Modica Cheryl, Lewis Joy H, Bay R Curtis
National Association of Community Health Centers, Bethesda, MD, USA.
Medicine and Public Health, SOMA Department of Public Health, School of Osteopathic Medicine in Arizona, A.T. Still University, Meza, AZ, USA.
J Multidiscip Healthc. 2021 Oct 27;14:3005-3014. doi: 10.2147/JMDH.S284885. eCollection 2021.
Diabetes and pre-diabetes impact more than 114 million Americans. Federally qualified health centers (FQHCs) provide care to some of the most high-risk and underinsured individuals throughout the US, twenty-one percent of whom report being told they have diabetes, compared to 11% of the general adult population. It is widely agreed our health care system requires a transformation to effectively address diabetes and its complications.
By applying the Value Transformation Framework (VTF) in health centers, the National Association of Community Health Centers (NACHC) aims to show improvements in diabetes control. This systematic strategy to transform the way health centers operate can lead to improvements in health outcomes, patient and staff experiences, costs, and equity (Quintuple Aim). Special attention is paid to the health centers' infrastructure, people systems and care delivery systems.
Evidence-based diabetes interventions, the learning community model, and the VTF were used together to drive system improvements and activate proven diabetes control practices within eight health centers. Multidisciplinary teams at select health centers in Georgia and Iowa, with their partner primary care associations, participated in this NACHC-led quality improvement project.
During the one-year intervention (January 2017-December 2017), the mean raw percentage of patients with HbA1c Poor Control decreased from 50.9% (range, 23.7-70.4%) in January to 27.5% (range, 13.6-37.4%) in December. This represents a relative improvement in diabetes control of 46%. The 1-year-intervention data also showed trends in the desired direction with statistically significant improvements related to the following interventions: a formal written clinical policy, standing orders, patient recall/outreach, performance data shared at the provider/team-level, and performance data shared at the site/organization level.
A conceptual model focused on transforming health center systems, organized by the NACHC Value Transformation Framework and supported by a strong learning community, can lead to better diabetes control outcomes among patients seen at health centers.
糖尿病和糖尿病前期影响着超过1.14亿美国人。联邦合格健康中心（FQHCs）为美国一些风险最高且保险不足的人群提供医疗服务，这些人群中有21%的人报告称被告知患有糖尿病，而普通成年人群中的这一比例为11%。人们普遍认为，我们的医疗保健系统需要进行变革，以有效应对糖尿病及其并发症。
通过在健康中心应用价值转型框架（VTF），美国社区健康中心协会（NACHC）旨在改善糖尿病控制情况。这种改变健康中心运营方式的系统策略能够带来健康结果、患者及工作人员体验、成本和公平性（五重目标）方面的改善。特别关注健康中心的基础设施、人员系统和护理提供系统。
基于证据的糖尿病干预措施、学习社区模式和价值转型框架共同用于推动系统改进，并在八个健康中心激活已证实的糖尿病控制实践。佐治亚州和爱荷华州选定健康中心的多学科团队及其合作的初级保健协会参与了这个由NACHC牵头的质量改进项目。
在为期一年的干预期间（2017年1月至2017年12月），糖化血红蛋白（HbA1c）控制不佳患者的平均原始百分比从1月份的50.9%（范围为23.7 - 70.4%）降至12月份的27.5%（范围为13.6 - 37.4%）。这代表糖尿病控制方面相对改善了46%。为期1年的干预数据还显示出朝着预期方向发展的趋势，与以下干预措施相关的改善具有统计学意义：正式的书面临床政策、长期医嘱、患者召回/外展、在提供者/团队层面共享的绩效数据以及在机构/组织层面共享的绩效数据。
由NACHC价值转型框架组织并由强大的学习社区支持的、专注于转变健康中心系统的概念模型，能够在健康中心就诊的患者中带来更好的糖尿病控制结果。
