dc.contributor.advisor | Fawcett, Stephen B | |
dc.contributor.author | Sepers, Charles Ethon | |
dc.date.accessioned | 2017-01-08T18:45:47Z | |
dc.date.available | 2017-01-08T18:45:47Z | |
dc.date.issued | 2015-05-31 | |
dc.date.submitted | 2015 | |
dc.identifier.other | http://dissertations.umi.com/ku:14089 | |
dc.identifier.uri | http://hdl.handle.net/1808/22517 | |
dc.description.abstract | Minority individuals experience a disproportionately greater incidence and prevalence of type 2 diabetes. Innovative approaches are needed to reduce health disparities and associated harms among vulnerable populations with diabetes. This thesis examines the effects of the implementation of a coordinated care model with underserved populations in Patient Centered Medical Homes (PCMH) at four sites (Florida, Ohio, Oklahoma, and Tennessee). The model featured diabetes self-management education (DSME) and a patient support intervention delivered within the PCMH context. The components of the comprehensive intervention included DSME, support for managing diabetes and distress, enhanced access and linkage to care, and improvement to quality of care. The primary dependent measures in this study included four clinical health measures—glycosylated hemoglobin (A1C), blood pressure, body mass index, and lipids—and the AADE7 Self-Care BehaviorsTM. Coordinated care teams that delivered the intervention included primary care physicians, nurse care coordinators, certified diabetes educators, health behavior coaches, and diabetes patient supporters. Community health workers and medical assistants provided additional individualized support to patients. Care teams provided DSME as well as customized and coordinated patient support within a PCMH setting. This study was part of a larger participatory evaluation of the Bristol-Myers Squibb Foundation’s Together on Diabetes initiative. A statistically significant decrease was seen in A1C, the primary clinical health outcome. This decrease was seen across all four implementation sites; ranging from a decrease of 0.4% to 0.9% after 6 months. This improved A1C level was associated with implementation of the DSME and support intervention. Substantial policy and practice changes were also brought about at two of the four PCMH sites. Use of DSME within the PCMH model is a promising strategy for reducing clinical markers for diabetes among vulnerable populations. Systems changes, including policy and practice changes, have the potential to have lasting effects within PCMH practice for reducing the burden of diabetes. | |
dc.format.extent | 92 pages | |
dc.language.iso | en | |
dc.publisher | University of Kansas | |
dc.rights | Copyright held by the author. | |
dc.subject | Public health | |
dc.subject | coordinated care | |
dc.subject | Diebetes self-management education | |
dc.subject | Patient-Centered Medical Homes | |
dc.title | Measuring the Implementation and Effects of a Coordinated Care Model Featuring Diabetes Self-Management Education within Four Patient-Centered Medical Homes | |
dc.type | Thesis | |
dc.contributor.cmtemember | DiGennaro Reed, Florence | |
dc.contributor.cmtemember | Schultz, Jerry A | |
dc.thesis.degreeDiscipline | Applied Behavioral Science | |
dc.thesis.degreeLevel | M.A. | |
dc.rights.accessrights | openAccess | |