The North Carolina experience with the diabetes health disparities collaboratives
Background: The Bureau of Primary Health Care (BPHC) adopted a collaborative approach that used the Chronic Care Model and quality improvement methods. The North Carolina Diabetes Prevention and Control Branch has partnered with the 12 participating community health centers since early 2000. Methods: Team leaders of the first four centers that participated in the collaboratives were interviewed. Information obtained included previous diabetes efforts, benefits of the collaborative, success factors, and barriers to sustainability. Case Study: In one of two case studies, a nonprofit community health center made Chronic Care Model-based changes to the organization of health care, clinical information systems, and delivery system design. Results: Centers tracked used the electronic registry to establish a baseline, trend key process and outcome measures, and raise the standard of care. Success factors included senior leadership support, physician champions, multidisciplinary teams, and priority of collaborative activities. Barriers included staff turnover and low priority in strategic planning. Glycohemoglobin (A1C) values from aggregated reports demonstrated improvement. Discussion: Useful strategies for future collaboratives may include providing provider-specific data, imparting vision to new team members, ensuring that leadership provides collaborative structure and resources, and pairing veteran and new participating sites.