Alliance to Reduce Disparities in Diabetes

Evaluation: Improving Diabetes Care and Outcomes on the South Side of Chicago

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Research Questions and Measures

RESEARCH QUESTION MEASURES
Does implementing a collaborative model program in six clinics improve the processes and outcomes of diabetes care for residents in the predominantly African American South Side of Chicago?
  • Medical record data on diabetes processes of care and clinical outcomes for 100 randomly chosen patients with diabetes aged 18+ from each of the 6 intervention clinics and 6 control sites
  • Pre- to post-intervention changes in HbA1c and survey measures for 12 cohorts (2 from each clinic) of patient education and activation classes. Measures conducted at baseline and at conclusion of intervention (~10 weeks) as well as at 3 and 6-months post-intervention. Surveys assess the following variables:
    • Patient activation1
    • Degree of M.D. participatory style2
    • Patient satisfaction3
    • Patient trust in physician4
    • Diabetes self-management5
    • Knowledge of diabetes6
    • Diabetes self-efficacy7
    • Patient’s perception of involvement in decision-making8
  • Pre-post questionnaire with a retrospective baseline assessment used to evaluate the perceived importance of and confidence in skills promoted in four, one hour-long training sessions for providers on cultural competency, communication, and behavioral counseling skills. Questionnaires administered immediately prior to and after the training sessions.
  • Changes in the ability of the 6 clinics to provide chronic illness care using the Assessment of Chronic Illness Care (ACIC)9 survey administered twice a year and clinic provider and staff experience surveys administered once every 2 years
What are the costs associated with implementing this intervention from the business case perspective of the outpatient clinics?
  • Determine the administrative, clinical, overall, and indirect costs and revenues associated with the intervention through:
    • Cost surveys and interviews with clinic personnel administered at least once at each of the 6 clinic sites10,11
    • Analysis of billing data collected from January 1, 2008 through the time of the clinic interview
What are the major barriers and solutions to successfully implementing this regional intervention?
  • Semi-structured one-on-one interviews assessing:
    • Key health center stakeholders’ facilitators and barriers to adoption and implementation of the intervention. Interviews conducted at the same time as the cost surveys described above.
    • Community partners’ perceptions of the intervention’s impact on the South Side of Chicago. Interviews will be conducted once during 2013.

References

  1. Hibbard, J.H., Stockard, J., Mahoney, E.R., & Tusler, M. (2004). Development of the Patient Activation Measure (PAM): Conceptualizing and measuring activation in patients and consumers. Health Serv Res, 39(4 Pt 1), 1005-1026.
  2. Kaplan, S.H., Gandek, B., Greenfield, S., Rogers, W., & Ware, J.E. (1995). Patient and visit characteristics related to physicians' participatory decision-making style: Results from the Medical Outcomes Study. Med Care, 33, 1176–1187.
  3. Wolf, M.H., Putnam, S.M., James, A.J., & Stiles, W.B. (1978). The medical interview satisfaction scale: Development of a scale to measure patient perceptions of physician behavior. J Behav Med, 1, 391–401.
  4. Anderson, L.A., & Dedrick, R.F. (1990). Development of the Trust in Physician scale: A measure to assess interpersonal trust in patient-physician relationships. Psychol Rep, 67(3 Pt 2), 1091-1100.
  5. Toobert, D.J., Hampson, S.E., & Glasgow, R.E. (2000). The Summary of Diabetes Self-Care Activities Measure: Results from 7 studies and a revised scale. Diabetes Care, 23(7), 943-950.
  6. Fitzgerald, J.T., Funnell, M.M., Hess, G.E., Barr, P.A., Anderson, R.M., Hiss, R.G., & Davis, W.K. (1998). The reliability and validity of a brief diabetes knowledge test. Diabetes Care, 21(5), 706-710.
  7. Heisler, M., Vijan, S., Anderson, R.M., Ubel, P.A., Berstein, S.J., & Hofer, T.P. (2003). When do patients and their physicians agree on diabetes treatment goals and strategies, and what difference does it make? J Gen Intern Med, 18, 893-903.
  8. Lerman, C.E., Brody, D.S., Caputo, G.C., Smith, D.G., Lazaro, C.G., & Wolfson, H.G. (1990). Patients’ perceived involvement in care scale: Relationship to attitudes about illness and medical care. J Gen Intern Med, 5, 29-33.
  9. Bonomi, A.E, Wagner, E.H., Glasgow, R.E., & VonKorff, M. (2002). Assessment of Chronic Illness Care (ACIC): A practical tool to measure quality improvement. Health Serv Res, 37(3), 791-820.
  10. Huang, E.S., Brown, S.E., Zhang, J.X., Kirchhoff, A.C., Schaefer, C.T., Casalino, L.P., & Chin, M.H. (2008). The cost consequences of improving diabetes care: The community health center experience. Jt Comm J Qual Patient Saf, 34(3), 138-146.
  11. Brown, S.E., Chin, M.H., & Huang, E.S. (2007). Estimating costs of quality improvement for outpatient healthcare organisations: A practical methodology. Qual Saf Health Care, 16(4), 248-251.

