PubMed · 2279947
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S Banks-Lang. 1990. Community-based primary care.. https://pubmed.ncbi.nlm.nih.gov/2279947/
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A LIFT development in St Helens brings together public, private and church organisations. A new health centre in a run-down area is planned to spur on wider socio-economic regeneration. Improving the range of services and physical access promises an influx of both retailers and consumers.
This column focuses on Eighth Street Bridge, a street newsletter printed in Sioux Falls, South Dakota. The evolution of the newsletter is depicted along with a discussion of the essence of a learning community. Teaching-learning endeavors associated with the newsletter are explicated and activities of this collaborative community effort are presented in light of Parse's community change concepts.
OBJECTIVE: To evaluate the Diabetes Health Disparities Collaborative, an initiative by the Bureau of Primary Health Care to reduce health disparities and improve the quality of diabetes care in community health centers. RESEARCH DESIGN AND METHODS: One year before- after trial. Beginning in 1998, 19 Midwestern health centers undertook a diabetes quality improvement initiative based on a model including rapid Plan-Do-Study-Act cycles from the continuous quality improvement field; a Chronic Care Model emphasizing patient self-management, delivery system redesign, decision support, clinical information systems, leadership, health system organization, and community outreach; and collaborative learning sessions. We reviewed charts of 969 random adults for American Diabetes Association standards, surveyed 79 diabetes quality improvement team members, and performed qualitative interviews. RESULTS: The performance of several key processes of care assessed by chart review increased, including rates of HbA(1c) measurement (80-90%; adjusted odds ratio 2.1, 95% CI 1.6-2.8), eye examination referral (36-47%; 1.6, 1.1-2.3), foot examination (40-64%; 2.7, 1.8-4.1), and lipid assessment (55-66%; 1.6, 1.1-2.3). Mean value of HbA(1c) tended to improve (8.5-8.3%; difference -0.2, 95% CI -0.4 to 0.03). Over 90% of survey respondents stated that the Diabetes Collaborative was worth the effort and was successful. Major challenges included needing more time and resources, initial difficulty developing computerized patient registries, team and staff turnover, and occasional need for more support by senior management. CONCLUSIONS: The Health Disparities Collaborative improved diabetes care in health centers in 1 year.