title: Improving diabetes care in midwest community health centers with the health disparities collaborative.
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.
  
  
  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.
authors.affiliation: Department of Medicine and Health Studies, Diabetes Research and Training Center, The University of Chicago, Chicago, Illinois 60637, USA. mchin@medicine.bsd.uchicago.edu
authors.forename: Marshall H
authors.initials: MH
authors.lastname: Chin
authors.forename: Sandy
authors.initials: S
authors.lastname: Cook
authors.forename: Melinda L
authors.initials: ML
authors.lastname: Drum
authors.forename: Lei
authors.initials: L
authors.lastname: Jin
authors.forename: Myriam
authors.initials: M
authors.lastname: Guillen
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Humikowski
authors.forename: Julie
authors.initials: J
authors.lastname: Koppert
authors.forename: James F
authors.initials: JF
authors.lastname: Harrison
authors.forename: Susan
authors.initials: S
authors.lastname: Lippold
authors.forename: Cynthia T
authors.initials: CT
authors.lastname: Schaefer
mesh_terms: D003151:Community Health Centers / Q000592:standards*; D003920:Diabetes Mellitus / Q000097:blood / Q000534:rehabilitation / Q000628:therapy*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D015146:Midwestern United States; D017146:Models, Organizational; D010353:Patient Education as Topic; D011785:Quality Assurance, Health Care
chemical_list: D006442:Glycated Hemoglobin