Health disparities diabetes care
Download
1 / 33

Health Disparities - PowerPoint PPT Presentation


  • 129 Views
  • Updated On :

Health Disparities/ Diabetes Care. Sheldon Greenfield, MD Orange County Diabetes Education Collaborative Conference January 31, 2009. Optimizing the ‘Physician Effect’ on HbA1c levels. Coached Care Team. Quyen Ngo-Metzger, MD, MPH Israel De Alba, MD, MPH Dara Sorkin, PhD

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Health Disparities' - juanita


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Health disparities diabetes care l.jpg

Health Disparities/ Diabetes Care

Sheldon Greenfield, MD

Orange County Diabetes Education Collaborative Conference

January 31, 2009



Coached care team l.jpg
Coached Care Team

  • Quyen Ngo-Metzger, MD, MPH

  • Israel De Alba, MD, MPH

  • Dara Sorkin, PhD

  • John Billimek, PhD

  • Dana Mukamel, PhD

  • Community-based Coaches


Background disparities in diabetes care in the u s l.jpg
Background: Disparities in Diabetes Care in the U.S.

  • More ethnic minorities fail to meet diabetes quality benchmarks than non-minority patients

  • Rates of diabetes complications are higher among many ethnic minorities

  • All cause mortality rates are higher among African Americans and Hispanic patients


Purposes of study l.jpg
Purposes of Study

  • Document disparities in diabetes care among three ethnic groups (Mexicans, Vietnamese, Non-Hispanic Whites) in defined population

  • Reduce disparities through Coached Care program for improving patients’ participation in care using community-based patients with diabetes


Study designs l.jpg
Study Designs

  • Diabetes Registry (population definition)

  • Cross-sectional DAWN Minority Survey (measures development; comparison ethnic groups)

  • Randomized controlled trial (intervention test)


Sampling l.jpg
Sampling

  • Diabetes Registry:

    • All patients seen for diabetes at UCI Medical Center clinics

  • Cross-sectional DAWN Minority Survey:

    • Random sample 300 patients each ethnic group

  • Randomized controlled trial:

    • Balanced design, n=100 exp/cont by ethnic group



Features of coached care l.jpg
Features of Coached Care

  • Algorithm mapping decisions, treatment options; detailed explanations

  • Patient’s medical record; tailored, personalized information

  • Reviewed immediately before office visit

  • ‘Coaching’ for more effective participation during visit


Tailored algorithm information example patient on insulin l.jpg
Tailored Algorithm Information: Example, Patient on Insulin

both

Using insulin alone

yes

Adherence as instructed

Problems with insulin regimen

OPTIONS

Change insulin to rapid acting qd

Use insulin Pen for administration

Stop or reduce insulin; add oral agent

Improve diet, exercises

yes

no

no


Control group l.jpg
Control Group

  • Matched for session length

  • Same venue, same staff

  • Content = state of the art patient education materials for each disease


Prior results from the coached care program health outcomes l.jpg
PRIOR RESULTS FROM THE COACHED CARE PROGRAM: Health Outcomes

  • Compared to controls, patients in experimental group had:

    • 1.5% reduction in HbA1c

    • 10 mm Hg reduction in diastolic BP

    • 25% reduction in symptoms

    • 30% improvement in functional status


Prior results from the coached care program communication l.jpg
PRIOR RESULTS FROM THE COACHED CARE PROGRAM: Communication Outcomes

  • Compared to controls, patients in experimental group (based on audiotapes):

    • 3 times more queries, ‘controlling’ conversational behaviors

    • 2 times more effective in information seeking

    • 30% increase in emotional response from physicians


Features of coached care for diabetes program l.jpg
Features of Coached Care Outcomesfor Diabetes Program

  • Use of community-based ethnic minority coaches

  • Training program for, quality monitoring of coaches

  • Use of diabetes registry at UC Irvine to ensure representativeness of patient sampling, assignment


Coached care for diabetes program dawn minority survey results l.jpg

Coached Care for Diabetes Program: OutcomesDAWN Minority Survey Results



Baseline hba1c by ethnicity l.jpg
Baseline HbA1c by Ethnicity Outcomes

F-value = 63.1, p<.001


Hba1c 7 by ethnicity l.jpg
% HbA1c <7 by Ethnicity Outcomes

Chi Square = 49.7, p<.001


Dawn minority survey measures l.jpg
DAWN Minority Survey Measures Outcomes

  • General health status

  • Diabetes specific health status

  • Adherence to diabetes regimen

  • Disease management/health enhancing behaviors

  • Quality of interpersonal care

  • Access to care

  • Total Illness Burden


Dawn minority survey measures22 l.jpg

General health status Outcomes

SF-36

General health distress

WHO

EuroQual

CESD

Quality of life

Stress level

Diabetes specific health status

Diabetes management hassles

Diabetes frustration

Diabetes distress

Diabetes worry/concern

Diabetes burden

Stress managing diabetes

DAWN Minority Survey Measures


Sample questions diabetes management hassles l.jpg
Sample Questions: Diabetes Management Hassles Outcomes

“During the past 4 weeks, how much of a problem or hassle has each of the following been for you in your everyday life?”

(A major hassle No hassle at all)

h. Having to keep your schedule (eating, drugs, exercise) in mind all the time…..


Sample questions diabetes frustrations l.jpg
Sample Questions: Diabetes Frustrations Outcomes

“Sometimes diabetes can be a source of frustration to those who have it. During the past 4 weeks, how often:

(All of the time None of the time) a. Were you frustrated about diabetes?....


Sample questions diabetes worries or concern l.jpg
Sample Questions: Diabetes Worries or Concern Outcomes

“Sometimes people with diabetes have concerns about complications that may develop. How much are you worried or concerned about each of the following?”

(Extremely worried Not worried at all) a. Losing my eyesight from diabetes?....


Sample questions diabetes burden l.jpg
Sample Questions: Diabetes Burden Outcomes

“Overall, how much of a burden is your having diabetes on you and your family in each of the following areas?”

(Very great burden No burden at all)

  • Our finances in general?....

  • Our finances due to the cost of my medications?….





Coached care for diabetes program dawn minority trial results l.jpg

Coached Care for Diabetes Program: OutcomesDAWN Minority Trial Results




Conclusions l.jpg
Conclusions Outcomes

  • Coached Care may improve diabetes outcomes among poor and ethnic minorities

  • Despite disparities in diabetes care at baseline, Coached Care improved HbA1c, diabetes health status across ethnic groups

  • Community-based coaches of same culture can be trained; less expensive


ad