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Diabetes Care 27:2-8, 2004
© 2004 by the American Diabetes Association, Inc.

Clinical Care/Education/Nutrition
Original Article

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

Marshall H. Chin, MD, MPH1, Sandy Cook, PHD1, Melinda L. Drum, PHD1, Lei Jin, MA, MS1, Myriam Guillen, BA1, Catherine A. Humikowski, BA1, Julie Koppert, RNC, BSN, CDE2, James F. Harrison, MD3, Susan Lippold, MD, MPH4 and Cynthia T. Schaefer, RN, CS5

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

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 HbA1c 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 HbA1c 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.

Abbreviations: BPHC, Bureau of Primary Health Care • HLM, hierarchical linear model • PDSA, Plan, Do, Study, Act


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