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
Bertie Memorial Hospital-University Health Systems and
East Carolina University
(a.k.a., East Carolina Health / Bertie All-County Health Services,
Windsor, North Carolina)
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 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
The attached power point is a detailed explanation of the projects' intervention