Background:
Kaiser Permanente has developed a Chronic Conditions Management department to assist physicians in the management of patients with diabetes. This program relies on collaboration between physicians, health educators, pharmacists and registered nurse case managers, and implements Clinical Care Guidelines developed by the medical group so that patient care is improved. Women ages 18-45 with diabetes will be placed in a preconception care program. Particular attention will address the use of two potential teratogens, lisinopril and statins, in the study population. The case managers will coordinate care through the women's health department, adult medicine and endocrinology to optimize the timing of pregnancy, the use of appropriate contraception and the condition of women as they conceive. Results will be compared to historic data from patients with similar medical conditions and from women at another Kaiser Permanente location.

Objectives:
Identify and contact the 1424 women between ages 18 and 45 in the North Valley with diabetes and enroll them in a preconception health care program that emphasizes reproductive choices and the optimization of their health.

Methods:
1. Implement Clinical Care Guidelines for diabetes, with an emphasis on reproductive awareness and contraceptive choices.
2. Optimize the role of the post-partum visit by identifying each patient with diabetes, gestational, Type I and Type II, and developing a strategy to decrease the recurrence of adverse outcomes.
3. Identify women in the study population who have been prescribed the potential teratogens, lisinopril and statins, and develop a strategy to minimize exposure to the fetus, through contraception, medication change and pregnancy timing
4. Assess preconception hemoglobin A1C in patients and pregnancy outcomes


Results:
The study will take place 2007-2008. We will be presenting the population management approach used here.

Conclusion and implications for practice:
In spite of research that emphasizes the importance of preconception glucose regulation in patients with diabetes, the Chronic Condition Management program has placed no emphasis on contraception counseling in this high risk group. This study will emphasize the need for an integrated approach to medical care in order to impact health choices and outcomes