Redesigning Diabetes Care for African Americans in Rural Fee-for-Service Practices

Objective:

1.To determine the effectiveness of implementing a redesigned model of interdisciplinary care delivery in a series of rural, fee-for-service, primary care practices on glycemic control, BP control, and lipid levels, at six months and one year following implementation compared to that from similar control practices.  A randomly selected cohort of African American adult patients with Type 2 diabetes mellitus and historically disparate outcomes will represent the effects of the intervention or usual care in the intervention and control practices respectively.

Hypothesis: redesigned interdisciplinary care will result in improved HbA1c, BP, and lipid levels relative to that observed in control practices.

2. To determine the business sustainability of this redesigned model of interdisciplinary care delivery for rural primary care practices caring for African American patients with diabetes mellitus.

Hypothesis: redesigned interdisciplinary care will constitute a model of care that is business sustainable for rural clinics.

Methods:Outcome Measures: HbA1c, BP, LDL cholesterol Control Measures: age, gender, baseline values, co-morbid conditions, health insurance, practice attended, # visits, # hours contact with a care manager, # self-management goals set, treatment intensification, and medication compliance. Process Measure: Patient Assessment of Chronic Illness Care (PACIC) Business Sustainability modeling: total cost of intervention; cost allocation, cost-sharing, and enhanced practice revenue

Results:  Hypothesis: redesigned interdisciplinary care will constitute a model of care that is business sustainable for rural clinics.

Conclusion:Use of clinic based support programs should be used to improve clinical outcomes of patients with DM