Coming Together to Improve the Health Status of Underserved Medicare Beneficiaries with Diabetes

Objective:To discuss a collaboration between a quality improvement organization (QIO) and a hospital-based community outreach department focused on improving the health status of 5% of underserved Medicare beneficiaries with diabetes in NYC

Methods:In 2008, IPRO, a QIO, contracted with North General Hospital to become a partner in providing an intervention for Medicare recipients with poorly controlled diabetes. Roles for each organization were delineated, strategies for recruitment and retention of participants and data collection were established, and parameters for the selection and training of community health workers were defined

Results:In one year, 24 community health workers and lay leaders were trained to facilitate the Stanford University Diabetes Self-Management Program, 600 Medicare beneficiaries have taken the program and data has been collected on all participants.

Conclusion:The collaboration between a QIO and a hospital-based community outreach department is an effective means of recruiting and retaining Medicare recipients with diabetes to receive a DSMP.