Improving diabetes care among low-income North Carolinians: Project IDEAL.
OBJECTIVE
Many barriers exist in implementing evidence-based guidelines for diabetes care, particularlyfor low-income patients. To address this, the North Carolina Project IDEAL (Improving Diabetes Education, Access to Care, and Living) Diabetes Initiative was created


METHODS
Fourteen programs representing different types of agencies and intervention strategies across the state participated in the initiative.


METHODS
Separate random samples of medical charts of participating patients were reviewed at baseline (n=429) and three-year follow-up (n=656) to assess changes in six process (assessment of hemoglobin A1c, cholesterol blood pressure, and urinary protein; conduction of foot and retina examination) and three outcome (glycemia, blood pressure, and lipid control) measures. Four national guidelines (DQIP, HEDIS, NCEP and ADA) were used as benchmarks.


RESULTS
Large increases were observed for some measures (hemoglobin A1c control and testing, LDL-cholesterol testing), while modest increases were observed for others (dilated eye exam, blood pressure testing, and control).


CONCLUSIONS
Project IDEAL was successful in improving access to high-quality diabetes care for low-income patients. Additional effort is needed to address specific areas of concern, particularly retinopathy screening.
Bell
Ronny A
RA
Department of Public Health Sciences, Wake Forest University School of Medicine, USA. rbell@wfubmc.edu
Camacho
Fabian
F
Duren-Winfield
Vanessa T
VT
Bonds
Denise E
DE
Anderson
Roger T
RT
Konen
Joseph C
JC
Goff
David C
DC
D000328:Adult; D000368:Aged; D003153:Community Health Services / Q000458:organization & administration*; D003920:Diabetes Mellitus / Q000191:economics / Q000628:therapy*; D003930:Diabetic Retinopathy / Q000191:economics / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007373:Interinstitutional Relations; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009657:North Carolina; D010865:Pilot Projects; D011203:Poverty; D017410:Practice Guidelines as Topic; D016730:Program Development; D012959:Socioeconomic Factors