288303
Disease registry tracking shows clinically-significant improvements in quality measures for patients enrolled in a community diabetes self-management program, 2003-2009
Rebecca Butler, AB,
Division of Chronic Disease & Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA
Noel Barragan, MPH,
Division of Chronic Diease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA
Heather Readhead, MD, MPH,
Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA
Tony Kuo, MD, MSHS,
Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA
Background: In low-income clinics with minimal technological resources, simple registries can provide quality assurance and inform quality improvement. The Long Beach Department of Health and Human Services' Diabetes Prevention and Management Program (DPMP) provides self-management education and support for Spanish-speaking diabetic adults through a 12-week course led by community health workers. The DPMP registry is helping elucidate the utility of this self-management intervention in the community. Objective/purpose: We examined program quality measures using disease registry data for 47 cohorts held from 2003-2009 to assist with program quality assurance and improvement activities in the DPMP. Methods: Using the registry database, we examined demographic information, clinical data, and survey data of diabetes knowledge and disease management skills of DPMP clients. Start and end point data were averaged over all cohorts. Statistical analyses used McNemar's paired test to assess change in dichotomous quality measures in individuals and paired t-test to assess change in hemoglobin A1c. Results: During 2003-2009, 846 clients enrolled in the DPMP. Most were foreign-born (96%) and female (78%). Improvements were demonstrated in diabetes knowledge, disease management, primary care access, and clinical measures. Using McNemar's test, the percentage of clients who reported having a glucometer significantly increased from 26.7% to 95.0% (p<0.0001), and the percentage of clients who knew how to use it increased from 32.1% to 96.6% (p<0.0001). Clients who did not have a regular doctor for diabetes care decreased from 18.8% to 3.4% (p<0.0001). Mean hemoglobin A1c of the DPMP clients decreased from 8.0% to 7.3% (t(303) = -10.28, p<0.0001). Discussion/conclusions: Although the database is basic, results suggest tracking of diabetes health measures is possible in the community setting and demonstrate favorable trends in health improvements among DPMP clients. In the absence of technological capacity, a simple database can be used to assess efficacy and inform improvement.
Learning Areas:
Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Learning Objectives:
Describe the use of a basic disease registry for tracking progress in a community diabetes self-management program.
Evaluate the utility of a registry database in a community program.
Assess the trends in mean hemoglobin A1c changes among a group of clients from a community diabetes self-management program.
Keyword(s): Registry, Disease Management
Presenting author's disclosure statement:Qualified on the content I am responsible for because: I am trained in epidemiology and public health practice and have been working on the Clinical Preventive Services project of the Division of Chronic Disease and Injury Prevention of the Los Angeles County Department of Public Health for the past year and a half.
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.
