title: Cross-site evaluation of the Alliance to Reduce Disparities in Diabetes: clinical and patient-reported outcomes.
abstract: Alliance programs implemented multilevel, multicomponent programs inspired by the chronic care model and aimed at reducing health and health care disparities for program participants. A unique characteristic of the Alliance programs is that they did not use a fixed implementation strategy common to programs using the chronic care model but instead focused on strategies that met local community needs. Using data provided by the five programs involved in the Alliance, this evaluation shows that of the 1,827 participants for which baseline and follow-up data were available, the program participants experienced significant decreases in hemoglobin A1c and blood pressure compared with a comparison group. A significant time by study group interaction was observed for hemoglobin A1c as well. Over time, more program participants met quality indicators for hemoglobin A1c and blood pressure. Those participants who attended self-management classes and experienced more resources and support for self-management attained more benefit. In addition, program participants experienced more diabetes competence, increased quality of life, and improvements in diabetes self-care behaviors. The cost-effectiveness of programs ranged from $23,161 to $61,011 per quality-adjusted life year. In sum, the Alliance programs reduced disparities and health care disparities for program participants.
authors.affiliation: RTI International, Research Triangle Park, NC, USA melewis@rti.org.
authors.forename: Megan A
authors.initials: MA
authors.lastname: Lewis
authors.affiliation: RTI International, Research Triangle Park, NC, USA.
authors.forename: Carla M
authors.initials: CM
authors.lastname: Bann
authors.affiliation: RTI International, Research Triangle Park, NC, USA.
authors.forename: Shawn A
authors.initials: SA
authors.lastname: Karns
authors.affiliation: RTI International, Research Triangle Park, NC, USA.
authors.forename: Connie L
authors.initials: CL
authors.lastname: Hobbs
authors.affiliation: RTI International, Research Triangle Park, NC, USA.
authors.forename: Sidney
authors.initials: S
authors.lastname: Holt
authors.affiliation: Cooper University Healthcare, Camden, NJ, USA.
authors.forename: Jeff
authors.initials: J
authors.lastname: Brenner
authors.affiliation: Baylor Scott & White Health, Dallas, TX, USA.
authors.forename: Neil
authors.initials: N
authors.lastname: Fleming
authors.affiliation: Memphis Healthy Churches, Memphis, TN, USA.
authors.forename: Patria
authors.initials: P
authors.lastname: Johnson
authors.affiliation: Sundance Research Institute, Sundance, WY, USA.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Langwell
authors.affiliation: University of Chicago, Chicago, IL, USA.
authors.forename: Monica E
authors.initials: ME
authors.lastname: Peek
authors.affiliation: RTI International, Research Triangle Park, NC, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Burton
authors.affiliation: RTI International, Research Triangle Park, NC, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Hoerger
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Noreen M
authors.initials: NM
authors.lastname: Clark
authors.affiliation: RTI International, Washington, DC, USA.
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Kamerow
mesh_terms: D003299:Cooperative Behavior; D003362:Cost-Benefit Analysis; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation / Q000379:methods*; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D014481:United States
keywords: diabetes; health disparities; quantitative evaluation