Redesigning diabetes care in rural fee-for-service practices

The Foundation's initiative, Finding Answers: Disparities Research for Change, was designed to use research and evaluation to test hypothetical solutions for reducing racial and ethnic disparities in health care settings and actual disparity reduction outcomes in ongoing programs.While studied in urban managed care sites, typical redesign elements have not been systematically evaluated in fee-for-service rural communities where the incentives for care of underserved minority citizens are markedly different. This project will evaluate the clinical effectiveness and feasibility of an innovative model of redesigned diabetes care for African American patients with historically disparate outcomes. Based on the Chronic Care Model, the redesign components include a circuit rider methodology in which a certified diabetes educator (CDE) nurse, dietitian and CDE qualified pharmacist rotate to clinics and partner with providers during patient visits as care managers. The redesign components also utilize an electronic health record disease registry system with decision support, a four-part American Diabetes Association patient curriculum, self-management support interventions, culturally relevant educational tools and community-based follow-up and support services. The study will specifically evaluate the effect of the redesigned model on glycemic control (HbA1c) and other diabetes-specific outcome measures and assess the costs of the intervention.

Grant Details

Amount Awarded $249,126.00

Awarded on: 4/16/2008

Time frame: 5/1/2008 - 1/31/2011

Grant Number: 64252