Approximately 3,000 federally funded community health centers (CHCs) are core care providers for indigent patients. To reduce health disparities and improve care quality in CHCs, the Health Resources and Services Administration's Bureau of Primary Health Care began a major 6-year Health Disparities Collaborative in 1998. The focus of the first year, a diabetes care quality improvement (QI) initiative, improved diabetes care in Midwest CHCs, according to a study supported by the Agency for Healthcare Research and Quality (HS10479).
Marshall H. Chin, M.D., M.P.H., of the University of Chicago, and his colleagues evaluated the impact of the diabetes QI initiative 1 year before and after the initiative began at 19 Midwestern CHCs. The initiative was based on a chronic care model that emphasized patient self-management, delivery system redesign, decision support, clinical information systems, leadership, health system organization, and community outreach, as well as collaborative learning sessions. The researchers reviewed the health center charts of 969 adults with diabetes, surveyed 79 diabetes QI team members, and conducted interviews to evaluate if clinic care met American Diabetes Association standards.
The QI initiative clearly improved diabetes care at the health centers. Based on the review of patient charts, the performance of several key diabetes care processes increased. For example, rates of HbA1c measurement, an indicator of blood sugar levels, rose from 80 to 90 percent of patients, eye examination referrals from 36 to 47 percent, foot examinations from 40 to 64 percent, and lipid assessments from 55 to 66 percent. In addition, patients' mean HbA1c levels were lowered from 8.5 to 8.3 percent. Over 90 percent of survey respondents stated that the Diabetes Collaborative was worth the effort and was successful.
See "Improving diabetes care in Midwest community health centers with the Health Disparities Collaborative," by Dr. Chin, Sandy Cook, Ph.D., Melinda L. Drum, Ph.D., and others, in the January 2004 Diabetes Care 27(1), pp. 2-8.