Theme Article
Diabetes Education: Quality Improvement Interventions Through Health Departments

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Background

As the burden of diabetes continues to overwhelm the public health system, there is increased demand on local health departments (LHDs) to improve public health services. Quality improvement (QI) techniques have been shown to be an effective means to improve the delivery of services by LHDs.

Purpose

To evaluate the extent to which the adoption of organizational QI strategies influences the delivery and outreach of diabetes self-management education (DSME) services provided by LHDs.

Methods

A change facilitation model that included QI team development and on-site QI training and facilitation was delivered to six LHDs that provide DSME, during 2010–2011. After training, each LHD developed and implemented a QI project to improve the outreach and delivery of DSME services. Pre- and post-intervention surveys were administered to evaluate the extent of change in DSME outreach and delivery. Data were analyzed in 2011.

Results

The number of individuals who completed an entire course of DSME increased by >100%, and 14% more diabetics attended DSME on a monthly basis. Half of LHDs reported receiving increased numbers of referrals per month, and 15% more healthcare providers referred diabetic patients to the LHD for DSME.

Conclusions

Participation in Community Outreach and Change for Diabetes Management (COACH 4DM) led to improvements in the LHD QI infrastructure, and in the outreach and delivery of services to diabetic patients. The techniques used during COACH 4DM are applicable to a wide variety of contexts and may be an effective tool to improve the delivery of other clinical and community preventive services.

Section snippets

Background

The Commonwealth of Kentucky is suffering from staggering levels of diabetes: 11.4% of Kentuckians have been diagnosed with diabetes (ranked 4th nationally), and diabetes is the seventh-leading cause of death in the state.1 Diabetes is also a major threat to the financial well-being of Kentucky; the estimated cost associated with diabetes in Kentucky in 2006 was more than $2 billion.2 The overwhelming burden of diabetes necessitates that local health departments (LHDs) improve the delivery of

Study Settings

Study sites included six of Kentucky’s 56 LHDs that, like the rest of the state, consist of a mix of single-county (2) and district (4) departments that largely served rural areas. The study departments were chosen in 2006 by the Kentucky Department for Public Health (KDPH) as Diabetes Centers of Excellence, which, through support from the Kentucky Diabetes Prevention and Control Program (KDPCP), provide education and support to individuals with diabetes. The KDPCP provides DSME training and

Results

The QI projects implemented by the LHDs focused on two major themes: increasing community outreach to patients and providers (three projects) and improving internal operations related to the delivery of DSME services (three projects). Motivations for the projects were diverse. For example, one of the projects that focused on internal operations was targeted toward process improvement relative to departmental operations with a private Medicaid managed care provider. Two of the six QI teams

Discussion

The QI projects developed and supported during COACH 4DM led to improvements in DSME service-delivery outcomes. Although notable gains were seen in the number of patients receiving DSME, the number of patients completing an entire series of DSME classes increased by more than 100%. This is particularly notable because diabetes self-management requires comprehensive education. Patients who receive any amount of DSME can benefit, but those who complete an entire training series will be more

Acknowledgements

Funding for this research was provided by the Robert Wood Johnson Foundation through the National Coordinating Center for Public Health Practice-Based Research Networks. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Robert Wood Johnson Foundation. This project was also supported by the National Center for Research Resources, UL1RR033173, and is now at the National Center for Advancing Translational Sciences. The content is

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