Center for Outcomes Research & Education (CORE), Providence St. Joseph Health, 5251 NE Glisan Street, Portland, OR, 97213, USA.
Community Health Division, Providence Health and Services, Portland, OR, USA.
J Gen Intern Med. 2023 Mar;38(Suppl 1):38-44. doi: 10.1007/s11606-022-07920-8. Epub 2023 Mar 2.
The Providence Diabetes Collective Impact Initiative (DCII) was designed to address the clinical challenges of type 2 diabetes and the social determinants of health (SDoH) challenges that exacerbate disease impact.
We assessed the impact of the DCII, a multifaceted intervention approach to diabetes treatment that employed both clinical and SDoH strategies, on access to medical and social services.
The evaluation employed a cohort design and used an adjusted difference-in-difference model to compare treatment and control groups.
Our study population consisted of 1220 people (740 treatment, 480 control), aged 18-65 years old with a pre-existing type 2 diabetes diagnosis who visited one of the seven Providence clinics (three treatment and four control) in the tri-county area of Portland, Oregon, between August 2019 and November 2020.
The DCII threaded together clinical approaches such as outreach, standardized protocols, and diabetes self-management education and SDoH strategies including social needs screening, referral to a community resource desk, and social needs support (e.g., transportation) to create a comprehensive, multi-sector intervention.
Outcome measures included SDoH screens, diabetes education participation, HbA1c, blood pressure, and virtual and in-person primary care utilization, as well as inpatient and emergency department hospitalization.
Compared to patients at the control clinics, patients at DCII clinics saw an increase in diabetes education (15.5%, p<0.001), were modestly more likely to receive SDoH screening (4.4%, p<0.087), and had an increase in the average number of virtual primary care visits of 0.35 per member, per year (p<0.001). No differences in HbA1c, blood pressure, or hospitalization were observed.
DCII participation was associated with improvements in diabetes education use, SDoH screening, and some measures of care utilization.
普罗维登斯糖尿病综合影响倡议（DCII）旨在解决 2 型糖尿病的临床挑战以及加剧疾病影响的健康社会决定因素（SDoH）挑战。
我们评估了 DCII 的影响，这是一种针对糖尿病治疗的多方面干预方法，既采用了临床策略，也采用了 SDoH 策略，对医疗和社会服务的获取产生了影响。
该评估采用了队列设计，并使用调整后的差异差异模型来比较治疗组和对照组。
我们的研究人群包括 1220 人（740 例治疗组，480 例对照组），年龄在 18-65 岁之间，患有 2 型糖尿病，在 2019 年 8 月至 2020 年 11 月期间，他们在俄勒冈州波特兰市三县地区的七家普罗维登斯诊所之一（三家治疗组和四家对照组）就诊。
DCII 将外联、标准化协议和糖尿病自我管理教育等临床方法与 SDoH 策略（如社会需求筛查、转介社区资源台、社会需求支持（如交通））结合在一起，形成了一个全面的、多部门的干预措施。
结果措施包括 SDoH 筛查、糖尿病教育参与、HbA1c、血压以及虚拟和现场初级保健利用情况，以及住院和急诊部门住院情况。
与对照组诊所的患者相比，DCII 诊所的患者接受糖尿病教育的比例有所增加（15.5%，p<0.001），接受 SDoH 筛查的可能性略高（4.4%，p<0.087），每位患者每年虚拟初级保健就诊次数平均增加 0.35 次（p<0.001）。未观察到 HbA1c、血压或住院治疗方面的差异。
参与 DCII 与提高糖尿病教育利用率、SDoH 筛查以及某些护理利用指标有关。
