Herges Joseph R, Stonerock Lauren R, Cole Kristin, McCoy Rozalina G
Department of Pharmacy, Mayo Clinic, Rochester, Minnesota
Department of Pharmacy, Trinity Health, Grand Rapids, Michigan.
Ann Fam Med. 2025 Jul 28;23(4):344-349. doi: 10.1370/afm.240210.
The Enhanced Primary Care Diabetes (EPCD) model is nurse led and leverages interdisciplinary support to improve diabetes quality indicators. The model has been found to be effective overall; however, because narrowing health disparities is a key objective, we aimed to assess differential effectiveness of the model among various racial and ethnic groups.
This retrospective cohort study compared the time to meeting the D5, a publicly reported quality measure (composite indicator of glycemic and blood pressure control, aspirin use for secondary prevention of cardiovascular disease, statin use, and documented abstinence from tobacco use), after enrollment in the EPCD program by Black, Hispanic/Latine, and Asian patients compared with White patients with diabetes (age 18-75 years) receiving care at 13 primary care practices by multivariable Cox proportional hazards regression. Patients enrolled in the program from January 1, 2020 to December 31, 2020; the study period end date was August 1, 2022.
The EPCD program enrolled 1,749 patients (none of whom met the D5 at entry) and 1,061 (60.7%) met the D5 during the study period. Black patients were less likely to meet the D5 compared with White patients (adjusted hazard ratio 0.68; 95% CI, 0.52-0.90; = .007); there was no difference among Asian and Hispanic patients compared with White patients. Compared with White patients (median 1.1/year; interquartile range [IQR] 0.4, 2.7), Asian patients had fewer nurse touch points (median 0.8/year; IQR 0, 1.4) during the study period, whereas Black patients had more (median 2.2/year; IQR 0.6, 4.0) and Hispanic patients showed no significant difference.
Time to meeting the D5 was longer for Black patients compared with White patients in the EPCD model, despite greater engagement with the care team. Further research is needed to identify factors driving these disparities.
强化初级护理糖尿病（EPCD）模式由护士主导，并利用多学科支持来改善糖尿病质量指标。该模式总体上已被证明是有效的；然而，由于缩小健康差距是一个关键目标，我们旨在评估该模式在不同种族和族裔群体中的差异有效性。
这项回顾性队列研究比较了黑人、西班牙裔/拉丁裔和亚裔患者在参加EPCD项目后达到D5（一项公开报告的质量指标，包括血糖和血压控制、用于心血管疾病二级预防的阿司匹林使用、他汀类药物使用以及记录在案的戒烟情况的综合指标）的时间，与在13家初级护理机构接受治疗的18至75岁糖尿病白人患者进行比较，采用多变量Cox比例风险回归分析。患者于2020年1月1日至2020年12月31日参加该项目；研究期结束日期为2022年8月1日。
EPCD项目招募了1749名患者（入组时均未达到D5），其中1061名（60.7%）在研究期间达到了D5。与白人患者相比，黑人患者达到D5的可能性较小（调整后的风险比为0.68；95%可信区间，0.52 - 0.90；P = 0.007）；与白人患者相比，亚裔和西班牙裔患者之间没有差异。与白人患者（中位数为每年1.1次；四分位间距[IQR]为0.4，2.7）相比，研究期间亚裔患者与护士的接触点较少（中位数为每年0.8次；IQR为0，1.4），而黑人患者较多（中位数为每年2.2次；IQR为0.6，4.0），西班牙裔患者无显著差异。
在EPCD模式中，黑人患者达到D5的时间比白人患者长，尽管他们与护理团队的接触更多。需要进一步研究以确定导致这些差异的因素。
