Redesigning Care Delivery in Fee-for-Service Practices
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East Carolina Health/Bertie All-County Health Services
Eastern North Carolina
Diabetes
Rural Primary Care Practices
African Americans |
PROJECT
Redesign the way diabetes care is delivered in a rural primary care practice.
Based on the Chronic Care Model, primary care practices are redesigned to include a “circuit rider” staffing method, in which a certified diabetes educator nurse, a dietitian and a certified diabetes educator pharmacist rotate to clinics and partner with providers during patient visits as care managers. In this way, patients receive their education and behavior-centered coaching by a trained non-physician. In addition to staffing changes, an electronic health record disease registry system with physician decision support reminders is created.
At the point-of-care, patients receive: four-part American Diabetes Association education materials, self-management
support, culturally relevant educational tools, and community-based follow-up and support services. This project is a collaborative effort involving: small rural hospitals, rural community health center practices, a regional medical school, and a pharmacy school program at a historically Black university.
RATIONALE
This intervention is directed at multiple components of the health care system including patients, providers, and the care team structure. Multi-component interventions have been shown to improve chronic disease outcomes for minority patients.
The circuit rider method of delivering skilled diabetes care is uniquely suited for medically underserved rural
communities and those with disparate outcomes because it allows multiple practices to share the high costs and
recruitment challenges of providing access to skilled diabetes care clinicians. It maximizes the efficiency of such a staff member because single clinic locations may not have a sufficient diabetic population to support a full-time staff member. Finally, circuit rider methodology requires scheduling provider and coaching visits on the same day (when the care manager is available). Clustering patients with a similar diagnosis together, this encourages staff to prepare diabetes specific educational tools and decision making protocols.
EVALUATION PLAN
Funded by Finding Answers in 2008.
The study involves a prospective cohort in three fee-for-service rural practices with historically disparate outcomes compared to that in five randomly selected control practices matched for practice and patient characteristics.
All data is being collected from existing electronic records/diabetes registries in these practices or abstracted from traditional medical records. The study is specifically evaluating the effect of the redesigned model on HbA1c, blood pressure, and lipid levels from baseline to six and 12 months follow-up.
Principal Investigators:
- Paul Bray, MA, LMFT (University Health Systems-Bertie Memorial Hospital)
- Doyle M. "Skip" Cummings, PharmD, FCP, FCCP (Brody School of Medicine, East Carolina University)
RESOURCES
E-CARE DIABETES Website
http://www.ecarediabetes.org
For More Information
Please contact:
Paul Bray
pbray@pcmh.com |
