Multifocal Interventions Enhance Outcomes and Reduce Disparities among Diverse Patient Populations
Kamerow, D., Brennan, J., Johnson, P., Langwell, K., Peek, M., Walton, J., Lewis, M.A., Clark, N.M.
2012 Science of Eliminating Health Disparities Summit, National Harbor, MD. [Presentation deferred to 2013 due to weather cancellation]
The Alliance to Reduce Disparities in Diabetes, sponsored by the Merck Company Foundation, is a consortium of five grantees focused on improving disparities in diabetes care and outcomes through clinical and community interventions guided by Chronic Care Model principles. The consortium’s goal is to reduce disparities for underserved, multi-ethnic, and low income populations that experience a disproportionate burden of poor health due to diabetes. Grantees based in Chicago, IL; Camden, NJ; Wind River Indian Reservation, WY; Dallas, TX; and Memphis, TN, have enrolled a patient group that is 36% African American, 8% Native American, 40% Latino, 7% White, 1% Asian Pacific Islander, 1% Other, and 7% unknown status, and implemented multi-level interventions to enhance patient skills, provider cultural competencies, and health care systems changes. Grantees provided clinical (HbA1c, blood pressure) and patient-reported (diabetes competence, quality of life, resources and supports for self-management, and diabetes self-care behaviors) outcomes to an external evaluator. Baseline and follow-up clinical data are reported for more than 1000 patients, with a decrease of mean HbA1c values from 8.4 to 7.8 percent and a decrease in blood pressures from 132/80 to 129/78, both significant at p<.001 levels. Analysis showed that patients who participated in more than half the programs had greater changes in both HbA1c and systolic blood pressures over time, controlling for age and gender. Analyses of the patient-reported measures in a smaller number of patients also showed significant improvements in perceived diabetes competence, resources and supports, and self-care behaviors. We conclude that multi-focal programs can reduce disparities and improve outcomes for people with diabetes.