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

• Published in: Diabetes care Vol. 27; no. 1; pp. 2 - 8
• Main Authors: CHIN, Marshall H, COOK, Sandy, DRUM, Melinda L, LEI JIN, GUILLEN, Myriam, HUMIKOWSKI, Catherine A, KOPPERT, Julie, HARRISON, James F, LIPPOLD, Susan, SCHAEFER, Cynthia T
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01-01-2004
• Subjects: Biological and medical sciences; Community Health Centers - standards; Demographic aspects; Diabetes; Diabetes Mellitus - blood; Diabetes Mellitus - rehabilitation; Diabetes Mellitus - therapy; Diabetes therapy; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Evaluation; Glycated Hemoglobin A - analysis; Health facilities; Humans; Medical care; Medical sciences; Midwestern United States; Models, Organizational; Patient Education as Topic; Quality Assurance, Health Care; Quality management; Quality of service; Utilization; United States; Endocrinopathy; Health center; Diabetes mellitus; Disparity; Community; Public health; Care
• DOI: 10.2337/diacare.27.1.2
• EISSN: 1935-5548
• ISSN: 0149-5992

Improving Diabetes Care in Midwest Community Health Centers With the Health Disparities Collaborative
Marshall H. Chin , MD, MPH 1 ,
Sandy Cook , PHD 1 ,
Melinda L. Drum , PHD 1 ,
Lei Jin , MA, MS 1 ,
Myriam Guillen , BA 1 ,
Catherine A. Humikowski , BA 1 ,
Julie Koppert , RNC, BSN, CDE 2 ,
James F. Harrison , MD 3 ,
Susan Lippold , MD, MPH 4 and
Cynthia T. Schaefer , RN, CS 5
1 Departments of Medicine and Health Studies, Diabetes Research and Training Center, The University of Chicago, Chicago, Illinois
2 Midwest Cluster Health Disparities Collaborative, Kenton, Ohio
3 North Woods Community Health Center, Minong, Wisconsin
4 Health Resources and Services Administration, Chicago, Illinois
5 Department of Nursing and Health Sciences, University of Evansville, Evansville, Indiana
Address correspondence and reprint requests to Marshall H. Chin, MD, MPH, University of Chicago, Section of General Internal
Medicine, 5841 South Maryland Ave., MC 2007, Chicago, Illinois 60637. E-mail: mchin{at}medicine.bsd.uchicago.edu
Abstract
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 −0.2, 95% CI −0.4 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 Disparities Collaborative improved diabetes care in health centers in 1 year.
BPHC, Bureau of Primary Health Care
HLM, hierarchical linear model
PDSA, Plan, Do, Study, Act
Footnotes
J.F.H. is currently affiliated with South Lane Medical Group, Cottage Grove, Oregon, and S.L. is currently affiliated with
the Centers for Disease Control City of Chicago Tuberculosis Program, Chicago, Illinois.
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.
Accepted September 15, 2003.
Received May 15, 2003.
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