American Diabetes Association's 73rd Scientific Sessions - Evaluation
Multilevel Interventions Can Enhance Diabetes Outcomes: Mid-term Results from the Alliance to Reduce Disparities in Diabetes
Megan A. Lewis, RTI International, Connie Hobbs, Camden Coalition of Healthcare Providers, Shawn Kams, RTI International, Joe Burton, RTI International, Jeffrey Brenner, Camden Coalition of Healthcare Providers, Patria Johnson, Memphis Healthy Churches, Kathy Langwell, Sundance Research Institute, Monica Peek, University of Chicago, James Walton, Baylor Healthcare System, Noreen M. Clark, University of Michigan, and Douglas Kamerow, RTI International
The Alliance to Reduce Disparities in Diabetes integrates innovative professional and patient education and quality of care improvements aimed at vulnerable patients, and focuses on reducing disparities in diabetes care and enhancing diabetes outcomes through clinical and community interventions. The Alliance is comprised of five grantees, a National Program Office, and an external evaluator. The five sites enrolled a multiethnic and multiracial patient population with diabetes and implemented multilevel and multicomponent interventions to enhance patient skills, clinician cultural competencies, and health care systems changes to address disparities and enhance care. Each grantee provided clinical (hemoglobin A1c [HbA1c], blood pressure [BP]) and patient-reported outcomes (diabetes competence, quality of life, resources and supports for self-management, and diabetes self-care behaviors) for program participants to the Alliance’s external evaluator, RTI International. Participant cohort data at midterm of the five-year program that participants are 64% female; 6% White, 39% African American, 7% Native American, 38% Latino, 1% Asian or Pacific Islander, and 7% Other or unknown race. 28% are aged 18-44, 31% are 45-54, and 41% are 55 or older. Baseline and one year follow-up clinical data are reported for more than 1300 patients with Type II diabetes, with a decrease of mean HbA1c values from 8.4% to 7.9%, significant at the p < .01 level. Multivariable regression analysis also showed that patients who participated in more than half of the program had greater changes in both HbA1c and BP over time, controlling for race, age and gender. Analyses of the patient-reported survey measures also showed significant improvements in perceived diabetes competence, mental functioning related to quality of life, resources and supports for self-management, and self-care behaviors.