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Quality Improvement Interventions to Reduce Disparities in African Americans with Diabetes

Quality improvement strategies can target several areas—health systems (case management, team changes, electronic patient registry, facilitated relay of information to clinicians, continuous QI), health-care providers (audit and feedback, clinician education, clinician reminders, financial incentives) or patients (patient education, promotion of self-management, reminder systems).  A recent systematic review and meta-analysis published in Diabetes Care in 2013 identified interventions studied in randomized controlled trials at each of these levels that improved diabetes care among African Americans.

  • Patient-targeted interventions within the healthcare organization: Among culturally adapted patient interventions, two of 22 increased patient attendance at screening visits and 20 of 22 promoted diabetes self-management. A meta-analysis of 8 studies showed that these interventions resulted in a significant 0.83% reduction in HbA1c.
  • Health care organization interventions: Among five health care system intervention trials, the two most highly effective interventions in improving HbA1c and frequency of therapy intensification included rapid turnaround HbA1c.
  • Multi-target interventions (patients and health care system): Among five studies, three studies showed an improvement in HbA1c. All of these interventions included patient education and self-management support and nurse case management, two included treatment algorithms and two involved collaboration with a physician in treatment decisions.

The results of this study emphasizes the need to target and intervene on multiple levels in the patient’s experience with the health care system to improve outcomes and reduce disparities in diabetes care.

-Sherita Golden, Executive Vice Chair

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Sherita Golden

Sherita Golden, MD, MHA, is the Executive Vice Chair for the Department of Medicine