Improving Diabetes Care and Outcomes on the South Side of Chicago

NCT01087073 | Completed

• 4 other identifiers: 16867B (TRACS ID: 40596)R18DK083946P30DK092949Alliance to Reduce Disparities
• Study Type: interventional
• Target: 6,209
• Locations: 1 country
• Sites: 6

Brief Summary

The Improving Diabetes Care and Outcomes project aims to reduce diabetes disparities and engages patients, providers, clinics, and community collaborators to improve the health care and outcomes of African-Americans on the South Side of Chicago. Initiated in 2009, this project is a collaborative, community-based intervention that employs a multifaceted, integrated approach to address many of the root causes of health disparities. The short-term goal of this project is to improve clinic processes such as appointment scheduling and patient counseling through quality improvement efforts, as well as clinical outcomes including HbA1c, cholesterol and blood pressure in patients with diabetes through patient education. Long-term goals are to strengthen the network of community health centers, community-based organizations and academic medical centers, while increasing awareness of local diabetes disparities and empowering communities to combat this problem.

Conditions

Diabetes Mellitus

Keywords

Healthcare Disparities; Health Care Quality Improvement; Shared Decision-Making; Patient Education; Patient Activation; Community Outreach; Provider Training

Outcome Measures

Primary Outcomes (3)

• HbA1c

  Chart audit will be conducted on 100 randomly selected diabetes patients meeting the age inclusion criteria (age 18 years and older). Will also be collected from patients in the patient activation component.

  Baseline data will be collected at the end of 1st year; follow-up data will be collected from years 2-7.

• Blood pressure

  Chart audit will be conducted on 100 randomly selected diabetes patients meeting the age inclusion criteria (age 18 years and older). Will also be collected from patients in the patient activation component.

  Baseline data will be collected at the end of 1st year; follow-up data will be collected from years 2-7.

• Lipids (HDL, LDL, total cholesterol, triglycerides)

  Chart audit will be conducted on 100 randomly selected diabetes patients meeting the age inclusion criteria (age 18 years and older). Will also be collected from patients in the patient activation component.

  Baseline data will be collected at the end of 1st year; follow-up data will be collected from years 2-7.

Secondary Outcomes (1)

• Processes of care

  Baseline data will be collected at the end of 1st year; follow-up data will be collected from years 2-7.

Study Arms (5)

Patient Activation

EXPERIMENTAL

Patient knowledge in diabetes self-management behaviors and clinical measures (HbA1c, LDL, HDL, BMI, BP) are tracked at baseline, 10-weeks (post-program), 3 months (post-program) and 6 months (post-program).

Behavioral: Patient Activation

Provider Training Evaluation

EXPERIMENTAL

Pre-post surveys are conducted at each training session to assess overall satisfaction with the curriculum, knowledge of SDM, and understanding of techniques to promote its use in the healthcare setting.

Behavioral: Provider Training

Quality Improvement Evaluation

EXPERIMENTAL

We measure quality improvement efforts through biannual staff experience surveys and one-on-one provider and clinic staff interviews.

Behavioral: Quality Improvement

Community Outreach Evaluation

EXPERIMENTAL

Pre-post surveys will be disseminated at nutrition tours (Save-A-Lot, Walgreens, 61st Street Farmers Market) to assess change in knowledge of healthy eating behaviors and proper nutrition. Surveys will also assess participant satisfaction of the tours. Interviews will also be performed with community stakeholders to assess the costs/benefits of the collaboration and overall feedback on involvement.

Behavioral: Community Outreach

Global Evaluation of the Intervention

NO INTERVENTION

A chart review will be performed in order to evaluate our intervention to improve diabetes processes of care and clinical outcomes among our target population. Chart abstractions will be performed on medical records obtained from our six intervention clinics. In addition, chart abstractions from two University of Illinois at Chicago clinics and three FQHCs located on the West Side of Chicago will serve as control data.100 charts will be randomly selected from each clinic per year of the intervention. The chart review will contain charts from adult diabetes patients over a seven year period that matches the duration of the Improving Diabetes project.

Interventions

Patient Activation BEHAVIORAL

Culturally tailored patient activation training classes providing education and communication strategies to empower patients to be proactive in their diabetes self-management behavior. Participants attend a 10 week interactive class. Diabetes support groups after the completion of these classes help patient maintain self-management and adherence to healthy behaviors.

Also known as: Patient Education

Patient Activation

Provider Training BEHAVIORAL

Provider patient-centered communication training focuses on cultural competency and communication skills training to aid in shared decision-making and tailoring treatment recommendations to the patient's cultural preferences and readiness. Providers attend 4 1-hour monthly modules and one booster workshop 3 months post-class.

