MODELS FOR PRACTICE
FOCUS
AREA: DIABETES
Program
Name:
Location:
Problem
Addressed: Diabetes
and Access to Primary Care
Healthy
People 2010 Objective: 5, 12
Web
Address: None
The
White River Rural Health Center, Inc. Diabetes Collaborative (WRRHCDC) is a
self-contained Federally Qualified Community Health Center (FQHC) and a participant
in the Arkansas Diabetes Collaborative and the National Diabetes Collaborative.
It is funded by the Bureau of Primary Health Care (BPHC) and provides primary
care and management of diabetes and associated conditions regardless of the
ability of the patient to pay.
This
model focuses on elimination of health disparities between populations of
persons with diabetes. WRRHCDC uses continuous quality control outcome
measurements based on the Cardiovascular and Diabetes Electronic Management
System (CVDEMS) software program from BPHC. Improved clinical practices and
other information are shared between sites. This model demonstrates that a
network of FQHCs can cooperate to improve access and quality of health care for
diabetics in rural areas.
Blueprint: WRRHCDC, a 501(c)(3) non-profit organization, is
part of the National Diabetes Collaborative (NDC), which is comprised of FQHCs
across the U.S. WRRHC receives no additional funds for the DC, but it did
receive staff training from BPHC during the first year. WRRHC covers a
four-county area in east central
While
each FQHC is independent, they share information and clinical practices. They
are organized into various levels, including state, “clusters” (regions
composed of more than one state), and nationally. Currently, there are at least
four additional FQHCs participating in the Arkansas DC.
WRRHCDC
provides primary care and management of diabetes and associated conditions,
regardless of the ability of the patient to pay. It provides all primary care
on-site, including laboratory and radiology services. Staff at the WRRHCDC
clinic consists of one licensed practical nurse and one medical doctor, one or
two secretaries, and sometimes a certified nursing assistant as needed. A
half-time nutritionist was recently hired. No donated or volunteer staff are
used. Additional data entry staff will be hired as the program spreads to
include multiple physician sites.
Information
on newly diagnosed diabetes patients is entered into a diabetes patient
registry. The registry is used to track the services needed and delivered. The
software is the CVDEMS program provided by BPHC.
WRRHCDC
serves all ages and also provides perinatal services. As a FQHC, it serves all
individuals, regardless of their ability to pay. Their target population is
approximately 20 percent black, 78 percent white, and 2 percent Hispanic.
Almost half of their population is below 200 percent of the federal poverty
level.
Making a Difference: WRRHCDC undergoes continuous quality improvement.
CVDEMS software is used to track progress, practices, and outcomes at the level
of the individual patient, specific provider, or clinic site. Data and outcomes
are reported monthly.
Specific
indicators reported by each site are percent of patients having HbA1c
<9.0 percent, having two HbA1c determinations in one year >91
days apart, blood pressure <135/80, goal setting in self management, annual
influenza vaccination, current pneumococcal vaccination, and annual lipid
profile. Outcomes are determined monthly, by searching the registry on the last
working day of the month for all diabetic patients who have met the criteria
for the past 12-month period. The percentage of patients meeting the goals is
based on the total number of patients in the registry on that day.
In
addition to the two original sites, two additional sites have been added, and
the Collaborative expects to add the remaining eight sites in 2002.
Beginnings: The Collaborative began in
January 1998 and is comprised of FQHCs across the U.S. The Arkansas DC
originally consisted of two sites.
Challenges and Solutions: The strategic plan of WRRHC includes its
commitment to the BHPC’s objectives of 100 percent access, 0 percent
disparities. The Diabetes Collaborative is only one of several programs at
WRRHC committed to these goals. WRRHC also began participating in the BPHC’s
Cardiovascular Collaborative in April 2001, which operates under the same
principles.
So far, WRRHC has operated the DC with no
additional funding or staffing levels. Their only source of external funding is
BPHC, and WRRHC participates in as many of BPHC’s initiatives as possible. The
main challenge has been finding resources for retinal eye exams, podiatry, and
other specialized services for treatment of complications, especially for
patients who are unable to pay. These problems are ongoing. WRRHCDC is working
with the Arkansas Department of Health Diabetes Coalition and Arkansas Disease
Management Collaborative to review external funding opportunities to fund
mobile services to cover rural areas.
WRRHCDC
publicizes its successes to BPHC by participating in the latter’s initiatives.
Its public relations in the community consist of newspaper announcements,
letters, and health fairs.
WRRHC
feels that its participation in the DC was instrumental in WRRHC receiving
Joint Commission on Accreditation of Health Organizations (JCAHO) accreditation
in December 1998. WRRHCDC was chosen to participate as a “high intensity” site
in a three-year study by the University of Chicago, beginning in 2001. This
program is designed to enhance WRRHCDC clinicians’ ability to assist in
behavioral change in their patients, to develop better patient communication
skills, to improve patient self-management, and to continue intensive
continuous quality improvement efforts.
Stakeholders
include the state primary care association for Arkansas Community Health
Centers for technical assistance, the Arkansas Department of Health Diabetes
Coalition for training staff and developing culturally appropriate patient
educational materials, county Extension agents and local hospital dietitians
for nutritional education, and University of Arkansas for Medical Sciences for
teleconferencing support.
Brenda
Kennedy, RN
White
River Rural Health Center, Inc. Diabetes Collaborative
623
North Ninth St.
Augusta,
AR 72006
Phone:
(870) 347-2534
Fax:
(870) 347-2882
E-mail:
bkennedyrn@yahoo.com