Quality of Diabetes and Hypertension Management at the DAWN (Dedicated to Aurora's Wellness and Needs) Student-Run Free Clinic

Abstract

Introduction Student-Run Free Clinics (SRFCs) are part of the safety-net healthcare system. Given variable settings and models, relatively little is known about the quality of care in these settings. Methods A mixed-methods evaluation of diabetes and hypertension management was conducted for patients initiating care from March 1, 2015, to September 31, 2016, at the DAWN (Dedicated to Aurora's Wellness and Needs) SRFC. Retrospective chart review assessed whether patients received recommended screening tests (process outcomes) and achieved disease control (short-term outcomes). These outcomes were compared to a local community health center (CHC), a local federally qualified health center (FQHC) network, and Colorado Medicaid (CoM) using one proportion t-tests. In-depth case studies of randomly selected individuals with good and poor disease control identified targets for quality improvement through nominal group technique. Results Diabetic patients (n=30) were recommended screening, including HbA1c (93.3%) (vs. 77.8% with CoM, p=0.04), nephropathy care (70%) (vs. 85.4% with CoM, p=0.02), retinopathy examination (30%) (vs. 40.47% with CoM, p=0.24). Diabetic short-term outcomes showed 46.6% with poor control (vs. 61.1% at the CHC, p=0.10; vs. 30.62% at the FQHC, p=0.06; vs. 55% with CoM, p=0.10). Patients with hypertension (n=75) 33.3% had controlled (<140/90) blood pressure (vs. 49.2% at the CHC, p<0.01; vs. 61.1% at the FQHC, p<0.01; vs. 58.9% with CoM, p<0.01). Themes for quality improvement included improving follow-up, documentation and data collection, clinic processes, and addressing barriers to care. Discussion DAWN outcomes were comparable to other safety-net providers for diabetes, similar to findings in evaluations conducted by other SRFCs. However, DAWN did not have equivalent outcomes for hypertension in contrast to other published findings from SRFCs. Poor access to care and baseline chronic disease control among DAWN patients may have contributed to these findings. Conclusions While this study is not directly generalizable to all SRFC models and communities, these results contribute to the growing body of data around SRFCs and chronic disease management and indicate that SRFCs may have a role in the safety-net healthcare system. However, more study is needed to ensure that SRFCs can provide high-quality care because otherwise efforts should focus on other strategies to expand access within the safety-net system.

Keywords: chronic disease management; diabetes; health care disparity; health care outcomes; hypertension; interprofessional care; quality improvement; student run free clinic; student-run clinic; unequal access to health care.

Figure 1. DAWN Diabetes Process Outcomes

*p<0.05 DAWN, Dedicated to Aurora’s Wellness and Needs

Figure 2. DAWN Diabetes and Hypertension Short-Term Outcomes

*p<0.05 ^p<0.01 DAWN, Dedicated to Aurora’s Wellness and Needs; CHC, community health center; FQHC, local federally qualified health center; CO, Colorado; DM, diabetes mellitus; BP, blood pressure