Addressing diabetes racial and ethnic disparities: lessons learned from quality improvement collaboratives

Abstract

SUMMARY A review of national data confirms that while the quality of healthcare in the USA is slowly improving, disparities in diabetes prevalence, processes of care and outcomes for racial/ethnic minorities are not. Many quality measures can be addressed through system level interventions, referred to as quality improvement (QI), and QI collaboratives have been found to effectively improve processes of care for chronic conditions, including diabetes. However, the impact of QI collaboratives on the reduction of health disparities has been mixed. Lessons learned from previous QI collaboratives including the complexity of impacting clinical outcomes, the need for expert support for skills outside of QI methodology, limiting impact of poor data, and the need to develop disparities quality measures, can be used to inform future QI collaborative approaches to reduce diabetes racial/ethnic minority health disparities.

New research directions on disparities in obesity and type 2 diabetes

“…34,[42][43][44][45][46][47][48][49][50][51][52][53][54] The research team utilized evidence-based strategies to develop the programs, and the intervention has improved patient experience, patient skills and health behaviors, processes within health systems, and diabetes-related health outcomes, including hemoglobin HbA1c, HDL cholesterol, and foot care. The University of Chicago research team works with four federally qualified health centers (FQHCs), each of which is part of a large network of health centers, an academic internal medicine/primary care practice, and an academic endocrinology/diabetes clinic.…”

“…47 Once there, patients receive tours of the healthy food items, participate in cooking demonstrations, and are exposed to other hands-on skills training to support healthy lifestyles. 34,[42][43][44][45][46][47][48][49][50][51][52][53][54] Making the business case for promising interventions A sound business case is a critical step for supporting the adoption, dissemination, and spread of promising interventions, yet this aspect of interventions is rarely addressed in research. Thus, there may be a greater opportunity to promote sustained behavioral changes among diabetes patients when health system changes (including patient education) are combined with community-based support programs.…”

“…The intervention is built on the Chronic Care Model and has four key pillars: patient education and empowerment (e.g., culturally tailored skills training in patient/provider communication and shared decision making), healthcare provider training, quality improvement (QI)/health systems change, and community connections to local resources for diabetes self-management. 34,[42][43][44][45][46][47][48][49][50][51][52][53][54] The research team utilized evidence-based strategies to develop the programs, and the intervention has improved patient experience, patient skills and health behaviors, processes within health systems, and diabetes-related health outcomes, including hemoglobin HbA1c, HDL cholesterol, and foot care. [43][44][45][50][51][52][53][54] The health system and community components of the intervention integrate to provide seamless support for patients' diabetes management.…”

Integrated Community-Healthcare Diabetes Interventions to Reduce Disparities

“…Quality improvement (QI) strategies are utilized widely across diabetes disparities interventions, and can improve care for diabetes patients in safety-net clinics with minority populations [35–36]. There is a growing trend for QI strategies to incorporate community components as part of broader implementation of the Chronic Care Model.…”

Early Lessons From An Initiative On Chicago’s South Side To Reduce Disparities In Diabetes Care And Outcomes

“…Such collaborative undertakings, which typically bring together staff members from different health care sites to learn better care techniques and share best practices, have been shown to improve diabetes care in safety-net clinics. 12,13 …”