Improving Diabetes Care in Community Health Centers

Community health centers (CHCs) play an important role, serving 11 million medically underserved patients in the United States. They are critical safety net providers with limited resources that serve predominantly indigent patients, many of whom are from minority groups. The University of Chicago DRTC has strong ties with networks of health centers in the Midwest and West Central regions of the country, as well as in the City of Chicago. While our interventions are designed to succeed in this particularly challenging setting, we expect that our findings will be generalizable to health systems with more resources.

Access to quality health care remains a pressing problem for the approximately 43 million Americans who either have no medical insurance or who are otherwise medically underserved. Many vulnerable patients in both urban and rural areas must rely upon a safety net system of care. To this end in 1965, the federal government funded neighborhood health centers which were later codified as community, migrant, and homeless health centers through section 330 of the Public Health Service Act. The approximately 1000 current federally-supported health centers are an important source of primary care for 11 million medically underserved Americans, a point emphasized by the priority President Bush has given to these centers in his administration’s health plan.

Relatively little research has studied the quality of diabetes care in rural and urban health centers, and little work has focused on what types of interventions are likely to succeed among the poorest diabetic patients in clinics with limited resources. Clinics serving poor patients have special challenges that make it unlikely that the findings from diabetes outcomes research in more advantaged populations will be directly generalizeable. First, these federally funded clinics have significantly fewer resources than the private sector. Second, their patients are impoverished and less educated. Third, many of these clinics, especially those located in rural settings, lack access to tightly integrated delivery systems. Fourth, the small size of these clinics limits the financial feasibility of creating full-time teams devoted solely to diabetes care. Thus, the clinical problems and managerial challenges of program implementation require fresh, innovative approaches.

This research program has been designed to assess the quality of current diabetes care and the barriers to improving care, and to develop and test system, provider, and patient level interventions. These are particularly important clinical and policy objectives because indigent, poorly educated patients seeking care at clinics with relatively few resources are at very high risk for suboptimal health outcomes. We have established strong ties with key public and private national organizations responsible for diabetes quality improvement in vulnerable populations, and this has resulted in additional projects being made available to work towards making changes and improvements in the quality of care. We plan to continue developing, implementing, and disseminating successful interventions in the local, regional, and national community health center networks. We have also developed strong ties with the City of Chicago public neighborhood clinics, and have been engaged in an active progr am of diabetes research with these collaborators. The Chicago DRTC is uniquely positioned to bring the skills of organizational change, behavioral change, and outcomes assessment to improving care in health centers and especially difficult to reach populations in.