Provider Training Evaluation

Quality Improvement BEHAVIORAL

Participating clinics participate in quality improvement (QI) programs which aim to redesign clinic operations to improve care for diabetes patients. QI initiatives have included instituting group visits, patient medication cards, peer support groups, flow sheets, nurse case management, and patient registries. New initiatives include improving access and tracking of specialists visits, employing community health workers/patient navigators, coordinating care, and implementing other team-based care initiatives. Provider and clinical staff members from all six project clinics attend collaborative quarterly QI sessions with project staff to discuss improvements in QI efforts, share QI methods among clinic teams, and provide brief training sessions.

Quality Improvement Evaluation

Community Outreach BEHAVIORAL

The project collaborates with many community based organizations and resources to reach out to communities at high risk for diabetes on the South Side of Chicago and facilitate diabetes education, particularly in the area of nutrition and physical activity. We provide monthly health education events, nutrition tours, and frequently participate in community-based health fairs and health promotion events. We also work to promote nutrition through the Food Rx program, which utilizes a prescription to link patients at our clinics with nutrition resources on the South Side of Chicago through a coupon that gives discounts towards healthy purchases at participating stores, and have initiated a 10-week fitness program to promote physical activity among minority patients with diabetes.

Also known as: Community Partnerships

Community Outreach Evaluation

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Patients must have a diabetes diagnosis (ICD-9 codes 250.X) and be age 18 years or older
• Patients must attend one of the participating health centers

You may not qualify if:

• Gestational diabetes patients

Sponsors & Collaborators

• University of Chicago: lead
• Merck Sharp & Dohme LLC: collaborator
• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): collaborator

Study Sites (6)

ACCESS Grand Boulevard Family Health Center

Chicago, Illinois, 60609, United States

Location

Friend Family Health Center

Chicago, Illinois, 60615, United States

Location

Chicago Family Health Center

Chicago, Illinois, 60617, United States

Location

Kovler Diabetes Center

Chicago, Illinois, 60637, United States

Location

University of Chicago, Primary Care Group

Chicago, Illinois, 60637, United States

Location

ACCESS Booker Family Health Center

Chicago, Illinois, 60653, United States

Location

Related Publications (19)

• Peek ME, Ferguson M, Bergeron N, Maltby D, Chin MH. Integrated community-healthcare diabetes interventions to reduce disparities. Curr Diab Rep. 2014 Mar;14(3):467. doi: 10.1007/s11892-013-0467-8.

  PMID: 24464339 BACKGROUND

• Wilkes AE, Bordenave K, Vinci L, Peek ME. Addressing diabetes racial and ethnic disparities: lessons learned from quality improvement collaboratives. Diabetes Manag (Lond). 2011 Nov;1(6):653-660. doi: 10.2217/dmt.11.48.

  PMID: 22563350 BACKGROUND

• Nundy S, Lu CY, Hogan P, Mishra A, Peek ME. Using Patient-Generated Health Data From Mobile Technologies for Diabetes Self-Management Support: Provider Perspectives From an Academic Medical Center. J Diabetes Sci Technol. 2014 Jan;8(1):74-82. doi: 10.1177/1932296813511727. Epub 2014 Jan 1.

  PMID: 24876541 BACKGROUND

• Nundy S, Dick JJ, Chou CH, Nocon RS, Chin MH, Peek ME. Mobile phone diabetes project led to improved glycemic control and net savings for Chicago plan participants. Health Aff (Millwood). 2014 Feb;33(2):265-72. doi: 10.1377/hlthaff.2013.0589.

  PMID: 24493770 BACKGROUND

• Nundy S, Dick JJ, Solomon MC, Peek ME. Developing a behavioral model for mobile phone-based diabetes interventions. Patient Educ Couns. 2013 Jan;90(1):125-32. doi: 10.1016/j.pec.2012.09.008. Epub 2012 Oct 10.

  PMID: 23063349 BACKGROUND

• Nundy S, Dick JJ, Goddu AP, Hogan P, Lu CY, Solomon MC, Bussie A, Chin MH, Peek ME. Using mobile health to support the chronic care model: developing an institutional initiative. Int J Telemed Appl. 2012;2012:871925. doi: 10.1155/2012/871925. Epub 2012 Dec 5.

  PMID: 23304135 BACKGROUND

• Peek ME, Gorawara-Bhat R, Quinn MT, Odoms-Young A, Wilson SC, Chin MH. Patient trust in physicians and shared decision-making among African-Americans with diabetes. Health Commun. 2013;28(6):616-23. doi: 10.1080/10410236.2012.710873. Epub 2012 Oct 10.

  PMID: 23050731 BACKGROUND

• Peek ME, Tang H, Cargill A, Chin MH. Are there racial differences in patients' shared decision-making preferences and behaviors among patients with diabetes? Med Decis Making. 2011 May-Jun;31(3):422-31. doi: 10.1177/0272989X10384739. Epub 2010 Dec 2.

