A systematic approach to diabetes mellitus care in underserved populations: improving care of minority and homeless persons.

BACKGROUND AND OBJECTIVES Discrepancy in care of diabetes between racial and ethnic minority groups and Caucasians is well documented in America. System-based practices have been shown to improve quality of care outcomes. We implemented a disease registry and management system proven successful in a suburban practice network in four community health centers to improve diabetes process outcomes. METHODS Diabetes care measures including HbA1C, LDL, microalbumin testing, and testing for retinopathy were compared for suburban practices and Community Health Center practices within the same health system. A comprehensive systems-based disease management process including a diabetes registry that had been successful with the suburban practices was implemented at the Community Health Centers. Diabetes care measures were followed to determine whether disparity in care could be improved with process-based initiatives. RESULTS Following implementation of a diabetes registry and system-based disease management process, the percent of Community Health Center patients meeting guidelines improved significantly in all quality measures except the percentage of patients with HbA1C>9%. Despite this improvement, there remained a statistically significant discrepancy in performance between the Community Health Clinics and the suburban practices in most measures including percentage of patients with HbA1C<7%, HbA1C>9%, LDL<130, LDL<100, and percentage of patients with retinopathy screen or microalbumin test within the past year, with the Community Health Centers lagging behind in all comparisons. CONCLUSIONS A structured systems-based approach to care of minority and at-risk populations utilizing diabetes registries resulted in significant improvement in clinical outcomes and helped to reduce but not eliminate disparities in diabetes outcome measurements between vulnerable and Caucasian populations.