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Translating the Chronic Care Model Into the Community

Results from a randomized controlled trial of a multifaceted diabetes care intervention

¹ Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
² University of Pittsburgh Diabetes Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
³ Waikato Clinical School, University of Auckland, Hamilton, New Zealand
⁴ Department of Internal Medicine, University of Pittsburgh Medical Center, McKeesport, Pennsylvania

Address correspondence and reprint requests to Gretchen Piatt, MPH, CHES, Kaufmann Building, Suite 601, 3471 Fifth Ave., Pittsburgh, PA 15213. E-mail: piattg{at}upmc.edu

OBJECTIVE—To determine whether using the chronic care model (CCM) in an underserved community leads to improved clinical and behavioral outcomes for people with diabetes.

RESEARCH DESIGN AND METHODS—This multilevel, cluster-design, randomized controlled trial examined the effectiveness of a CCM-based intervention in an underserved urban community. Eleven primary care practices, along with their patients, were randomized to three groups: CCM intervention (n = 30 patients), provider education only (PROV group) (n = 38), and usual care (UC group) (n = 51).

RESULTS—A marked decline in HbA_1c was observed in the CCM group (–0.6%, P = 0.008) but not in the other groups. The magnitude of the association remained strong after adjustment for clustering (P = 0.01). The same pattern was observed for a decline in non-HDL cholesterol and for the proportion of participants who self-monitor blood glucose in the CCM group (non-HDL cholesterol: –10.4 mg/dl, P = 0.24; self-monitor blood glucose: +22.2%, P < 0.0001), with statistically significant between-group differences in improvement (non-HDL cholesterol: P = 0.05; self-monitor blood glucose: P = 0.03) after adjustment. The CCM group also showed improvement in HDL cholesterol (+5.5 mg/dl, P = 0.0004), diabetes knowledge test scores (+6.7%, P = 0.07), and empowerment scores (+2, P = 0.02).

CONCLUSIONS—These results suggest that implementing the CCM in the community is effective in improving clinical and behavioral outcomes in patients with diabetes.

Abbreviations: ADA, American Diabetes Association • CCM, chronic care model • CDE, certified diabetes educator • DSMT, diabetes self-management training • WHO-QWB10, World Health Organization (Ten) Quality of Well-Being • RCT, randomized controlled trial

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