Evaluation of a program to improve intermediate diabetes outcomes in rural communities in the Dominican Republic

Henry J. Dethlefs, Elizabeth A. Walker, Clyde B. Schechter, Rachel Dowd, Linda Filipi, Juan Francisco Garcia, Charles Filipi

Research output: Contribution to journalArticle

Abstract

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/m2, 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.

Original languageEnglish (US)
Pages (from-to)212-221
Number of pages10
JournalDiabetes Research and Clinical Practice
Volume148
DOIs
StatePublished - Feb 1 2019

Fingerprint

Dominican Republic
Program Evaluation
Rural Population
Quality Improvement
Hypertension
Continuing Education
Health
Self Care
Foot
Linear Models
Databases
Blood Pressure
Delivery of Health Care
Lipids
Education
Equipment and Supplies
Growth
Population

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Evaluation of a program to improve intermediate diabetes outcomes in rural communities in the Dominican Republic. / Dethlefs, Henry J.; Walker, Elizabeth A.; Schechter, Clyde B.; Dowd, Rachel; Filipi, Linda; Garcia, Juan Francisco; Filipi, Charles.

In: Diabetes Research and Clinical Practice, Vol. 148, 01.02.2019, p. 212-221.

Research output: Contribution to journalArticle

Dethlefs, Henry J. ; Walker, Elizabeth A. ; Schechter, Clyde B. ; Dowd, Rachel ; Filipi, Linda ; Garcia, Juan Francisco ; Filipi, Charles. / Evaluation of a program to improve intermediate diabetes outcomes in rural communities in the Dominican Republic. In: Diabetes Research and Clinical Practice. 2019 ; Vol. 148. pp. 212-221.
@article{3cdfc3e20aca40ea850703c4d043973b,
title = "Evaluation of a program to improve intermediate diabetes outcomes in rural communities in the Dominican Republic",
abstract = "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/m2, 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.",
author = "Dethlefs, {Henry J.} and Walker, {Elizabeth A.} and Schechter, {Clyde B.} and Rachel Dowd and Linda Filipi and Garcia, {Juan Francisco} and Charles Filipi",
year = "2019",
month = "2",
day = "1",
doi = "10.1016/j.diabres.2019.01.010",
language = "English (US)",
volume = "148",
pages = "212--221",
journal = "Diabetes Research and Clinical Practice",
issn = "0168-8227",
publisher = "Elsevier Ireland Ltd",

}

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

PY - 2019/2/1

Y1 - 2019/2/1

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/m2, 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/m2, 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.

UR - http://www.scopus.com/inward/record.url?scp=85060546345&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85060546345&partnerID=8YFLogxK

U2 - 10.1016/j.diabres.2019.01.010

DO - 10.1016/j.diabres.2019.01.010

M3 - Article

VL - 148

SP - 212

EP - 221

JO - Diabetes Research and Clinical Practice

JF - Diabetes Research and Clinical Practice

SN - 0168-8227

ER -