 

Presentations and Publications

2014 Presentations

Peek, M.E., Geary, N.A., Gao, Y., Rowell, D.J., O’Neal, Y., Roberson, T.S., Whyte, J.L., Bergeron, N.Q., & Chin, M.H. (2014, December). Integrating interventions to improve diabetes care and outcomes. Poster presentation at the 2014 Minority Health and Health Disparities Grantees' Conference, National Harbor, MD.

Roberson, T., Solomon, M., Peek, M., Chin, M.H., O'Neal, Y., & Geary, N. (2014, November). Helping communities help themselves: The roles of peer health leaders in a farmer's market to provide culturally-tailored nutrition and diabetes education. Oral presentation at the 142nd American Public Health Association Annual Meeting.

Peek, M.E., Geary, N., Gao, Y., Rowell, D.J., O’Neal, Y., Roberson, T.S., Whyte, J.L., Bergeron, N., & Chin, M.H. (2014, September). Diabetes Empowerment Program: Changes in patient self-confidence, diabetes self-management, and health outcomes. Oral presentation at the Midwest Regional Meeting of the Society of General Internal Medicine, Chicago, IL.

Roberson, T. S., Solomon, M. C., O'Neal, Y., Rowell, D. J., Geary, N., Peek, M. E., & Chin, M. (2014, September). Helping communities help themselves: The importance of a collaboration between communities and academic institutions at a farmer's market to provide culturally tailored nutrition and diabetes education. Oral presentation at the Midwest Regional Meeting of the Society of General Internal Medicine, Chicago, IL.

Peek, M.E. (2014, August). Enhancing shared decision-making among African-Americans with diabetes. Oral presentation at the American Association of Diabetes Educators Annual Meeting, Orlando, FL.

Peek, M.E., Geary, N., Gao, Y., Rowell, D.J., O’Neal, Y., Roberson, T.S., Whyte, J.M., Bergeron, N., & Chin, M.H. (2014, June). Integrating multi-level interventions to improve diabetes care and outcomes. Poster presented at the AcademyHealth Annual Research Meeting, San Diego, CA.

Peek, M.E., Geary, N., Gao, Y., Rowell, D.J., O’Neal, Y., Roberson, T.S., Whyte, J.L., Bergeron, N., & Chin, M.H. (2014, April). Diabetes Empowerment Program: Changes in patient self-confidence, diabetes self-management, and health outcomes. Poster presented at the Society of General Internal Medicine 37th Annual Meeting, San Diego, CA.

2014 Publications

Chien, A.T., Chin, M.H., Alexander, G.C., Tang, H., & Peek, M.E. (2014). Physician financial incentives and care for the underserved in the United States. American Journal of Managed Care, 20(2), 121-129.

Chin, M.H., Goddu, A.P., Ferguson, M.J., & Peek, M.E. (2014). Expanding and sustaining integrated health care: Community efforts to reduce diabetes disparities. Health Promotion Practice, 15(2S), 29S-39S.

Nundy, S., Lu, C.E., Hoga, P., Mishra, A., & Peek, M.E. (2014). Using patient-generated health data from mobile technologies for diabetes self-management support: Provider perspectives from an academic medical center, Journal of Diabetes Science and Technology, 8(1), 74–82.

