Dissemination of Diabetes Care Guidelines: Lessons Learned From Community Health Centers

Walker, Elizabeth A.; Engel, Samuel S.; Zybert, Patricia

doi:10.1177/014572170102700112

Cited by 10 publications

(5 citation statements)

References 23 publications

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“…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)(6)(7).…”

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confidence: 99%

Improving Diabetes Care in Midwest Community Health Centers With the Health Disparities Collaborative

et al. 2004

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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...

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confidence: 99%

Improving Diabetes Care in Midwest Community Health Centers With the Health Disparities Collaborative

et al. 2004

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“…Participants' risk perception for developing diabetes in the future was measured by an item extracted from the Risk Perception Survey for Developing Diabetes (RPS-DD) 17,18 : "In your opinion, what is your level of risk of developing diabetes in the next 10 years?" The scores ranged from 1 (almost no risk) to 4 (maximum risk).…”

Section: Diabetic Risk Perception For Oneselfmentioning

confidence: 99%

Determinants of Health Behaviors After Gestational Diabetes Mellitus: A Prospective Cohort Study in Geneva

Kaiser¹,

Jeannot²,

Razurel³

2016

J Midwife Womens Health

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Introduction: Gestational diabetes mellitus (GDM) is one of the most common complications in pregnancy. The objective of this study was to specify the determinants of postpartum physical activity and dietary habits after a pregnancy complicated by GDM in a population of Swiss women. This information will be used to improve health promotion and diabetes prevention interventions for women with a history of GDM.

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“…Such programs, with emerging evidence for prevention of severe disease, reduction in acute hospital presentations, and minimising of development of chronic disease states, include diabetes education, obesity and eating disorder prevention, antismoking, cardiovascular risk, mental health promotion, illness prevention and early intervention strategies, provided in individual, family and group formats. [26][27][28][29][30][31] Some of these programs can, and should, be run initially as special public activities in other communal venues, for example, local town halls, church halls etc. But if participants are to return for more detailed information sessions or personal advice, which are highly desirable interim outcomes, they need to be able to access a local, attractive, welcoming, well maintained community health centre, convenient to shops, transport and parking.…”

Section: Persistent Long-term and Recurrent Conditionsmentioning

confidence: 99%

The future of community-centred health services in Australia: lessons from the mental health sector

Rosen

Gurr

Fanning

2010

Aust. Health Review

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Abstract* It is apparent that hospital-dominated health care produces limited health outcomes and is an unsustainable health care system strategy. * Community-centred health care has been demonstrated to be a more cost-efficient and cost-effective alternative to hospitalcentred care, particularly for prevention and care of persistent, long-term or recurrent conditions. Nevertheless, hospitalcentred services continue to dominate health care services in Australia, and some state governments have presided over a retreat from, or even dismantling of, community health services. * The reasons for these trends are explored. * The future of community health services in Australia is uncertain, and in some states under serious threat. We consider lessons from the partial dismantling of Australian community mental health services, despite a growing body of Australian and international studies finding in their favour. * Community-centred health services should be reconceptualised and resourced as the centre of gravity of local, effective and affordable health care services for Australia. A growing international expert consensus suggests that such communitycentred health services should be placed in the centre of their communities, closely linked or collocated where possible with primary health care, and functionally integrated with their respective hospital-based services.What is known about the topic? Community-centred health care has been widely demonstrated to be a more cost-efficient and cost-effective alternative to hospital-centred care, particularly for prevention and care of persistent, long-term or recurrent conditions, e.g. in mental health service systems. A growing international expert consensus suggests that such communitycentred health services should be placed in the centre of their communities, closely linked or collocated where possible with primary health care, and functionally integrated with their respective hospital-based services. What does this paper add? Despite this global consensus, hospital-centred services continue to dominate health care services in Australia, and some state governments have presided over a retreat from, or even dismantling of, community health services. The reasons for these trends and possible solutions are explored. What are the implications for practitioners? Unless this trend is reversed, the loss of convenient public access to community health services at shopping and transport hubs and the consequent compromising of intensive home-based clinical care, will lead to a deterioration of preventative interventions and the health care of long-term conditions, contrary to international studies and reviews.

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Dissemination of Diabetes Care Guidelines: Lessons Learned From Community Health Centers

Abstract: Improvements in diabetes care were not consistent among community health centers. Interventions involving system and policy changes may be more effective in implementing and sustaining improvements than just provider education.

Cited by 10 publications

References 23 publications

Improving Diabetes Care in Midwest Community Health Centers With the Health Disparities Collaborative

Improving Diabetes Care in Midwest Community Health Centers With the Health Disparities Collaborative

Determinants of Health Behaviors After Gestational Diabetes Mellitus: A Prospective Cohort Study in Geneva

The future of community-centred health services in Australia: lessons from the mental health sector

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