Lewis Megan A, Bann Carla M, Karns Shawn A, Hobbs Connie L, Holt Sidney, Brenner Jeff, Fleming Neil, Johnson Patria, Langwell Kathryn, Peek Monica E, Burton Joseph A, Hoerger Thomas J, Clark Noreen M, Kamerow Douglas B
RTI International, Research Triangle Park, NC, USA
RTI International, Research Triangle Park, NC, USA.
Health Promot Pract. 2014 Nov;15(2 Suppl):92S-102S. doi: 10.1177/1524839914545168.
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.
联盟项目实施了受慢性病护理模式启发的多层次、多组件项目，旨在减少项目参与者的健康和医疗保健差距。联盟项目的一个独特之处在于，它们没有采用使用慢性病护理模式的项目常见的固定实施策略，而是专注于满足当地社区需求的策略。利用联盟中五个项目提供的数据，本次评估表明，在有基线和随访数据的1827名参与者中，与对照组相比，项目参与者的糖化血红蛋白和血压显著下降。糖化血红蛋白也观察到了显著的研究组与时间交互作用。随着时间的推移，更多的项目参与者达到了糖化血红蛋白和血压的质量指标。那些参加自我管理课程并获得更多自我管理资源和支持的参与者受益更多。此外，项目参与者的糖尿病能力增强、生活质量提高，糖尿病自我护理行为也有所改善。每个质量调整生命年的项目成本效益在23,161美元至61,011美元之间。总之，联盟项目减少了项目参与者的差距和医疗保健差距。
