OBJECTIVE -To evaluate the Diabetes Health Disparities Collaborative, an initiative by the Bureau of Primary Health Care to reduce health disparities and improve the quality of diabetes care in community health centers.RESEARCH DESIGN AND METHODS -One year before-after trial. Beginning in 1998, 19 Midwestern health centers undertook a diabetes quality improvement initiative based on a model including rapid Plan-Do-Study-Act cycles from the continuous quality improvement field; a Chronic Care Model emphasizing patient self-management, delivery system redesign, decision support, clinical information systems, leadership, health system organization, and community outreach; and collaborative learning sessions. We reviewed charts of 969 random adults for American Diabetes Association standards, surveyed 79 diabetes quality improvement team members, and performed qualitative interviews.RESULTS -The performance of several key processes of care assessed by chart review increased, including rates of HbA 1c measurement (80 -90%; adjusted odds ratio 2.1, 95% CI 1.6 -2.8), eye examination referral (36 -47%; 1.6, 1.1-2.3), foot examination (40 -64%; 2.7, 1.8 -4.1), and lipid assessment (55-66%; 1.6, 1.1-2.3). Mean value of HbA 1c tended to improve (8.5-8.3%; difference Ϫ0.2, 95% CI Ϫ0.4 to 0.03). Over 90% of survey respondents stated that the Diabetes Collaborative was worth the effort and was successful. Major challenges included needing more time and resources, initial difficulty developing computerized patient registries, team and staff turnover, and occasional need for more support by senior management. CONCLUSIONS -The Health DisparitiesCollaborative improved diabetes care in health centers in 1 year. Diabetes Care 27:2-8, 2004D iabetes care is a critical issue for the ϳ3,000 federally funded community health center delivery sites that provide primary care for 11 million medically underserved Americans (1,2). Nationally, African Americans and patients of lower socioeconomic status suffer disproportionately high morbidity from diabetes (3), and racial disparities in the quality of diabetes care are prevalent (4). Since community health centers are vanguard providers of indigent patients, interventions in the health-center setting are of particular interest to clinicians, administrators, and policymakers seeking to improve the care of the most vulnerable patients with diabetes (5-7).Providers in all settings frequently do not meet diabetes quality-of-care standards as outlined by the American Diabetes Association (8). Suboptimal care has been found in academic medical centers (9), private doctors' offices (10), managed care organizations (11), Medicare providers (4), and the Indian Health Service (12). Because health centers have fewer resources and more vulnerable patients (13), it might be assumed that their performance on these standards of care might be lower. However, rates of adherence to the standards in health centers have been as high as other providers or even better despite the extra challenges (14 -17). Nonet...

Diabetes care and outcomes improved in HCs during the first 4 years of the HDC quality improvement collaborative. More intensive interventions helped marginally.