Michael S. Wolf|Hilary K. Seligman|Terry C. Davis|David A. Fleming|Laura M. Curtis|Anjali U. Pandit|Ruth M. Parker|Dean Schillinger|Darren A. DeWalt
Clinic-Based Versus Outsourced Implementation of a Diabetes Health Literacy Intervention
Northwestern University|San Francisco General Hospital|University of California, San Francisco|Louisiana State University Health Sciences Center Shreveport|University of Missouri|Northwestern University|Northwestern University|Emory and Henry College|San Francisco General Hospital|University of California, San Francisco|University of North Carolina Health Care
compared two implementation approaches health literacy diabetes intervention designed community health centers quasiexperimental clinicrandomized evaluation conducted six community health centers rural suburban urban locations missouri august 2008 january 2010 486 adult patients type 2 diabetes mellitus participated clinics set implement either 1 clinicbased approach involved practice redesign routinely provide brief diabetes education counseling services set actionplans perform followup without additional financial resources carvein 2 outsourced approach clinics referred patients telephonebased diabetes educator services carveout fidelity intervention determined number contacts patients selfreport services received patient satisfaction intervention effectiveness investigated assessing patient knowledge selfefficacy health behaviors clinical outcomes carveout patients received average 43 contacts sd 22 telephonebased diabetes educator versus 17 contacts sd 20 clinic nurse carvein arm p 0001 also likely recall setting action plans rated process positively carvein patients p 0001 differences diabetes knowledge selfefficacy health behaviors found two approaches however clinical outcomes vary multivariable analyses carveout patients lower hba1c 031 95 ci 056 006 p 002 systolic blood pressure 365 95 ci 639 090 p 001 lowdensity lipoprotein ldl cholesterol 796 95 ci 1008 583 p 0001 6 months outsourced diabetes education counseling approach community health centers appears feasible clinicbased models patients receiving carveout strategy also demonstrated better clinical outcomes compared receiving carvein approach study limitations unclear causal mechanisms explaining change patient behavior suggest research needed