Cross-site evaluation of the Alliance to Reduce Disparities in Diabetes: clinical and patient-reported outcomes

Abstract

Alliance programs implemented multilevel, multicomponent programs inspired by the chronic care model and aimed at reducing health and health care disparities for program participants. A unique characteristic of the Alliance programs is that they did not use a fixed implementation strategy common to programs using the chronic care model but instead focused on strategies that met local community needs. Using data provided by the five programs involved in the Alliance, this evaluation shows that of the 1,827 participants for which baseline and follow-up data were available, the program participants experienced significant decreases in hemoglobin A1c and blood pressure compared with a comparison group. A significant time by study group interaction was observed for hemoglobin A1c as well. Over time, more program participants met quality indicators for hemoglobin A1c and blood pressure. Those participants who attended self-management classes and experienced more resources and support for self-management attained more benefit. In addition, program participants experienced more diabetes competence, increased quality of life, and improvements in diabetes self-care behaviors. The cost-effectiveness of programs ranged from $23,161 to $61,011 per quality-adjusted life year. In sum, the Alliance programs reduced disparities and health care disparities for program participants.

Keywords: diabetes; health disparities; quantitative evaluation.

FIGURE 1. Model-Adjusted Mean HbA1c, by Measurement Order and RSSM: Alliance to Reduce Disparities in Diabetes Program Participants Only

NOTE: HbA1c = hemoglobin A1c; RSSM = resources and support for self-management. Means adjusted for site, age, gender, measurement order, RSSM, and interaction between measurement order and RSSM. Changes in HbA1c values over time differed significantly for patients with different RSSM values: RSSM × measurement order: Wald χ²(3) = 12.80, p = .005.

FIGURE 2. Model-Adjusted Mean HbA1C Values, by Measurement Order and Attending All Program Classes: Alliance to Reduce Disparities in Diabetes Program Participants Only

NOTE: HbA1c = hemoglobin A1c .Means adjusted for site, age, gender, measurement order, class attendance, and interaction between measurement order and class attendance. Changes in HbA1c values over time differed significantly across patients, depending on class attendance: class attendance × measurement order: Wald χ²(3) = 9.93, p = .019.