Affiliated with East Carolina University, Brody School of Medicine, Department of Family Medicine
Redesigning Diabetes Care in Rural Fee-for-Service Practices

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

Intervention Design

Funded Institutions
Bertie Memorial Hospital-University Health Systems and
East Carolina University
(a.k.a., East Carolina Health / Bertie All-County Health Services, Windsor, North Carolina)
Intervention Design
The target population for this effectiveness study will be the current African American adult patients with an established diagnosis of Type 2 diabetes mellitus attending rural fee-for-service primary care practices. The primary intervention is clinical care provided by a "circuit rider" diabetes care manager - an advanced practice nurse, dietitian, or pharmacist that partners with doctors and other providers. Their aim is to increase the quality of care delivered and to reduce racial disparity in care outcomes. The specific primary interventions include the following:
Circuit Rider Methodology. A certified diabetes educator (CDE) nurse, dietitian and CDE qualified pharmacist rotate to different clinics on different days to partner with providers in delivering diabetes clinical care. Patients with diabetes are "same day scheduled" for both their provider visit and the care management - education visit. The care management - education visit is initiated by a standing order from the provider for all patients with diabetes in the intervention practices. A circuit rider methodology of delivering skilled diabetes care is uniquely suited for medically underserved rural communities and those with disparate outcomes.
Four-part American Diabetes Association (ADA) curriculum. The care managers also provide and document a standard 4-part ADA curriculum including topics of disease overview, nutrition, medication and complications. These curricular materials are reviewed with patients as part of the care management visits and help facilitate self management goal setting.
Self-management support. Self-management support by project staff will address the following content areas: a) patient-provider agreement on and documentation of a self-management goal; b) the provision of nutritional counseling; and c) medication compliance.
Culturally relevant educational tools and methodology. The care managers have been specifically trained in the use of tools and materials that are culturally relevant. These include such basic items as educational audio-visual and other handout materials using African- American patients. The tools include meal planning that is relevant to a southern African-American cuisine.
The care managers work alongside providers in the rural intervention practices. They see diabetic patients for 20-45 minutes in both individual and group settings on the same day the patient sees their doctor. The care managers regularly consult with providers through both "hallway" discussions and electronic notes.

The attached power point is a detailed explanation of the projects' intervention design Delivery%20Design.ppt

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