title: The Improving Primary Care of African Americans with Diabetes (IPCAAD) project: rationale and design.
abstract: African Americans have an increased burden of both diabetes and diabetes complications. Since many patients have high glucose levels novel interventions are needed, especially for urban patients with limited resources. In the Grady Diabetes Clinic in Atlanta, a stepped care strategy improves metabolic control. However, most diabetes patients do not receive specialized care. We will attempt to translate diabetes clinic approaches to the primary care setting by implementing a novel partnership between specialists and generalists. We hypothesize that endocrinologist-supported strategies aimed at providers will result in effective diabetes management in primary care sites, and the Improving Primary Care of African Americans with Diabetes project will test this hypothesis in a major randomized, controlled trial involving over 2000 patients. Physicians in Grady Medical Clinic units will receive (1) usual care, (2) computerized reminders that recommend individualized changes in therapy and/or (3) directed discussion by endocrinologists providing feedback on performance. We will measure outcomes related to both microvascular disease (HbA1c, which reflects average glucose levels over an approximately 2-month period) and macrovascular disease (blood pressure and lipids) and assess provider performance as well. We will compare two readily generalizable program interventions that should delineate approaches effective in a primary care setting as needed to improve care and prevent complications in urban African Americans with type 2 diabetes.
authors.affiliation: Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA. medlsp@emory.edu
authors.forename: Lawrence S
authors.initials: LS
authors.lastname: Phillips
authors.forename: Vicki S
authors.initials: VS
authors.lastname: Hertzberg
authors.forename: Curtiss B
authors.initials: CB
authors.lastname: Cook
authors.forename: Imad M
authors.initials: IM
authors.lastname: El-Kebbi
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Gallina
authors.forename: David C
authors.initials: DC
authors.lastname: Ziemer
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Miller
authors.forename: Joyce P
authors.initials: JP
authors.lastname: Doyle
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Barnes
authors.forename: Wrenn
authors.initials: W
authors.lastname: Slocum
authors.forename: Robert H
authors.initials: RH
authors.lastname: Lyles
authors.forename: Risa P
authors.initials: RP
authors.lastname: Hayes
authors.forename: Dennis N
authors.initials: DN
authors.lastname: Thompson
authors.forename: David J
authors.initials: DJ
authors.lastname: Ballard
authors.forename: William M
authors.initials: WM
authors.lastname: McClellan
authors.forename: William T
authors.initials: WT
authors.lastname: Branch
mesh_terms: D044383:Black People; D019091:Critical Pathways / Q000592:standards; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000208:ethnology / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000208:ethnology / Q000209:etiology / Q000628:therapy; D005246:Feedback; D005845:Georgia; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007400:Interprofessional Relations; D010348:Patient Care Team / Q000592:standards; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000592:standards*; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012107:Research Design; D014505:Urban Population; D001741:Black or African American
chemical_list: D006442:Glycated Hemoglobin