  PMID: 21127318 BACKGROUND

• Peek ME, Wagner J, Tang H, Baker DC, Chin MH. Self-reported racial discrimination in health care and diabetes outcomes. Med Care. 2011 Jul;49(7):618-25. doi: 10.1097/MLR.0b013e318215d925.

  PMID: 21478770 BACKGROUND

• Peek ME, Odoms-Young A, Quinn MT, Gorawara-Bhat R, Wilson SC, Chin MH. Race and shared decision-making: perspectives of African-Americans with diabetes. Soc Sci Med. 2010 Jul;71(1):1-9. doi: 10.1016/j.socscimed.2010.03.014. Epub 2010 Mar 24.

  PMID: 20409625 BACKGROUND

• Peek ME, Odoms-Young A, Quinn MT, Gorawara-Bhat R, Wilson SC, Chin MH. Racism in healthcare: Its relationship to shared decision-making and health disparities: a response to Bradby. Soc Sci Med. 2010 Jul;71(1):13-7. doi: 10.1016/j.socscimed.2010.03.018. Epub 2010 Mar 24. No abstract available.

  PMID: 20403654 BACKGROUND

• Chin MH, Walters AE, Cook SC, Huang ES. Interventions to reduce racial and ethnic disparities in health care. Med Care Res Rev. 2007 Oct;64(5 Suppl):7S-28S. doi: 10.1177/1077558707305413.

  PMID: 17881624 BACKGROUND

• Peek ME, Cargill A, Huang ES. Diabetes health disparities: a systematic review of health care interventions. Med Care Res Rev. 2007 Oct;64(5 Suppl):101S-56S. doi: 10.1177/1077558707305409.

  PMID: 17881626 BACKGROUND

• Chin MH. Quality improvement implementation and disparities: the case of the health disparities collaboratives. Med Care. 2010 Aug;48(8):668-75. doi: 10.1097/MLR.0b013e3181e3585c.

  PMID: 20613665 BACKGROUND

• Raffel KE, Goddu AP, Peek ME. "I Kept Coming for the Love": Enhancing the Retention of Urban African Americans in Diabetes Education. Diabetes Educ. 2014 May;40(3):351-360. doi: 10.1177/0145721714522861. Epub 2014 Feb 13.

  PMID: 24525568 RESULT

• Peek ME, Wilkes AE, Roberson TS, Goddu AP, Nocon RS, Tang H, Quinn MT, Bordenave KK, Huang ES, Chin MH. Early lessons from an initiative on Chicago's South Side to reduce disparities in diabetes care and outcomes. Health Aff (Millwood). 2012 Jan;31(1):177-86. doi: 10.1377/hlthaff.2011.1058.

  PMID: 22232108 RESULT

• Peek ME, Harmon SA, Scott SJ, Eder M, Roberson TS, Tang H, Chin MH. Culturally tailoring patient education and communication skills training to empower African-Americans with diabetes. Transl Behav Med. 2012 Sep;2(3):296-308. doi: 10.1007/s13142-012-0125-8.

  PMID: 24073128 RESULT

• Chin MH, Goddu AP, Ferguson MJ, Peek ME. Expanding and sustaining integrated health care-community efforts to reduce diabetes disparities. Health Promot Pract. 2014 Nov;15(2 Suppl):29S-39S. doi: 10.1177/1524839914532649.

  PMID: 25359247 RESULT

• Peek ME, Ferguson MJ, Roberson TP, Chin MH. Putting theory into practice: a case study of diabetes-related behavioral change interventions on Chicago's South Side. Health Promot Pract. 2014 Nov;15(2 Suppl):40S-50S. doi: 10.1177/1524839914532292.

  PMID: 25359248 RESULT

Related Links

• Improving Diabetes Care and Outcomes Project Website

MeSH Terms

Conditions

Diabetes Mellitus; Patient Participation

Interventions

Patient Education as Topic; Quality Improvement; Community-Institutional Relations

Condition Hierarchy (Ancestors)

Glucose Metabolism Disorders; Metabolic Diseases; Nutritional and Metabolic Diseases; Endocrine System Diseases; Patient Acceptance of Health Care; Treatment Adherence and Compliance; Health Behavior; Behavior

Intervention Hierarchy (Ancestors)

Health Education; Preventive Health Services; Health Services; Health Care Facilities Workforce and Services; Engineering; Technology, Industry, and Agriculture; Quality of Health Care; Health Services Administration; Public Relations; Organization and Administration

Study Officials

• Marshall Chin, MD, MPH

  University of Chicago

  PRINCIPAL INVESTIGATOR

• Monica Peek, MD, MPH

  University of Chicago

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 12, 2010
• First Posted: March 15, 2010
• Study Start: January 1, 2009
• Primary Completion: November 9, 2016
• Study Completion: November 9, 2016
• Last Updated: April 26, 2023

Record last verified: 2023-04

Locations

US (6)