Improving and Sustaining Diabetes Care in Community Health Centers With the Health Disparities Collaboratives

Nursing and Health Sciences, University of Evansville, Evansville, Indiana, United States
Medical Care (Impact Factor: 3.23). 01/2008; 45(12):1135-43. DOI: 10.1097/MLR.0b013e31812da80e
Source: PubMed


In 1998, the Health Resources and Services Administration's Bureau of Primary Health Care began the Health Disparities Collaboratives (HDC) to improve chronic disease management in community health centers (HCs) nationwide. The HDC incorporates rapid quality improvement, a chronic care model, and best practice learning sessions.
To determine whether the HDC improves diabetes care in HCs over 4 years and whether more intensive interventions enhance care further.
Chart review of 2364, 2417, and 2212 randomly selected patients with diabetes from 34 HCs in 17 states in 1998, 2000, and 2002, respectively.
American Diabetes Association standards.
We performed a randomized controlled trial with an embedded prospective longitudinal study. We randomized 34 HCs that had undergone 1-2 years of the HDC. The standard-intensity arm continued the baseline HDC intervention. High-intensity arm centers received 4 additional learning sessions, provider training in behavioral change, and patient empowerment materials. To assess the impact of the HDC, we analyzed changes in clinical processes and outcomes in the standard-intensity centers. To determine the effect of more intensive interventions, we compared the standard- and high-intensity centers.
Between 1998 and 2002, HCs undertaking the standard HDC improved 11 diabetes processes and lowered hemoglobin A1c [-0.45%; 95% confidence interval (CI), -0.72 to -0.17] and low-density lipoprotein cholesterol (-19.7 mg/dL; 95% CI, -25.8 to -13.6). High-intensity intervention centers had greater use of angiotensin converting enzyme inhibitors [adjusted odds ratio (OR), 1.47; 95% CI, 1.07-2.01] and aspirin (OR, 2.20; 95% CI, 1.28-3.76), but lower use of dietary (OR, 0.24; 95% CI, 0.08-0.68) and exercise counseling (OR, 0.34; 95% CI, 0.15-0.75).
Diabetes care and outcomes improved in HCs during the first 4 years of the HDC quality improvement collaborative. More intensive interventions helped marginally.

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Available from: Michael T Quinn, May 10, 2015
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    • "In another large-scale multisite evaluation, Chin et al. (2007) compared measures of care processes and intermediate outcomes at three different time points (1998, 2000, and 2002) at community health centers that focused on diabetes and participated in the CCM Collaborative. This study randomized health centers into a " standardintensity " or " high-intensity " arm of the study in order to compare effects of additional activities to support implementation of the CCM. "
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