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 University of Chicago

Project Funded May 1, 2008- Two Years Funding

Problem Statement: Disparities

The Issue
Certain racial and ethnic populations—African Americans, Latinos, and American Indians—suffer from worse health and receive lower-quality health care than Caucasians. In 2002 the Institute of Medicine released Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, which summarized the results of hundreds of research studies showing lower quality care for minority patients.
Recent research continues to show worse health outcomes for minority populations and lower socioeconomic status groups:

African Americans received poorer quality care than Caucasians for 16 out of 22 (73%) core quality measures.

Hispanics received poorer quality care than Caucasians for 17 out of 22 (77%) core quality measures.

Poor people received worse quality care than those with high income for 12 out of 17 core quality measures.

(reprinted from the Robert Wood Johnson Foundation web site on Disparities) http://www.rwjf.org/pr/os.jsp?topicid=1180

Background
While the existence of racial and ethnic health care disparities has been firmly established, health care systems have not found a practical blend of strategies and interventions that measurably reduce these differences. Without better knowledge about practical steps to reduce disparities in care, health care organizations are often unable to address these gaps. Furthermore, recent research indicates that most past efforts to close these gaps have either failed or led to limited improvements. We need to move beyond documenting health care disparities to finding solutions that will eliminate them.

(reprinted from the Finding Answers: Disparities Research for Change, a National Program of the Robert Wood Johnson Foundation at the University of Chicago) http://www.solvingdisparities.org/

Disparities in Diabetes Care in Eastern North Carolina

Data from the UKPDS study has clearly shown that improving glycemic and blood pressure control in patients with diabetes can result in significant reductions in both morbidity and mortality (see UKPDS 1998). The American Diabetes Association and other entities have published guidelines for diabetes care based on this and other evidence (see American Diabetes Association, 2007). However, many patients, particularly rural minority patients, do not receive these recommended levels of care, demonstrating the need for redesigning systems of care to minimize long-term morbidity/mortality.

Rural minority patients with Type 2 diabetes mellitus are a vulnerable population. Age adjusted mortality rates for diabetes in the predominantly rural state of North Carolina (NC) are 2.2 times higher for minority males and almost 3 times higher for minority females than their white counterparts. In rural eastern NC (the proposed rural region for this investigation) the adjusted mortality rate from diabetes is 42% higher than the rest of the state. Further, Dansky et al (1998) demonstrated that Medicare beneficiaries with diabetes mellitus in rural communities reported fewer physician office visits than urban patients while others have shown that low income, rural patients with diabetes are more likely to receive care from a primary care physician (our target for intervention) than from a specialist (McCall et al 2004, Woodwell et al 2004).

(reprinted from the grant application of E-Care members to Finding Answers: Disparities Research for Change)







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