Nundy, S.N., Dick, J., Chou, C., Nocon, R.S., Chin, M.H., & Peek, M.E. (2014). Mobile phone diabetes project led to improved glycemic control and net savings for Chicago Plan participants, Health Affairs, 33(2), 265-272.

Peek, M.E., Ferguson, M., Bergeron, N., Maltby, D., & Chin, M.H. (2014). Integrated community-healthcare diabetes interventions to reduce disparities, Current Diabetes Reports, 14(3), 467.

Peek, M.E., Ferguson, M J., Roberson, T.P., & Chin, M.H. (2014). Putting theory into practice: A case study of diabetes-related behavior change interventions on Chicago’s South Side. Health Promotion Practice, 15(2S), 40S-50S.

Raffel, K.E., Goddu, A.P., & Peek, M.E. (2014). "I Kept Coming for the Love": Enhancing the retention of urban African Americans in diabetes education, Diabetes Educator. Published online 13 February 2014.

2013 Presentations

Goddu, A., Roberson, T., Raffel, K., Chin, M., & Peek, M. (2013). Food Rx: Mobilizing outpatient clinics to prescribe healthy food for underserved patients. Presented at the Society of General Internal Medicine's 36th Annual Meeting, Denver, CO. 

Peek, M., Gao, Y., Goddu, A., Roberson, T., Maltby, D., & Chin, M. (2013). An integrated approach to improving diabetes Care and outcomes on Chicago’s South Side. Presented at the American Diabetes Association's 73rd Scientific Sessions, Chicago, IL. 

Peek, M.E., Goddu, A., Roberson, T., Maltby, D., & Chin, M. (2013, May). The Diabetes Empowerment Program: Culturally tailoring patient education and communication skills training to empower African-Americans with diabetes. Presented at the Institute for Healthcare Advancement's 12th Annual Health Literacy Conference, Irvine, CA.

2013 Publications

Nundy, S., Dick, J.J., Solomon, M.C., & Peek, M.E. (2013, January). Developing a behavioral model for mobile phone-based diabetes interventions. Patient Education and Counseling, 90(1), 125-32. 

2012 Presentations

Chin, M. (2012, October). Interventions to reduce racial and ethnic disparities in health care. Presented at Diversity Doctor 2012: Remaining Competitive While Reducing Healthcare Disparities and Improving Patient Satisfaction, Johns Hopkins University, Baltimore, MD.

Chin, M. (2012, October). A roadmap to reducing racial and ethnic disparities: Evidence based game changing strategies. Keynote address presented at Kaiser Permanente's 35th Annual National Diversity Conference – Diversity Excellence: A 21st Century Game Changer, Long Beach, CA.

Bergeron, N., Quinn, M., Goddu, A., Roberson, T., & Peek, M. (2012, September). The value of shared decision-making training for providers in the community health center setting. Presented at the Midwest Meeting of the Society of General Internal Medicine, Chicago, IL.

Nundy, S., Dick, J., Solomon, M., & Peek, M. (2012, September). Developing an integrated text message-based care management program for diabetes. Presented at the Midwest Regional Meeting of the Society for General Internal Medicine, Chicago, IL.

Nundy, S., Dick, J., Goddu, A., Hogan, P., Lu, C., Solomon, M., Bussie, A., Chin, M., & Peek, M. (2012, September). Developing an integrated text message-based care management program for diabetes. Poster presented at the Midwest Regional Meeting of the Society for General Internal Medicine, Chicago, IL. Winner, Best Research Abstract – Poster Presentation.

Chin, M. (2012, August). Integrating diabetes education, quality improvement, and community partnerships in Chicago's South Side. Presented at In Clinical and Community Partnerships for Diabetes Care during the American Association of Diabetes Educators Annual Meeting, Indianapolis, IN.

Chin, M. (2012, July). RWJF Finding Answers: Disparities research for change: Reducing disparities and implementing in the wider community. Presented at Robert Wood Johnson Foundation Physician Faculty Scholars Program Implementation Science Meeting, Menlo Park, CA.

