TY - JOUR
T1 - Evaluation of a program to improve intermediate diabetes outcomes in rural communities in the Dominican Republic
AU - Dethlefs, Henry J.
AU - Walker, Elizabeth A.
AU - Schechter, Clyde B.
AU - Dowd, Rachel
AU - Filipi, Linda
AU - Garcia, Juan Francisco
AU - Filipi, Charles
N1 - Funding Information:
Partial support for the CCI program is provided by USA foundation grants from Chicago Cubs Charities and the Robert P. Heaney Family Foundation. USA-based divisions of Direct Relief, Inc., Abbott Laboratories, Siemens Inc., TEVA Pharamceuticals, and Creighton University Medical Center are acknowledged gratefully for supplies, equipment or medication donations. The Dominican Development Alliance branch of USAID partially supported early program development. We are grateful to the Joslin Diabetes Center, Boston, MA, USA for donating copies of their audio-novellas. We thank the Boards of Directors of CCI, ILAC and CESI, and individual donors supporting this work. Dr. Walker was partially supported by a USA National Institutes of Health grant P30 DK111022. We gratefully acknowledge the skillful dedication of our Dominican clinic teams and the kindness of patients who seek care at CCI clinics. Thanks to John M. Bertoni MD, PhD and Allison M. Lai, MPH for helpful comments on a manuscript draft.
Funding Information:
Partial support for the CCI program is provided by USA foundation grants from Chicago Cubs Charities and the Robert P. Heaney Family Foundation . USA-based divisions of Direct Relief, Inc. , Abbott Laboratories , Siemens Inc. , TEVA Pharamceuticals , and Creighton University Medical Center are acknowledged gratefully for supplies, equipment or medication donations. The Dominican Development Alliance branch of USAID partially supported early program development. We are grateful to the Joslin Diabetes Center, Boston, MA, USA for donating copies of their audio-novellas. We thank the Boards of Directors of CCI, ILAC and CESI, and individual donors supporting this work. Dr. Walker was partially supported by a USA National Institutes of Health grant P30 DK111022. We gratefully acknowledge the skillful dedication of our Dominican clinic teams and the kindness of patients who seek care at CCI clinics. Thanks to John M. Bertoni MD, PhD and Allison M. Lai, MPH for helpful comments on a manuscript draft.
Publisher Copyright:
© 2019 Elsevier B.V.
PY - 2019/2
Y1 - 2019/2
N2 - Aims: To describe implementation of diabetes and hypertension program in rural Dominican Republic (DR), and report six years of quality improvement process and health outcomes. Methods: Dominican teams at two clinics are supported by Chronic Care International with: supervision and continuing education, electronic database, diabetes and hypertension protocols, medications, self-management education materials, behavior change techniques, and equipment and testing supplies (e.g., HbA1c, lipids, blood pressure, BMI). A monthly dashboard for care processes and health outcomes guides problem solving and goal setting. Results were analyzed for quality improvement reports and by fitting the clinical data to random-effects linear models. Results: 1191 adults were enrolled in the program at two clinics (44% men, baseline means: 56.4 years, BMI 27.4 kg/m 2 , HbA1c 8.8% (73 mmol/mol), BP 133/81 mmHg). Data show steady growth in clinic populations reaching capacity. Protocols for comprehensive foot examinations, BP and HbA1c assessments, and proportions reaching quality measures improved over time, especially after clinic goal setting. Modeling of BP, BMI and HbA1c values revealed important differences in outcomes by clinic over time. Conclusions: Improvements in process and health outcomes are attainable in rural DR when medical teams have support and access to data. Scalability and sustainability are continuing goals.
AB - Aims: To describe implementation of diabetes and hypertension program in rural Dominican Republic (DR), and report six years of quality improvement process and health outcomes. Methods: Dominican teams at two clinics are supported by Chronic Care International with: supervision and continuing education, electronic database, diabetes and hypertension protocols, medications, self-management education materials, behavior change techniques, and equipment and testing supplies (e.g., HbA1c, lipids, blood pressure, BMI). A monthly dashboard for care processes and health outcomes guides problem solving and goal setting. Results were analyzed for quality improvement reports and by fitting the clinical data to random-effects linear models. Results: 1191 adults were enrolled in the program at two clinics (44% men, baseline means: 56.4 years, BMI 27.4 kg/m 2 , HbA1c 8.8% (73 mmol/mol), BP 133/81 mmHg). Data show steady growth in clinic populations reaching capacity. Protocols for comprehensive foot examinations, BP and HbA1c assessments, and proportions reaching quality measures improved over time, especially after clinic goal setting. Modeling of BP, BMI and HbA1c values revealed important differences in outcomes by clinic over time. Conclusions: Improvements in process and health outcomes are attainable in rural DR when medical teams have support and access to data. Scalability and sustainability are continuing goals.
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U2 - 10.1016/j.diabres.2019.01.010
DO - 10.1016/j.diabres.2019.01.010
M3 - Article
C2 - 30641164
AN - SCOPUS:85060546345
SN - 0168-8227
VL - 148
SP - 212
EP - 221
JO - Diabetes Research and Clinical Practice
JF - Diabetes Research and Clinical Practice
ER -
