Beyond Race, Ethnicity and Language Data - Community Actions to Improve Diabetes Care and Outcomes

Baylor Health Care System
Dallas, TX
3,653 Beds

The Problem
The Baylor Health Care System Office of Health Equity aims to reduce variation in health care access, health care delivery, and health outcomes among its diverse patient populations. Diabetes, a severe epidemic in Texas, is more than twice as likely to occur in minority populations. Race, ethnicity and language outpatient diabetes management data analysis indicated the presence of disparities in diabetes management within the primary care practices at Baylor Health Care System. As a first step in reducing diabetes care disparities, Baylor Health Care System recognized an opportunity to develop a community-based self-management diabetes education and advocacy intervention, reducing the burden on clinicians while improving disparities in diabetes control. A low-cost, patient-centered self-management education program was designed to support patient needs with less expensive community health workers functioning as diabetes health promoters. With funding from a Merck Company Foundation grant, the Office of Health Equity developed the Diabetes Equity Project. The goal was to reduce observed disparities in diabetes care and outcomes in the predominately Hispanic, medically underserved communities around Baylor Health Care System.

The Solution
Hispanics with diabetes experience a higher burden of diabetes-related illness and mortality than non-Hispanics. The Diabetes Equity Project was designed to improve access to preventive care and diabetes management programs. The project is deployed in five community charity clinics and makes use of community health workers who receive extensive training in diabetes care and management, enabling them to serve as a bridge between patients and providers. Patients are referred to the Diabetes Equity Project from both community and private practice clinics, following emergency room visits and hospitalizations related to uncontrolled diabetes. The Diabetes Equity Project seeks to be responsive to patient-reported needs like education, communication and respect, removal of financial constraints, and access to medication and transportation by (1) placing an emphasis on community health worker recruitment and training; (2) building on existing community infrastructure through partnerships with local clinics; (3) integrating the community health workers' into the health care system's care coordination strategy; and (4) developing an electronic diabetes registry that tracks patient metrics and facilitates disease management communication between community health workers and primary care clinicians.

The Result
Enrollment in the Diabetes Equity Project began at the end of September 2009 and, had 806 patients in the program within the first 18 months. A preliminary analysis of the first year of results revealed a statistically significant drop in HgbA1c value from a baseline of 8.7 percent to 7.4 percent. Patient satisfaction surveys revealed that over 98 percent of participants indicated the highest level of satisfaction with the care they received. The program performance suggests that the long-term value of the program is that sustainable diabetes control can be achieved for patients who previously experienced poor diabetes control by augmenting “usual care” with community health worker-led patient education and advocacy. The next step in Baylor Health Care System's diabetes management disparity improvement journey will be to apply the community-based success to a group of private practice clinic patients experiencing care management disparities.


Contact Information
James W. Walton
jameswa@BaylorHealth.edu

This case study was originally featured in the HPOE guide: 'Eliminating Health Disparities: Implementing the National Call to Action Using Lessons Learned,' published February, 2012.