A North Carolina program is out to level the playing field of health disparities, particularly among the underserved — those patients not covered by any type of health insurance. How are they doing it? By attacking the explosive increase in diabetes.
The state’s Diabetes Collaborative, primarily funded by a grant from The Robert Wood Johnson Foundation, began in January 2003. The funding made it possible to expand efforts from community health and rural health centers to include all kinds of providers, targeting those who provide care to the underserved. The Collaborative recruited providers through existing partners, the state medical society, the Blue Cross Blue Shield newsletter, various listservs, advisory board members, and others.
Now nearly 1,400 patients have been enrolled in the registry, through 13 practice sites. The team hopes to more than double this number within the next year. Through January 2004, changes in providers’ practices have become evident:
These data are clear markers of improvement. Yet the team isn’t content to rest on these laurels: next they want to move from intermediate outcomes to solid, long-term data that document outcomes. Part of this goal includes improving patient self-management, an area in which the Collaborative has so far had less success. Janet Reaves, the Collaborative’s co-director, says one relevant issue is that “maybe we don’t know yet what best practice here is — what motivates people.”
Reaves highlights a number of steps in the recruitment, planning, and learning processes that she considers particularly important in the Collaborative’s success. First, the initial Learning Sessions with the teams included standard didactic sessions, followed by teams teaching each other. But a third, innovative aspect of the Learning Sessions harnessed the power of competition, when each team was given a very short amount of time, in “rapid-fire sessions,” to discuss what had really worked for them. Second, in a two-day event, teams sat down and developed plans for implementing the changes that would help them reach their goals. Instead of stopping there, though, they went back to their clinics and ran the plans through the PDSA (Plan-Do-Study-Act) cycle, actually testing the plans they had just developed. Third, Reaves considers their best innovation to be the assembling of a diverse and unique lead team representing many key stakeholders and partnering agencies. Initially, North Carolina hired an information technology specialist, who assessed hardware and software needs for the sites, provided inservice education, assisted in installing the software and population data, and this specialist remains available for consultation by phone and email. A Preventive Medicine Resident who was well versed in the Collaborative models attended the IHI Breakthrough Series training, participated on the lead team, devoted many hours to the project in developing its charter and measures, and served as faculty. The Improvement Advisor, a physician champion with expertise in data analysis and experience in the Collaborative process, was critical to establishing linkages to the health care community. Finally, the team was led by co-directors with experience in applying the models at the local level and in providing technical assistance for Collaboratives in federally qualified community health centers. This diverse lead team and faculty have been key to this state Collaborative’s success.
