Alliance to Reduce Disparities in Diabetes

Lessons Learned, 2012

Across the Alliance, the five grantee partners have learned and are continuing to learn that efforts to reduce diabetes disparities in high risk populations need more than skilled and committed diabetes educators and patients. Most lessons suggest changes that need to be implemented at the physician, health system and even policy levels. 

  • Financial incentives are needed for sustaining new models of health care delivery, e.g. reimbursement for incorporating CHW into care management teams.
  • Developing a shared vision for diabetes care coordination takes time and requires "champions", direct communication, trust, and shared goals. Transformation is most successful with a variety of ways to engage based on practice/clinic interests and capacity and with coaching support.
  • As interventions are delivered in new clinic settings and ongoing delivery is transferred to members of clinic teams, a balance between exposure, adherence and adaptability is needed. Data are needed to determine which elements of each component are essential and which can or should be adapted to the new staff and settings.
  • Training and competence (certification, skills verification, diabetes instruction, formalized protocols, and centralized management) of emerging team roles (e.g., the CHW) are essential to acceptance of new roles by PCP/clinic staff.
  • Electronic medical record access and communication between the PCP and the CHW can facilitate the acceptance and effectiveness of emerging care management model.