title: Evaluation of quality improvement performance in the Community Diabetes Education (CoDE) program for uninsured Mexican Americans: results of a randomized controlled trial.
abstract: The objective of this article is to quantify quality improvement using data from a randomized controlled trial that tested the effectiveness of a community health worker in the primary role of diabetes educator in a clinic serving uninsured Mexican Americans. The intervention group received 7 hours of diabetes education/case management in excess of usual medical care. Of 16 process and outcome measures evaluated, the intervention group was significantly more likely to have received a dilated retinal examination, and 53% achieved a hemoglobin A1c below 7% compared with 38% of the control group participants. Composite quality measures were similar in magnitude with published practice-based benchmarks at study conclusion. This suggests that the overall diabetes care delivered in this clinic serving uninsured patients was comparable to the levels of excellence achieved in other primary care settings. Quantitative measurements of quality improvement can inform health policy regarding the relative effectiveness of diabetes interventions.
authors.affiliation: 1University of Texas School of Public Health, Dallas, TX.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Prezio
authors.forename: Bijal A
authors.initials: BA
authors.lastname: Balasubramanian
authors.forename: Kerem
authors.initials: K
authors.lastname: Shuval
authors.forename: Dunlei
authors.initials: D
authors.lastname: Cheng
authors.forename: Darla E
authors.initials: DE
authors.lastname: Kendzor
authors.forename: Dan
authors.initials: D
authors.lastname: Culica
mesh_terms: D000328:Adult; D003150:Community Health Workers; D003920:Diabetes Mellitus; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D017057:Medically Uninsured / Q000208:ethnology*; D017058:Mexican Americans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic / Q000592:standards*; D015397:Program Evaluation; D058996:Quality Improvement
chemical_list: D006442:Glycated Hemoglobin
keywords: community health worker; diabetes education; quality improvement; randomized controlled trial