Translating the chronic care model into the community: results from a randomized controlled trial of a multifaceted diabetes care intervention.
OBJECTIVE
To determine whether using the chronic care model (CCM) in an underserved community leads to improved clinical and behavioral outcomes for people with diabetes.


METHODS
This multilevel, cluster-design, randomized controlled trial examined the effectiveness of a CCM-based intervention in an underserved urban community. Eleven primary care practices, along with their patients, were randomized to three groups: CCM intervention (n = 30 patients), provider education only (PROV group) (n = 38), and usual care (UC group) (n = 51).


RESULTS
A marked decline in HbA(1c) was observed in the CCM group (-0.6%, P = 0.008) but not in the other groups. The magnitude of the association remained strong after adjustment for clustering (P = 0.01). The same pattern was observed for a decline in non-HDL cholesterol and for the proportion of participants who self-monitor blood glucose in the CCM group (non-HDL cholesterol: -10.4 mg/dl, P = 0.24; self-monitor blood glucose: +22.2%, P < 0.0001), with statistically significant between-group differences in improvement (non-HDL cholesterol: P = 0.05; self-monitor blood glucose: P = 0.03) after adjustment. The CCM group also showed improvement in HDL cholesterol (+5.5 mg/dl, P = 0.0004), diabetes knowledge test scores (+6.7%, P = 0.07), and empowerment scores (+2, P = 0.02).


CONCLUSIONS
These results suggest that implementing the CCM in the community is effective in improving clinical and behavioral outcomes in patients with diabetes.
Department of Epidemiology, University of Pittsburgh, PA 15213, USA. piattg@upmc.edu
Gretchen A
GA
Piatt
Trevor J
TJ
Orchard
Sharlene
S
Emerson
David
D
Simmons
Thomas J
TJ
Songer
Maria M
MM
Brooks
Mary
M
Korytkowski
Linda M
LM
Siminerio
Usman
U
Ahmad
Janice C
JC
Zgibor
D000368:Aged; D015190:Blood Glucose Self-Monitoring; D002784:Cholesterol / Q000097:blood; D003153:Community Health Services; D003920:Diabetes Mellitus / Q000097:blood / Q000523:psychology / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006442:Glycated Hemoglobin; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D010353:Patient Education as Topic / Q000379:methods*; D012648:Self Care; D016896:Treatment Outcome; D014505:Urban Population
D002784:Cholesterol; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin