Alliance to Reduce Disparities in Diabetes

Cross-site Evaluation Results

Cross-site Alliance Program Evaluation

The Foundation is working with RTI International to conduct a five-year (2009–2013), cross-site evaluation of the Alliance and its programs. We anticipate that the final results of this evaluation will be published in November 2014.

Results from the evaluation through May 2013 are provided below.  These include an overview of provider enrollment and participation as well as baseline patient self-reported outcome measures.

In 2013, 48 clinics or practices participated in at least two of the three areas of intervention (i.e., patients, providers and systems). Cumulatively, from 2009 to 2013, 173 individual physicians have been actively engaged in program implementation (e.g., recruiting patients with type 2 diabetes, and identifying and implementing systems change in the practice setting). In addition, Alliance sites have served a diverse patient population through their programs. From 2009 to 2013, across the sites, 40 percent of patients were Hispanic or Latino, 38 percent were African-American, 8 percent were Native American, 6 percent were white, 1 percent were Asian, and 7 percent were of another racial or ethnic background or of unknown ethnicity.

The Alliance program sites have been enrolling participants on a rolling basis since the program was first implemented in 2009.  Enrollment was ongoing through 2013.  Because not all program participants started at the same time, the numbers and values for participant baseline and follow-up measures continue to change until program implementation is completed. For ease of interpretation, we present the most recent overall baseline and follow-up data on all participants who had these measures as of May 2013. Note that the data below are not site-specific, but rather were aggregated across the five sites in an independent evaluation.

Patient & Provider Participation
(cumulative over time)
2010  2011  2012 2013
Number of adults with type 2 diabetes enrolled in DSME1 804 1,570 2,151 2,268
Number of providers who received cultural awareness training2 39 72 138 162

1DSME: Diabetes self-management education. DSME commonly addresses enhancing self-care behaviors (such as nutrition, exercise, and blood glucose monitoring) and informing decision-making in order to improve clinical outcomes and quality of life. Note: The number of adult enrollees reported in 2010 and 2011 has been adjusted to reflect a change in enrollment criteria for one of the program sites. The more conservative enrollment criteria resulted in an overall decrease in their participant numbers.

2Cultural awareness training is a part of the process by which better patient care is delivered. It helps clinicians become better communicators and makes them more aware of cultural differences.

Patient Self-reported Outcomes  Baseline  Follow-up as of 5/2013
Diabetes competence1 5.3 6.0
Diabetes Self-Care Behaviors2 
General diet 3.9 4.7
Diabetes-specific diet 4.2 4.5
Exercise 3.0 3.2
Blood-glucose testing 4.2 5.1
Foot care 4.3 5.4
Quality-of-Life Measures 
Physical functioning3 40.4 40.4
Mental functioning4 42.8 44.6
Objectively Measured Patient Clinical Outcomes
Hemoglobin A1c5 8.4 7.9
Low density lipid (LDL) Cholesterol6  99 98
Blood pressure7  131/79 132/79

1Weighted averages for the cohort of participants with baseline and follow-up measures to four competence questions rated on a scale from 1 to 7, where higher ratings reflected better feelings of competence about engaging in diabetes self-management. The baseline score here demonstrates slightly above average competence and shows improvement at follow-up.

2Weighted averages for each behavior for the cohort of participants with baseline and follow-up measures. Self-care behaviors are scored on a scale from 0 to 7 reflecting on how many of the past 7 days a behavior was performed. Higher numbers reflect more days on which the behavior is performed. The scores here demonstrate that participants, on average, engaged in these behaviors between 3 and 4 days a week at baseline, and there is improvement at follow-up.

3Weighted averages shown for baseline and follow-up measures for the cohort of participants for self-reported physical functioning (e.g., physical ability or limitations, bodily pain), where higher scores reflect better physical functioning. Population norm: 50. Scores are below population norm at baseline and follow-up.

4Weighted averages shown for baseline and follow-up measures for the cohort of participants for self-reported mental functioning (e.g., feelings of depression, anxiety, calm); higher scores reflect better mental functioning. Population norm: 50. Scores are below population norm, but mental functioning shows improvement over time.

5Weighted averages for the cohort of participants with baseline and follow-up for the Hemoglobin A1c blood test. Lower numbers indicate better values. Changes in Hemoglobin A1c show improvement over time.

6Weighted averages for the cohort of participants with baseline and follow-up blood LDL cholesterol tests. Lower numbers indicate better values. Changes in LDL cholesterol show slight improvement over time.

7Weighted averages for the cohort of participants with baseline and follow-up measures for blood pressure measurements. Lower numbers indicate better values. Changes in blood pressure show no improvement over time.

 

Presentations and Publications

2014 Presentations

Holt, S.L., Lewis, M.A., Taylor, O.M., Stine, A.D., Brenner, J., Fleming, N., Johnson, P., Langwell, K., & Peek, M. (2014, December). "I thank you because you have saved my life..." Patient perspectives on the Alliance to Reduce Disparities in Diabetes. Poster presentation at the 2014 Minority Health and Health Disparities Grantees' Conference, National Harbor, MD.

Kamerow, D.B., Moultrie, R.R., Lewis, M.A., Bann, C.M., Karns, S.A., Hobbs, C.L., Burton, J.A., Brenner, J., Fleming, N., Johnson, P., Langwell, K., & Peek, M. (2014, December). Evaluation of the Alliance to Reduce Disparities in Diabetes. Poster presentation at the 2014 Minority Health and Health Disparities Grantees' Conference, National Harbor, MD.

2014 Publications

Lewis, M.A., Bann, C.M., Karns, S.A., Hobbs, C.L., Holt, S., Brenner, J., Fleming, N., Johnson, P., Langwell, K., Peek, M.E., Burton, J.A., Hoerger, T.J., Clark, N.M., & Kamerow, D.B. (2014). Cross-site evaluation of the Alliance to Reduce Disparities in Diabetes: Clinical and patient-reported outcomesHealth Promotion Practice, 15(2S), 92S-102S.

Lewis, M.A., Williams, P.A., Fitzgerald, T.M., Heminger, C.L., Hobbs, C.L., Moultrie, R.R., Taylor, O.M., Holt, S., Karns, S.A., Burton, J.A., & Kamerow, D.B. (2014). Improving the implementation of diabetes self-management: Findings from the Alliance to Reduce Disparities in DiabetesHealth Promotion Practice, 15(2S), 83S-91S.