The Cost‐Effectiveness of Improving Diabetes Care in U.S. Federally Qualified Community Health Centers

Huang, Elbert S.; Zhang, Qi; Brown, Sydney E. S.; Drum, Melinda L.; Meltzer, David O.; Chin, Marshall H.

doi:10.1111/j.1475-6773.2007.00734.x

Cited by 87 publications

(126 citation statements)

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“…The business case for reducing disparities is evolving and must be viewed from both societal and individual organization/provider perspectives. [33][34][35] From a societal perspective, the business case for reducing disparities centers on direct medical costs, indirect costs, and the creation of a healthy national workforce in an increasingly competitive global economy. Laveist 36 America's demographics are becoming progressively more diverse.…”

Section: Assess Organizational Capacitymentioning

confidence: 99%

A Roadmap and Best Practices for Organizations to Reduce Racial and Ethnic Disparities in Health Care

et al. 2012

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Over the past decade, researchers have shifted their focus from documenting health care disparities to identifying solutions to close the gap in care. Finding Answers: Disparities Research for Change, a national program of the Robert Wood Johnson Foundation, is charged with identifying promising interventions to reduce disparities. Based on our work conducting systematic reviews of the literature, evaluating promising practices, and providing technical assistance to health care organizations, we present a roadmap for reducing racial and ethnic disparities in care. The roadmap outlines a dynamic process in which individual interventions are just one part. It highlights that organizations and providers need to take responsibility for reducing disparities, establish a general infrastructure and culture to improve quality, and integrate targeted disparities interventions into quality improvement efforts. Additionally, we summarize the major lessons learned through the Finding Answers program. We share best practices for implementing disparities interventions and synthesize cross-cutting themes from 12 systematic reviews of the literature. Our research shows that promising interventions frequently are culturally tailored to meet patients' needs, employ multidisciplinary teams of care providers, and target multiple leverage points along a patient's pathway of care. Health education that uses interactive techniques to deliver skills training appears to be more effective than traditional didactic approaches. Furthermore, patient navigation and engaging family and community members in the health care process may improve outcomes for minority patients. We anticipate that the roadmap and best practices will be useful for organizations, policymakers, and researchers striving to provide high-quality equitable care.

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Section: Assess Organizational Capacitymentioning

confidence: 99%

A Roadmap and Best Practices for Organizations to Reduce Racial and Ethnic Disparities in Health Care

et al. 2012

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“…22 We also incorporated a reduction in total cholesterol of 20 mg/dl, a ten-percentage-point absolute increase in the use of angiotensin-converter enzyme (ACE) inhibitor (from 50 percent to 60 percent), and a ten-percentage-point absolute increase in use of aspirin (from 45 percent to 55 percent) based on the experience of the Health Disparities Collaborative, a four-year observational study of a quality improvement program in federally qualified community health centers. 26 The program would enroll people ages 24-64 with existing type 2 diabetes. With each subsequent year, 60,000 to 100,000 representative individuals, among those who had existing diabetes and aged into the program or those who developed diabetes in this age range, would be enrolled.…”

Section: Policy Projectionsmentioning

confidence: 99%

Using Clinical Information To Project Federal Health Care Spending

et al. 2009

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ABSTRACT:Complications from chronic illnesses often do not emerge for many years. Current federal cost projection methods are constrained by ten-year cost estimates, which capture increases in near-term intervention costs but not changes in long-term costs. Current methods also cannot easily capture the cost implications of changes in disease progression. Type 2 diabetes is a prime example of a chronic illness with long-term health and cost consequences. We present results from an epidemiologically based model that projects federal costs for diabetes under alternative policies, and we discuss the potential changes in the federal budget process needed to capture the full impact of these interventions. T h e h i g h c o s ts a s s o c i at e d w i t h c a r i n g f o r people with chronic diseases is one of the most pressing health policy issues in the United States today.1 The baby-boom generation is entering its retirement years, and advanced age is associated with the development of several costly chronic illnesses. As a result, Medicare and other payers will be under tremendous financial pressure as costs rise from predictable demographic and epidemiological forces. Current Practice, The Ten-Year Budget Window, And DiabetesForecasting future health care costs for the federal government is done primarily by the Office of the Actuary (OACT) at the Centers for Medicare and Medicaid Services (CMS) for the administration and by the Congressional Budget Office (CBO) for Congress. The CMS Office of the Actuary has lead responsibility for w 9 7 8 1 S e p t e m b e r 2 0 0 9

