Cross-Site Evaluation of the Alliance to Reduce Disparities in Diabetes

Abstract

Alliance programs implemented multilevel, multicomponent programs inspired by the chronic care model and aimed at reducing health and health care disparities for program participants. A unique characteristic of the Alliance programs is that they did not use a fixed implementation strategy common to programs using the chronic care model but instead focused on strategies that met local community needs. Using data provided by the five programs involved in the Alliance, this evaluation shows that of the 1,827 participants for which baseline and follow-up data were available, the program participants experienced significant decreases in hemoglobin A1c and blood pressure compared with a comparison group. A significant time by study group interaction was observed for hemoglobin A1c as well. Over time, more program participants met quality indicators for hemoglobin A1c and blood pressure. Those participants who attended self-management classes and experienced more resources and support for self-management attained more benefit. In addition, program participants experienced more diabetes competence, increased quality of life, and improvements in diabetes self-care behaviors. The cost-effectiveness of programs ranged from $23,161 to $61,011 per quality-adjusted life year. In sum, the Alliance programs reduced disparities and health care disparities for program participants.

Chronic care model and cost reduction in initial health: a new approach for satisfaction and improvement of chronicity

“…Cross-site evaluation of the Alliance to Reduce Disparities in Diabetes: clinical and patient-reported outcomes 22 2014, USA Evaluation Studies 5. Study protocol of EMPOWER participatory action research (EMPOWER-PAR): a pragmatic cluster randomised controlled trial of 2014, Malaysia multifaceted chronic disease management strategies to improve diabetes and hypertension outcomes in primary care 23 Randomized Controlled Trial 6.…”

“…Subsequently, the following limits were imposed: i) text availability: free full text; ii) publication dates: 5 years; and iii) species: human, with the exclusion of 94 studies, for a total of 14 studies useful for the revision (Table 2). [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] …”

Service innovation from the edges: enhanced by telemedicine decision support

“…Furthermore, as chronic diseases such as diabetes affect everyday life and demand close follow-up, support from a healthcare provider in close proximity is important [43,44]. Specialist healthcare providers may lack important information regarding facilities and local parameters for treating the patient.…”

National Strategies to Decrease the Burden of Diabetes and Its Complications

“…The Alliance is a 5-year program sponsored by the Merck Company Foundation to reduce disparities and improve patient outcomes for underserved populations that experience a disproportionate burden of diabetes [8]. Five programs, 47 clinics, and 2328 patients across the USA participated in Alliance, which incorporated a multicomponent, multilevel approach to improving diabetes care.…”

“…Five programs, 47 clinics, and 2328 patients across the USA participated in Alliance, which incorporated a multicomponent, multilevel approach to improving diabetes care. This approach involved utilizing community resources, coordinating health systems, creating strategies to improve patient and provider communication, and enhancing patient self-management for diabetes [8]. Instead of a prescribed or regimented intervention, Alliance programs were guided by the above principles and focused on meeting the needs of the local community.…”