260034 Reducing disparities and improving outcomes in unmanaged patients with Diabetes Mellitus cared for at a large Community Health Center in Miami, Florida

Tuesday, October 30, 2012

Nicole Cook, PhD, MPA , Master of Public Health Program, College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL
Loyda Lavado Rosales, MD , Nova Southeastern University, Fort Lauderdale, FL
Gabriel Suciu, MSPH, PhD , Public Health Program, Nova Southeastern University, Fort Lauderdale, FL
Sainth Anthony Amofah, MD, MBA , Chief Medical Officer, Community Health of South Florida, Inc., Miami, FL
  
It is estimated that more than $512 billion could be spent in the US on Diabetes Mellitus (DM) related care by 2021. Management of DM can reduce associated complications of the disease. According to the NIH, every percentage point drop in HgBA1c blood test correlates to a 40% decrease in the risk of developing DM complications. Community Health Centers (CHCs), our nation's primary care safety net for vulnerable populations, who suffer disproportionately from DM and related complications, have initiated numerous strategies to support the management of DM including disease management, chronic care collaborative, and patient centered medical home. This paper investigates the role of one large innovative CHC in Miami FL, Community Health of South Florida, Inc. (CHI) in improving the management of a group of unmanaged (HgbA1c>9) patients with DM from 10/1/09 to 9/30/11. This retrospective cohort study uses data from an established Electronic Health Record to further investigate improvement in HgbA1c by a number of demographic variables including gender, race/ethnicity, age, marital status and primary language. Results demonstrate that for this high-risk group of patients with DM who received care over the two year period, average HgBa1c dropped 1.27 points (P<.0001). Interestingly, demographic variables included in the GLM regression model did not identify significant explanation for the reduction of A1c, suggesting that CHI provides quality care to all individuals seen across their sites and that all regularly seen patients may have an equal opportunity to achieve improved DM management over time. Results support the important role of CHCs in managing patients with DM.

Learning Areas:
Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Epidemiology

Learning Objectives:
- Evaluate the role of the Community Health Center in caring for unmanaged patients with Diabetes Mellitus, including the implementation of disease management and panel management - Analyze factors (race, ethnicity, gender, age, marital status, language) on Diabetes Mellitus improvement among patients cared for at a large Community Health Center - Assess the role of electronic health record data to conduct epidemiologic investigation of chronic disease

Keywords: Health Disparities, Community Health Centers

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Prior to joining Nova Southerastn University last year, I spent 8 years in management at Health Choice Network, Inc. a large network of FQHCs. Among my roles included Sr. Director, Epidemiology, Director, Care Management and AVP, Clinical Data and Evaluation. I have directed multiple federal and state funded grants in disease mangement, EHR clinical outcome reporting and meaningful use preparedness.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 4170.0: Social and Behavioral Epidemiology Poster Session