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“…While there are anecdotal reports of difficulties with sustaining QI activities, there are currently little data on important questions such as how much time the different tasks of quality improvement require, how much time devoted to the HDC is uncompensated, and whether participants are still enthusiastic several years after undertaking the initiative. In addition, it is unclear whether there is an economic business case for quality for outpatient facilities given that QI requires upfront personnel time and health centers may not receive the downstream financial benefits from prevented hospitalizations (Leatherman et al, 2003;Huang et al, 2008;Huang et al, 2007). What is required to maintain and enlarge the gains in quality of care, and how can an ongoing QI process be nurtured?…”

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Sustaining Quality Improvement in Community Health Centers

Chin

Kirchhoff²,

Schlotthauer³

et al. 2008

Journal of Ambulatory Care Management

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The Health Disparities Collaboratives (HDC) are the largest national quality improvement (QI) initiative in community health centers. This paper identifies the incentives and assistance personnel believe are necessary to sustain QI. In 2004, 1006 survey respondents (response rate 67%) at 165 centers cited lack of resources, time, and staff burnout as common barriers. Release time was the most desired personal incentive. The highest funding priorities were direct patient care services (44% ranked #1), data entry (34%), and staff time for QI (26%). Participants also needed help with patient self-management (73%), information systems (77%), and getting providers to follow guidelines (64%). Keywordsquality improvement; quality of care; disparities; community health center; vulnerable populations Quality improvement (QI) efforts can improve health care in the short-term (Chien et al., 2007), but little is known about how to sustain improvements over time. Most QI studies track changes in outcomes over relatively brief 1-2 year periods (Chien et al., 2007), but few examine (Landon et al., 2007;Chin et al., 2004). At the four-year follow-up period among patients with diabetes, clinical outcomes such as glucose and cholesterol control also improved . In addition, the HDC intervention has been generally very well-received by staff (Chin et al., 2004). While these early successes are promising, the impact of the HDC on the long-term health of patients will be significant only if current improvements are maintained or enlarged because of the natural history of many chronic diseases. NIH Public AccessThe need to maintain or enlarge improvements in care raises important questions regarding the sustainability of QI programs. In particular, little is known about what is required to sustain a QI collaborative at the organizational level (Ovretveit et al., 2002;Daniel et al., 2004;Mills & Weeks, 2004;Wilson et al., 2003). Some of the challenges of the HDC are probably common in other settings such as time burdens associated with data collection during initial HDC implementation (Chin et al., 2004). Other difficulties, including staff turnover, may be more severe in health centers (Chin et al., 2004). Enthusiasm for QI may be high when an intervention begins, but may wither once health care organizations confront the daily work and expense associated with the effort. While there are anecdotal reports of difficulties with sustaining QI activities, there are currently little data on important questions such as how much time the different tasks of quality improvement require, how much time devoted to the HDC is uncompensated, and whether participants are still enthusiastic several years after undertaking the initiative. In addition, it is unclear whether there is an economic business case for quality for outpatient facilities given that QI requires upfront personnel time and health centers may not receive the downstream financial benefits from prevented hospitalizations (Leatherman et al., 2003;Huang et al., 2008;Huang et ...

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The Cost‐Effectiveness of Improving Diabetes Care in U.S. Federally Qualified Community Health Centers

Abstract: During the first 4 years of the HDC, multiple improvements in diabetes care were observed. If these improvements are maintained or enhanced over the lifetime of patients, the HDC program will be cost-effective for society based on traditionally accepted thresholds.

Cited by 87 publications

References 62 publications

A Roadmap and Best Practices for Organizations to Reduce Racial and Ethnic Disparities in Health Care

A Roadmap and Best Practices for Organizations to Reduce Racial and Ethnic Disparities in Health Care

Using Clinical Information To Project Federal Health Care Spending

Sustaining Quality Improvement in Community Health Centers

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