a complete list of the articles included in this supplement, please view its Table of Contents. Requests for Reprints: Roland G. Hiss, MD, University of Michigan Medical School, Postgraduate Medicine and Health Professions Education, G1100 Towsley Center, Ann Arbor, MI 48109-0201. Current Author Addresses: Dr. Hiss: University of Michigan Medical School, Postgraduate Medicine and Health Professions Education, G1100 Towsley Center, Ann Arbor, MI 48109-0201.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;124(1_Part_2):180-183. doi:10.7326/0003-4819-124-1_Part_2-199601011-00021
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At the conclusion of the conference detailed in this supplement, conference attendees participated in one of three fora to discuss an assigned topic and incorporate conference presentations into the discussion.Forum Three, the results of which are reported here, addressed the challenging question of what changes in the U.S. health care system would facilitate improved care for patients with non–insulin-dependent diabetes mellitus (NIDDM).

Using the nominal group process-a discussion technique designed to obtain a rank-ordered list of responses to the challenge question from a group of informed persons—Forum Three made the following priority recommendations: 1) Establish universal access to the comprehensive preventive services necessary to optimally manage the estimated 16 million Americans with NIDDM; 2) create a system of co-management between primary and specialty care services; and 3) modify the current health care system to include a program for increased patient and public awareness of the seriousness of NIDDM, special training for primary care residents and practicing physicians in this area, development of standards of care, creation of a central coordinating agency for all aspects of diabetes care, and development of outcome-based goals for patients and providers.





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