Improving Diabetes Care and Outcomes on the South Side of Chicago
- Conditions
- Diabetes Mellitus
- Interventions
- Behavioral: Patient ActivationBehavioral: Provider TrainingBehavioral: Quality ImprovementBehavioral: Community Outreach
- Registration Number
- NCT01087073
- Lead Sponsor
- University of Chicago
- Brief Summary
The Improving Diabetes Care and Outcomes project aims to reduce diabetes disparities and engages patients, providers, clinics, and community collaborators to improve the health care and outcomes of African-Americans on the South Side of Chicago. Initiated in 2009, this project is a collaborative, community-based intervention that employs a multifaceted, integrated approach to address many of the root causes of health disparities. The short-term goal of this project is to improve clinic processes such as appointment scheduling and patient counseling through quality improvement efforts, as well as clinical outcomes including HbA1c, cholesterol and blood pressure in patients with diabetes through patient education. Long-term goals are to strengthen the network of community health centers, community-based organizations and academic medical centers, while increasing awareness of local diabetes disparities and empowering communities to combat this problem.
- Detailed Description
This multifactorial intervention contains four overlapping core components reflecting key elements of the Chronic Care Model.This model identifies patients, practice teams, the community, and health systems as four necessary elements in the successful management of chronic diseases such as diabetes. Six health centers (two academic center clinics affiliated with the University of Chicago and four FQHCs) are part of the intervention. Researchers at the University of Chicago received grant funding from the Merck Company Foundation's Alliance to Reduce Disparities in Diabetes and the National Institutes of Health to implement and evaluate the intervention.
The research and implementation team includes faculty and staff members with expertise in quality improvement, behavioral change, community outreach, patient education, and research methods.
The intervention has four main components:
1. Patient Activation: We hold culturally tailored, 10-week patient education classes that combine culturally tailored patient education with training in shared decision-making skills to empower patients to be proactive in their diabetes self-management.
2. Provider Training: We provide educational workshops for provider, clinical, and non-clinical staff at our six intervention clinics on patient-centered communication, cultural competency, behavior change counseling, and shared decision making.
3. Quality Improvement: Our team facilitates quality improvement (QI) programs redesigning clinic operations to improve care for diabetes patients. QI initiatives have included instituting group visits, patient medication cards, peer support groups, flow sheets, nurse case management, and patient registries. New initiatives include improving access and tracking of specialists visits through EMR, employing community health workers/patient navigators, coordinating care, and implementing other team-based care initiatives. We also perform a cost/benefits analysis of intervention implementation from the business case perspective of the outpatient clinics and determine the major barriers and solutions to successfully implement and sustain the project at each location.
4. Community Outreach: We collaborate with existing community resources to create sustainable collaborations that support diabetes patients outside of the health care system and promote nutrition and a healthy lifestyle. We collaborate with grocery stores, food pantries, the Chicago Park District, farmers markets, media outlets, grocery stores and other community-based organizations.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 6209
- Patients must have a diabetes diagnosis (ICD-9 codes 250.X) and be age 18 years or older
- Patients must attend one of the participating health centers
- Gestational diabetes patients
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Patient Activation Patient Activation Patient knowledge in diabetes self-management behaviors and clinical measures (HbA1c, LDL, HDL, BMI, BP) are tracked at baseline, 10-weeks (post-program), 3 months (post-program) and 6 months (post-program). Provider Training Evaluation Provider Training Pre-post surveys are conducted at each training session to assess overall satisfaction with the curriculum, knowledge of SDM, and understanding of techniques to promote its use in the healthcare setting. Quality Improvement Evaluation Quality Improvement We measure quality improvement efforts through biannual staff experience surveys and one-on-one provider and clinic staff interviews. Community Outreach Evaluation Community Outreach Pre-post surveys will be disseminated at nutrition tours (Save-A-Lot, Walgreens, 61st Street Farmers Market) to assess change in knowledge of healthy eating behaviors and proper nutrition. Surveys will also assess participant satisfaction of the tours. Interviews will also be performed with community stakeholders to assess the costs/benefits of the collaboration and overall feedback on involvement.
- Primary Outcome Measures
Name Time Method HbA1c Baseline data will be collected at the end of 1st year; follow-up data will be collected from years 2-7. Chart audit will be conducted on 100 randomly selected diabetes patients meeting the age inclusion criteria (age 18 years and older). Will also be collected from patients in the patient activation component.
Blood pressure Baseline data will be collected at the end of 1st year; follow-up data will be collected from years 2-7. Chart audit will be conducted on 100 randomly selected diabetes patients meeting the age inclusion criteria (age 18 years and older). Will also be collected from patients in the patient activation component.
Lipids (HDL, LDL, total cholesterol, triglycerides) Baseline data will be collected at the end of 1st year; follow-up data will be collected from years 2-7. Chart audit will be conducted on 100 randomly selected diabetes patients meeting the age inclusion criteria (age 18 years and older). Will also be collected from patients in the patient activation component.
- Secondary Outcome Measures
Name Time Method Processes of care Baseline data will be collected at the end of 1st year; follow-up data will be collected from years 2-7. Chart audit will be conducted on 100 randomly selected diabetes patients meeting the age inclusion criteria (age 18 years and older).
Annual Processes of Care:
At least 1 HbA1c, Lipid assessment, Microalbumin assessment, ACE inhibitor or ARB prescribed, Aspirin prescribed, Dental referral, Eye exam or referral, Foot exam or referral, Influenza vaccination, Home glucose monitoring, Dietary counseling or referral, Exercise counseling, Diabetes education
Trial Locations
- Locations (6)
Kovler Diabetes Center
🇺🇸Chicago, Illinois, United States
Chicago Family Health Center
🇺🇸Chicago, Illinois, United States
University of Chicago, Primary Care Group
🇺🇸Chicago, Illinois, United States
ACCESS Grand Boulevard Family Health Center
🇺🇸Chicago, Illinois, United States
Friend Family Health Center
🇺🇸Chicago, Illinois, United States
ACCESS Booker Family Health Center
🇺🇸Chicago, Illinois, United States