Community Health Centers Show Improved Diabetes Care

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Over the four-year span between 1998 and 2002, community health centers not only improved their processes for managing diabetes, such as testing for blood glucose and cholesterol, but also saw gains in their patients' health, a new study finds.

Researchers found "a statistically and clinically significant" reduction in hemoglobin A1c (a measure of long-term "blood sugar" control) and low-density lipoprotein ("bad" cholesterol) levels in center patients.

Lead investigator Marshall Chin, M.D., associate professor of medicine at the University of Chicago, said that earlier measures of community health center efforts had shown improvement in actions taken, but the studies were not long lasting enough to gauge patient outcomes resulting from the programs.

The study of 34 community health centers in 17 states appears in the December issue of the journal Medical Care and focuses on disadvantaged and underserved populations.

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The community health centers took cues from several initiatives, foremost among them the decade-old federal Health Disparities Collaborative, which lays down guidelines and oversight for chronic disease management. They incorporated the rapid quality improvement approach, dubbed "Plan, Do, Study, Act," created by Associates in Learning.

This model adapts elements of improvement into practice as soon as they show results, raising quality of care at an accelerated pace. "If you try something on a few patients and it works, you implement it," Chin said.

Also woven into the study was the MacColl Chronic Care Model, created by Group Health's MacColl Institute for Healthcare Innovations, which is aimed at helping primary care doctors proactively manage people with long-term conditions -- and creating informed, activated patients who cooperate in their own care.

"The idea," said Katie Coleman, a research associate at the MacColl Institute, "is that people all over the country are trying to find ways of improving care. In this intervention, not only did physicians deliver better care, but patients' health improved, likely because they changed their behavior, ate better, exercised and checked their sugar more often."

Earlier one-year studies did not show this improvement. "It takes time to make a dent," Chin said. Improved glucose and cholesterol control can reduce blindness and cardiovascular events, he added.

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