Improving diabetes care among low-income North Carolinians: Project IDEAL.

Abstract

OBJECTIVES: Many barriers exist in implementing evidence-based guidelines for diabetes care, particularlyfor low-income patients. To address this, the North Carolina Project IDEAL (Improving Diabetes Education, Access to Care, and Living) Diabetes Initiative was created STUDY DESIGN/SETTING: Fourteen programs representing different types of agencies and intervention strategies across the state participated in the initiative. DATA COLLECTION: Separate random samples of medical charts of participating patients were reviewed at baseline (n=429) and three-year follow-up (n=656) to assess changes in six process (assessment of hemoglobin A1c, cholesterol blood pressure, and urinary protein; conduction of foot and retina examination) and three outcome (glycemia, blood pressure, and lipid control) measures. Four national guidelines (DQIP, HEDIS, NCEP and ADA) were used as benchmarks. RESULTS: Large increases were observed for some measures (hemoglobin A1c control and testing, LDL-cholesterol testing), while modest increases were observed for others (dilated eye exam, blood pressure testing, and control). CONCLUSIONS/RELEVANCE: Project IDEAL was successful in improving access to high-quality diabetes care for low-income patients. Additional effort is needed to address specific areas of concern, particularly retinopathy screening.