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OBJECTIVE -To evaluate the Diabetes Health Disparities Collaborative, an initiative by the Bureau of Primary Health Care to reduce health disparities and improve the quality of diabetes care in community health centers.RESEARCH DESIGN AND METHODS -One year before-after trial. Beginning in 1998, 19 Midwestern health centers undertook a diabetes quality improvement initiative based on a model including rapid Plan-Do-Study-Act cycles from the continuous quality improvement field; a Chronic Care Model emphasizing patient self-management, delivery system redesign, decision support, clinical information systems, leadership, health system organization, and community outreach; and collaborative learning sessions. We reviewed charts of 969 random adults for American Diabetes Association standards, surveyed 79 diabetes quality improvement team members, and performed qualitative interviews.RESULTS -The performance of several key processes of care assessed by chart review increased, including rates of HbA 1c measurement (80 -90%; adjusted odds ratio 2.1, 95% CI 1.6 -2.8), eye examination referral (36 -47%; 1.6, 1.1-2.3), foot examination (40 -64%; 2.7, 1.8 -4.1), and lipid assessment (55-66%; 1.6, 1.1-2.3). Mean value of HbA 1c tended to improve (8.5-8.3%; difference Ϫ0.2, 95% CI Ϫ0.4 to 0.03). Over 90% of survey respondents stated that the Diabetes Collaborative was worth the effort and was successful. Major challenges included needing more time and resources, initial difficulty developing computerized patient registries, team and staff turnover, and occasional need for more support by senior management. CONCLUSIONS -The Health DisparitiesCollaborative improved diabetes care in health centers in 1 year. Diabetes Care 27:2-8, 2004D iabetes care is a critical issue for the ϳ3,000 federally funded community health center delivery sites that provide primary care for 11 million medically underserved Americans (1,2). Nationally, African Americans and patients of lower socioeconomic status suffer disproportionately high morbidity from diabetes (3), and racial disparities in the quality of diabetes care are prevalent (4). Since community health centers are vanguard providers of indigent patients, interventions in the health-center setting are of particular interest to clinicians, administrators, and policymakers seeking to improve the care of the most vulnerable patients with diabetes (5-7).Providers in all settings frequently do not meet diabetes quality-of-care standards as outlined by the American Diabetes Association (8). Suboptimal care has been found in academic medical centers (9), private doctors' offices (10), managed care organizations (11), Medicare providers (4), and the Indian Health Service (12). Because health centers have fewer resources and more vulnerable patients (13), it might be assumed that their performance on these standards of care might be lower. However, rates of adherence to the standards in health centers have been as high as other providers or even better despite the extra challenges (14 -17). Nonet...

OBJECTIVE -We aimed to identify barriers to improving care for individuals with diabetes in community health centers. These findings are important because many such patients, as in most other practice settings, receive care that does not meet evidence-based standards. RESEARCH DESIGN AND METHODS -In 42Midwestern health centers, we surveyed 389 health providers and administrators about the barriers they faced delivering diabetes care. We report on home blood glucose monitoring, HbA 1c tests, dilated eye examinations, foot examinations, diet, and exercise, all of which are a subset of the larger clinical practice recommendations of the American Diabetes Association (ADA).RESULTS -Among the 279 (72%) respondents, providers perceived that patients were significantly less likely than providers to believe that key processes of care were important (overall mean on 30-point scale: providers 26.8, patients 18.2, P = 0.0001). Providers were more confident in their ability to instruct patients on diet and exercise than on their ability to help them make changes in these areas. Ratings of the importance of access to care and finances as barriers varied widely; however, Ͼ25% of the providers and administrators agreed that significant barriers included affordability of home blood glucose monitoring, HbA 1c testing, dilated eye examination, and special diets; nonproximity of ophthalmologist; forgetting to order eye examinations and to examine patients' feet; time required to teach home blood glucose monitoring; and language or cultural barriers.CONCLUSIONS -Providers in health centers indicate a need to enhance behavioral change in diabetic patients. In addition, better health care delivery systems and reforms that improve the affordability, accessibility, and efficiency of care are also likely to help health centers meet ADA standards of care.

Abstract:We calculate the strong isospin breaking and QED corrections to meson masses and the hadronic vacuum polarization in an exploratory study on a 64 × 24 3 lattice with an inverse lattice spacing of a −1 = 1.78 GeV and an isospin symmetric pion mass of m π = 340 MeV. We include QED in an electro-quenched setup using two different methods, a stochastic and a perturbative approach. We find that the electromagnetic correction to the leading hadronic contribution to the anomalous magnetic moment of the muon is smaller than 1% for the up quark and 0.1% for the strange quark, although it should be noted that this is obtained using unphysical light quark masses. In addition to the results themselves, we compare the precision which can be reached for the same computational cost using each method. Such a comparison is also made for the meson electromagnetic mass-splittings.

The first four states of the CH2 molecule ([Formula: see text]3B1, ã1 A1, [Formula: see text]1A1, and [Formula: see text]1A1) are examined using state-of-the-art ab initio methods and basis sets. The construction of potential energy curves with respect to the C + H2 and CH + H channels provides significant clues to understanding the geometric and electronic structure of the above states. All of our numerical findings are in excellent agreement with the existing experimental data. Key words: CH2, MRCI, potential curves, vbL icons.