Supported by Finding Answers: Disparities Research for
Change, a National
Program of the Robert Wood Johnson Foundation with direction and technical
assistance provided by the University of Chicago
Project Funded May 1, 2008- Two Years Funding
Goal Statement and Specific Aims
Bertie Memorial Hospital-University Health Systems and
East Carolina University
(a.k.a., East Carolina Health / Bertie All-County Health Services,
Windsor, North Carolina)
Paul Bray, MA, LMFT, PI
Assistant Research Professor, Dept. of Family Medicine
East Carolina University Project Coordinator-ECARE
Coordinator Group Diabetes Program
University Health Systems-Bertie Memorial Hospital
Doyle M. "Skip" Cummings, Pharm.D., FCP, FCCP, Co-PI
Berbecker Distinguished Professor of Rural Medicine
Professor of Family Medicine and Pediatrics, ECU
Director, Research Division, Family Medicine, ECU
Brody School of Medicine at East Carolina University
The proposed study will evaluate the clinical effectiveness and feasibility of
an innovative model of redesigned diabetes care for African American patients
with historically disparate outcomes in rural, fee-for-service primary care
practices. While studied in urban managed care sites, these redesign elements
have not been systematically evaluated in fee-for-service rural communities
where the incentives for care of underserved minority citizens are markedly
different. The proposed study will specifically address this important need.
The specific aims are to evaluate the effect of the redesigned model on
glycemic control (HbA1c) and other diabetes-specific outcome measures, to
explore the effects of the model on transitions in care from inpatient to
outpatient settings, and to assess the cost-benefit and cost-effectiveness
of the intervention.
The redesign components are based on the Chronic Care
Model described by Wagner et al. The intervention is already funded by two
regional foundations. The study is designed as a cohort study in which six
rural fee-for-service practices (three intervention practices already begun
and three control practices yet to be selected) will be pair matched based
on practice size and patient demographics. A total of 510 patients will
be randomly selected from these six practices and will reflect the
effects of the intervention or control conditions in each practice.
The primary outcome of interest will be the change in HbA1c from baseline
to 6 and 12 months after initiation of the intervention or usual care,
along with other diabetes specific clinical and cost analysis measures.
The proposed study has tremendous potential to inform disparities
improvement through the evaluation of an innovative model that can
bring state of the art diabetes care to minority patients in underserved
and vulnerable rural communities at a cost that is reasonable and acceptable.
Specific Research Aims
1. To determine the effectiveness of implementing a redesigned model of
interdisciplinary care delivery in a series of rural, fee-for-service, primary
care practices on glycemic control (and secondarily on other diabetes-specific
and cardiovascular risk outcomes), in a representative cohort of African
American adult patients with Type 2 diabetes mellitus and previously disparate
outcomes, at six months and one year following implementation compared to
that from similar control practices.
Hypothesis: redesigned interdisciplinary care will result in improved glycemic
control (decrease in HbA1c) among adult African American patients with Type 2
diabetes mellitus relative to that observed in control practices.
2. For African American patients with diabetes mellitus who are hospitalized,
to assess the impact of redesigned interdisciplinary care on short-term care
outcomes during the transition from inpatient (hospitalist) to outpatient
(outpatient provider) settings.
Hypothesis: redesigned interdisciplinary care will result in improved delivery
of diabetes self-management education and improved glycemic control
3. To determine the cost-benefit and cost-effectiveness of this redesigned
model of interdisciplinary care delivery among African American patients with
Hypothesis: redesigned interdisciplinary care will result in fewer emergency
room visits and shorter length of stay hospitalizations compared to usual care
and will constitute a sustainable model of care.