Implementing the Chronic Care Model to Improve Diabetes Care in the Community: Translating Theory to Practice

Diabetes mellitus is a prevalent, costly condition associated with substantial morbidity and mortality. It is an important public health problem as it is equally burdensome to individuals and to society, and disproportionately affects disadvantaged people and nations. Despite the number of possibilities for reducing much of this burden, the incidence of diabetes continues to grow. New approaches to how diabetes care is delivered are needed to improve care at the patient, provider, community, and health systems levels. It was therefore our objective to explore the effectiveness of implementing a multifaceted diabetes care intervention, based on the Chronic Care Model, into an underserved community, with the goal of changing the way diabetes care is delivered to improve outcomes in patients who receive their diabetes care in the primary care setting. A marked decline in HbA1c was observed in the multifaceted intervention group (-0.6%, p=0.008) but not in the other groups. The magnitude of the association remained strong after adjustment for clustering (p=0.01). The same pattern was observed for a decline in Non-HDL-c and for the proportion of participants who self-monitor blood glucose (SMBG) in the multifaceted intervention group (Non-HDL-c: -10.4 mg/dl, p=0.24; SMBG: +22.2%, p<0.0001) with statistically significant between group differences in improvement (Non-HDL-c: p=0.05; SMBG: p=0.03) after adjustment. The multifaceted intervention group also showed improvement in diabetes knowledge test scores (+6.7%, p=0.07), and empowerment scores (+2, p=0.02). Secondary analyses revealed that psychosocial and psychological factors accounted for a greater amount of the variation in HbA1c, Non-HDLc, and blood pressure values than clinical factors, and are important in contributing to improvement. The improvements observed in HbA1c, systolic and diastolic blood pressure, and the proportion of participants who self monitor their blood glucose at 12-month follow-up were sustained at 36-month follow-up in all study groups. Additional improvements occurred in Non-HDLc levels in all study groups, and quality of well-being scores in the multifaceted intervention group, but not the other groups. These findings are important as they help to close a gap in the literature on improving the quality of care for people with diabetes through redesigning the process of diabetes care delivery

Cost-Effectiveness Analysis of Efforts to Reduce Risk of Type 2 Diabetes and Cardiovascular Disease in Southwestern Pennsylvania, 2005-2007

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938403/pdf/PCD75A109.pd

Patients with Complex Chronic Diseases: Perspectives on Supporting Self-Management

A Complex Chronic Disease (CCD) is a condition involving multiple morbidities that requires the attention of multiple health care providers or facilities and possibly community (home)-based care. A patient with CCD presents to the health care system with unique needs, disabilities, or functional limitations. The literature on how to best support self-management efforts in those with CCD is lacking. With this paper, the authors present the case of an individual with diabetes and end-stage renal disease who is having difficulty with self-management. The case is discussed in terms of intervention effectiveness in the areas of prevention, addiction, and self-management of single diseases. Implications for research are discussed

The impact of the affordable care act on perinatal mood and anxiety disorder diagnosis and treatment rates among Michigan Medicaid enrollees 2012–2018

Abstract Background Perinatal Mood and Anxiety Disorders (PMADs) affect one in five birthing individuals and represent a leading cause of maternal mortality. While these disorders are associated with a variety of poor outcomes and generate significant societal burden, underdiagnosis and undertreatment remain significant barriers to improved outcomes. We aimed to quantify whether the Patient Protection Affordable Care Act (ACA) improved PMAD diagnosis and treatment rates among Michigan Medicaid enrollees. Methods We applied an interrupted time series framework to administrative Michigan Medicaid claims data to determine if PMAD monthly diagnosis or treatment rates changed after ACA implementation for births 2012 through 2018. We evaluated three treatment types, including psychotherapy, prescription medication, and either psychotherapy or prescription medication. Participants included the 170,690 Medicaid enrollees who had at least one live birth between 2012 and 2018, with continuous enrollment from 9 months before birth through 3 months postpartum. Results ACA implementation was associated with a statistically significant 0.76% point increase in PMAD diagnosis rates (95% CI: 0.01 to 1.52). However, there were no statistically significant changes in treatment rates among enrollees with a PMAD diagnosis. Conclusion The ACA may have improved PMAD detection and documentation in clinical settings. While a higher rate of PMAD cases were identified after ACA Implementation, Post-ACA cases were treated at similar rates as Pre-ACA cases

Effectiveness of a Community Health Worker-Led Diabetes Intervention among Older and Younger Latino Participants: Results from a Randomized Controlled Trial

Diabetes management for older Latino adults is complex, given a higher incidence of multiple coexisting medical conditions and psychosocial barriers to self-management. Community health workers (CHWs) may be effective in reducing these barriers. The REACH Detroit CHW randomized controlled intervention studies with Latino/as with diabetes found improvements in self-management behaviors and glucose control after participating in a CHW-led intervention. Using data from the REACH Detroit Partnership&prime;s cohort 3, this study used descriptive statistics and multiple linear regression analyses to evaluate whether the six-month CHW intervention had a greater effect on older Latino/as (ages 55 and older) than younger participants between baseline and post-intervention follow-up at six months. There were significant intervention effects by age group that varied by outcome. Compared to a control group that received enhanced usual care, there were statistically significant intervention effects demonstrating greater self-efficacy scores 1.27 (0.23, 2.32); p &lt; 0.05, and reductions in HbA1c 1.02 (&minus;1.96, &minus;0.07); p &lt; 0.05, among older participants in the CHW intervention, and increases in diabetes support 0.74 (0.34, 1.13); p &lt; 0.001; and understanding of diabetes management 0.39 (0.08, 0.70); p &lt; 0.01 among younger participants