The Robert Wood Johnson Foundation (RWJF) launched the Diabetes Initiative in 2002 as two related national programs: Advancing Diabetes Self-Management and Building Community Supports for Diabetes Care:
- Advancing Diabetes Self-Management (six project sites) was designed to demonstrate that effective multicomponent diabetes self-management programs can be delivered in primary care settings and can significantly improve patient outcomes.
- The goal of Building Community Supports for Diabetes Care (eight project sites) was to extend support for diabetes management beyond the clinical setting into patients' communities through clinic/community partnerships.
Combined, the two programs sought to assist people with diabetes to manage their own health care by providing the clinical and community support and resources they needed.
Key Activities and Results: National program staff:
- Created an ecological model of Resources and Supports for Self-Management to guide the development of the projects.
- Offered a wide array of technical assistance through a "Collaborative Learning Network" that emphasized collaboration, peer-to-peer learning and synergy among Diabetes Initiative project staff, program staff and advisors.
- Developed the Assessment of Primary Care Resources and Supports for Chronic Disease Self-Management, a tool that allows primary care sites to assess their capacity for self-management and guide quality improvement.
- Produced many reports, handbooks, tools, articles and other publications; developed and routinely updated a program website; and made many presentations at regional, national and international conferences.
Staff at the projects:
- Created models of providing care for patients with diabetes and supporting their self-management. These models typically integrated clinical care in a variety of settings and with a range of providers, with support groups, linkages to community resources, skill-building and exercise classes, social marketing and educational initiatives.
- Incorporated community health workers, also called promotoras, coaches or lay health workers, as key components of patient self-management support in many sites. These workers share the environment and language of the patients they serve and are trained to provide advocacy, support and education for people with diabetes and help them manage their condition.
- Established close working partnerships with other clinical sites, community organizations, churches and government agencies to expand access to interventions and supports that help people manage their diabetes.
Key Findings: An evaluation of the Diabetes Initiative by an external evaluation team at Research Triangle Institute and the national program office at Washington University in St. Louis found that:
- Diabetes self-management programs and services can be implemented in a variety of clinical and community settings.
- The Resources and Supports for Self-Management model provided a framework for project design that offered enough flexibility to allow project staffs to custom-tailor their approaches.
- Clinical indicators suggested that Diabetes Initiative projects contributed to health improvements. Overall, average HbA1c (a key measure of diabetes control) decreased from 8.3 percent to 7.7 percent, which is considered clinically significant (7% or less is an indicator of good metabolic control in people with diabetes).
- Patients who reported having high levels of resources and supports had better-controlled diabetes.
- Programs can be cost effective. An analysis of four projects yielded an incremental cost-effectiveness ratio of $39,563 per quality adjusted life year (QALY) for diabetic patients. This is well below the standard of $50,000 per QALY that is widely considered an acceptable value for resources expended.
- Diabetes Initiative grantees reported four key approaches to assuring the sustainability of their interventions:
- Broaden program scope and reach
- Systematize quality improvements
- Increase patient and provider expectations
- Build new partnerships or expand the role of existing partners
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