American Diabetes Association's 73rd Scientific Sessions - Policy Changes
Reducing Diabetes Disparities: Policy Change Associated with Implementation of Interventions
Noreen M. Clark, Belinda Nelson, and Martha Quinn
Improved services, education and support systems are required to reduce disparities in diabetes outcomes. The 5 community based sites of the Alliance to Reduce Disparities in Diabetes have introduced innovative interventions for those most at risk. Sites soon recognized that policy changes were necessary to move their efforts from periodic programs and projects to institutionalized ways of functioning that ensured sustainability. This study examined policy changes initiated by Alliance sites. Data were initially collected from project leaders via a form requesting enumeration of all policy change efforts. These were examined against site documents provided routinely to the National Program Office (NPO) at the University of Michigan. A policy expert extracted confirming information from these documents, refined the original lists to include only confirmed policy changes, and elaborated to include level of change (local, citywide, statewide) and stage of accomplishment (1, beginning; 2, adoption; 3, implementation; and 4, full maintenance). Final lists were then verified by the Alliance teams (N= 44 individuals) in face to face meetings with the NPO leaders (N=3). Analysis of data revealed 31 distinct policy changes initiated across the 5 sites and classified into 3 levels: 22 local, 4 citywide, 5 statewide. Of the changes, 16 were classified as being implemented or maintained. These included, for example, shaping policy decisions that led to legislation creating ACO’s in New Jersey; implementation of ongoing diabetes self-management education and support in FQHCs and related networks (Chicago); creation of new job codes making community health workers part of the clinical team (Dallas); and establishing protocols for sharing patient data across clinical and community systems (Wind River Reservation). These data suggest that supportive policy changes at the local, city and state levels are fundamental to institutionalizing and sustaining interventions to reduce disparities.