The North Carolina Experience with the Diabetes Health Disparities Collaboratives

Wang, Anthea; Wolf, Marti; Carlyle, Randy; Wilkerson, Janice; Porterfield, Deborah S; Reaves, Janet

doi:10.1016/s1549-3741(04)30045-6

Cited by 24 publications

(30 citation statements)

References 6 publications

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“…Among large medical groups, fewer than half have implemented improvement tools such as diabetes registries, tracking systems, case managers, feedback to physicians, or clinical guidelines with reminders, whereas other systems lack the technology necessary to sustain quality improvement eff o r t s ( 5 , 1 0 -1 2 ) . M a n y d i a b e t e s intervention studies are limited by inadequate sample size, nonrandomized patients and clinics, lack of control subjects, or limited scope of implementation within a single medical group or health system (11,13,14). Although some trials of quality improvement strategies have demonstrated small improvements in the process of care delivery, demonstrating improvement in control of A1C, LDL, and systolic blood pressure (SBP) has been more challenging (15)(16)(17)(18).…”

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confidence: 99%

Improving Diabetes Care in Practice

et al. 2008

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OBJECTIVE -The purpose of this study was to determine whether implementation of a multicomponent organizational intervention can produce significant change in diabetes care and outcomes in community primary care practices.RESEARCH DESIGN AND METHODS -This was a group-randomized, controlled clinical trial evaluating the practical effectiveness of a multicomponent intervention (TRANSLATE) in 24 practices. The intervention included implementation of an electronic diabetes registry, visit reminders, and patient-specific physician alerts. A site coordinator facilitated previsit planning and a monthly review of performance with a local physician champion. The principle outcomes were the percentage of patients achieving target values for the composite of systolic blood pressure (SBP) Ͻ130 mmHg, LDL cholesterol Ͻ100 mg/dl, and A1C Ͻ7.0% at baseline and 12 months. Six process measures were also followed.RESULTS -Over 24 months, 69,965 visits from 8,405 adult patients with type 2 diabetes were recorded from 238 health care providers in 24 practices from 17 health systems. Diabetes process measures increased significantly more in intervention than in control practices, giving net increases as follows: foot examinations 35.0% (P Ͻ 0.0.001); annual eye examinations 25.9% (P Ͻ 0.001); renal testing 28.5% (P Ͻ 0.001); A1C testing 8.1%(P Ͻ 0.001); blood pressure monitoring 3.5% (P ϭ 0.05); and LDL testing 8.6% (P Ͻ 0.001). Mean A1C adjusted for age, sex, and comorbidity decreased significantly in intervention practices (P Ͻ 0.02). At 12 months, intervention practices had significantly greater improvement in achieving recommended clinical values for SBP, A1C, and LDL than control clinics (P ϭ 0.002).CONCLUSIONS -Introduction of a multicomponent organizational intervention in the primary care setting significantly increases the percentage of type 2 diabetic patients achieving recommended clinical outcomes.

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confidence: 99%

Improving Diabetes Care in Practice

et al. 2008

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“…Previous literature has yielded unclear results regarding the effectiveness of QI initiatives at improving diabetes care, showing positive change in clinical process measures and intensification of medication but no change in clinical outcomes. 36,[42][43][44] Recent chart audit studies showed inconsistent improvement in A1c, BP, and LDL, depending on the length of the period after the initiative. 16,[45][46][47] This study had a relatively short period after the program (1 year), yet significant improvements were found.…”

Section: Discussionmentioning

confidence: 99%

Results of a Mixed-Methods Evaluation of Partnerships for Health: A Quality Improvement Initiative for Diabetes Care

Harris

Paquette-Warren

Roberts

et al. 2013

The Journal of the American Board of Family Medicine

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Purpose: Quality improvement (QI) initiatives have been implemented to facilitate transition to a chronic disease management approach in primary health care. However, the effect of QI initiatives on diabetes clinical processes and outcomes remains unclear. This article reports the effect of Partnerships for Health, a QI program implemented in Southwestern Ontario, Canada, on diabetes clinical process and outcome measures and describes program participants' views of elements that influenced their ability to reach desired improvements.Methods: Part of an external, concurrent, comprehensive, mixed-methods evaluation of Partnerships for Health, a before/after audit of 30 charts of patient of program physicians (n ‫؍‬ 35) and semistructured interviews with program participants (physicians and allied health providers) were conducted.Results: The proportion of patients (n ‫؍‬ 998) with a documented test/examination for the following clinical processes significantly improved (P < .005): glycosylated hemoglobin (A1c), cholesterol, albumin-to-creatinine ratio, serum creatinine, glomerular filtration rate, electrocardiogram, foot/eye/neuropathy examination, body mass index, waist circumference, and depression screening. Data showed intensification of treatment and significant improvement in the number of patients at target for lowdensity lipoprotein (LDL) and blood pressure (BP) (P < .001). Mean LDL and BP values decreased significantly (P < .01), and an analysis of patients above glycemic targets (A1c >7% at baseline) showed a significant decrease in mean A1c values (P < .01). Interview participants (n ‫؍‬ 55) described using a team approach, improved collaborative and proactive care through better tracking of patient data, and increased patient involvement as elements that positively influenced clinical processes and outcomes.

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“…65 Although this model is now being replicated in centers across the country in an initiative called the Health Disparities Collaboratives, the primary focus is on quality of care and health outcomes such as glycemic control across the health center's entire patient population (ie, the reduction in disparities will come from universally improving care for a de facto high-disparity patient population, as opposed to reducing disparities rate ratios within the practice). 66 …”

Section: Dynamic Versus Static Interventionsmentioning

confidence: 99%

How Can Practice-based Research Contribute to the Elimination of Health Disparities?

Rust¹,

Cooper²

2007

The Journal of the American Board of Family Medicine

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Racial, ethnic, and socioeconomic disparities in health care and health outcomes are well documented. Disparities research is evolving from documenting these disparities, to understanding their causes and mechanisms, and finally to conducting interventional research to reduce or eliminate disparities. Unfortunately, few studies to date have demonstrated substantial reductions in health outcomes disparities.Traditional experimental models of research that test a single intervention held constant throughout the study period may not have the power to impact complex clusters of comorbid health disparities in patients who receive care in underresourced primary care safety net practice settings. New models of research will be required to test dynamic, multidimensional interventions that triangulate on patients, providers, and communities and are continuously improved with every radar-sweep of feedback from rapid-cycle measurement of population health outcomes on a community-wide basis. In this article, we review 12 promising strategies that could substantially increase the impact of research on eliminating health disparities in America.

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The North Carolina Experience with the Diabetes Health Disparities Collaboratives

Cited by 24 publications

References 6 publications

Improving Diabetes Care in Practice

Improving Diabetes Care in Practice

Results of a Mixed-Methods Evaluation of Partnerships for Health: A Quality Improvement Initiative for Diabetes Care

How Can Practice-based Research Contribute to the Elimination of Health Disparities?

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