Chin, M. (2012, June). Strengths and challenges in using qualitative and mixed method research to study complex interventions for vulnerable populations. Presented at Qualitative and Mixed Methods in Health Research: A One Day Conference, University of Wisconsin, Madison, WI.

Roberson, T., Goddu, A., Wilkes, A., Solomon, M., Scott, S., Harmon, S., Chin, M., & Peek, M. (2012, May). Integrated diabetes education with community partnerships. Presented at the National Meeting of the Society for General Internal Medicine, Orlando, FL.

Sathe, N., Nocon, R., Wilkes, A., Huang, E., Peek, M., & Chin, M. (2012, May). The costs and benefits of participating in a diabetes quality improvement collaborative. Presented at the Academy for Healthcare Improvement National Meeting, Arlington, VA.

Lu, C., Wilkes, A., Vinci, L., Peek, M., & Chin, M. (2012, May). Assessing organizational readiness for quality improvement in a general internal medicine faculty practice. Presented at the National Meeting of the Society for General Internal Medicine, Orlando, FL.

Lu, C., Wilkes, A., Quinn, M., Peek, M., Chin, M., & Vinci, L. (2012, May). Tailoring quality improvement interventions based on physician readiness for change. Presented at Academy the Academy for Healthcare Improvement National Meeting, Arlington, VA.

Goddu A., Raffel K., & Peek M. (2012, May). A story of change: The influence of narrative on African Americans with diabetes. Presented at the National Meeting of the Society for General Internal Medicine, Orlando, FL.

Chin, M. (2012, March). Tackling racial/ethnic disparities in diabetes care and outcomes on the South Side of Chicago. Presented in the In Learning from the Local Experience Panel at Making the Link: Connecting Community Experience and National Policy to Reduce Disparities in Diabetes, the Alliance to Reduce Disparities in Diabetes Invited Summit, Washington, DC.

Roberson, T., Chin, M., Peek, M., Goddu, A., Bordenave, K., & Quinn, M. (2012, February). Models for improving diabetes: Risk prevention & diabetes self–care. In Eradicating Health Inequities: Advancing Solutions-Orientated Discourses, a symposium conducted at the 4th Annual Minority Health in the Midwest Conference, Chicago, IL.

2012 Publications

Nundy, S.N., Dick, J., Goddu, A., Hogan, P., Lu, C.E., Soloman, M., Bussie, A., Chin, M.H., & Peek, M.E. (2012). Using mobile health to support the Chronic Care Model: Developing an institutional initiative. International Journal of Telemedicine and Applications.

Peek, M.E., Gorawara-Bhat, R., Quinn, M.T., Young, A.O., Wilson, S.C., & Chin, M.H. (2012, October). Trust and shared decision-making among African-Americans with diabetes. Health Communication, 28(6), 616-623.

Peek, M.E., Harmon, S., Scott, S., Eder, M., Roberson, T.S., Tang, H., & Chin, M.H. (2012). Culturally tailoring patient education and communication skills training to empower African-Americans with diabetes. Translational Behavioral Medicine: Practice, Policy, Research, 2(3), 296-308.

Peek, M.E., Wilkes, A., Roberson, T., Goddu, A., Nocon, R., Tang. H., Quinn, M.T., Bordenave, K., Huang, E., & Chin, M.H. (2012). Early lessons from an initiative on Chicago's South Side to reduce disparities in diabetes care and outcomes. Health Affairs, 31(1), 177-186.

2011 Publications

Chin, M.H., & Goldmann, D. (2011). Meaningful disparities reduction through research and translation programs. JAMA, 1(6), 653-660.

Dick, J.J., Nundy, S., Solomon, M.C., Bishop, K.N., Chin, M.H., & Peek, M.E. (2011). The feasibility and usability of a text-message-based program for diabetes self-management in an urban African-American population. Journal of Diabetes Science and Technology, 5(5), 1246-54.

Wilkes, A.E., Bordenave, K., Vinci, L., & Peek, M.E. (2011). Addressing diabetes racial and ethnic disparities: lessons learned from quality improvement collaboratives. Diabetes Management, 305(4), 404-405.