Diabetes mellitus is a prevalent, costly condition associated with substantial morbidity and mortality. It is an important public health problem as it is equally burdensome to individuals and to society, and disproportionately affects disadvantaged people and nations. Despite the number of possibilities for reducing much of this burden, the incidence of diabetes continues to grow. New approaches to how diabetes care is delivered are needed to improve care at the patient, provider, community, and health systems levels. It was therefore our objective to explore the effectiveness of implementing a multifaceted diabetes care intervention, based on the Chronic Care Model, into an underserved community, with the goal of changing the way diabetes care is delivered to improve outcomes in patients who receive their diabetes care in the primary care setting. A marked decline in HbA1c was observed in the multifaceted intervention group (-0.6%, p=0.008) but not in the other groups. The magnitude of the association remained strong after adjustment for clustering (p=0.01). The same pattern was observed for a decline in Non-HDL-c and for the proportion of participants who self-monitor blood glucose (SMBG) in the multifaceted intervention group (Non-HDL-c: -10.4 mg/dl, p=0.24; SMBG: +22.2%, p<0.0001) with statistically significant between group differences in improvement (Non-HDL-c: p=0.05; SMBG: p=0.03) after adjustment. The multifaceted intervention group also showed improvement in diabetes knowledge test scores (+6.7%, p=0.07), and empowerment scores (+2, p=0.02). Secondary analyses revealed that psychosocial and psychological factors accounted for a greater amount of the variation in HbA1c, Non-HDLc, and blood pressure values than clinical factors, and are important in contributing to improvement. The improvements observed in HbA1c, systolic and diastolic blood pressure, and the proportion of participants who self monitor their blood glucose at 12-month follow-up were sustained at 36-month follow-up in all study groups. Additional improvements occurred in Non-HDLc levels in all study groups, and quality of well-being scores in the multifaceted intervention group, but not the other groups. These findings are important as they help to close a gap in the literature on improving the quality of care for people with diabetes through redesigning the process of diabetes care delivery.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-04122006-134928 |
| Date | 01 June 2006 |
| Creators | Piatt, Gretchen A |
| Contributors | Robert M. Anderson, EdD, Janice C. Zgibor, RPh, PhD, Linda M. Siminerio, RN, PhD, CDE, Thoma J. Songer, PhD, Maria M. Brooks, PhD |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-04122006-134928/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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