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The Diabetes Educator, Vol. 31, No. 2,
225-234 (2005)
DOI: 10.1177/0145721705275325
Implementing the Chronic Care Model for Improvements in Diabetes Care and Education in a Rural Primary Care Practice
Linda M. Siminerio, RN, PhD, CDE,
Gretchen Piatt, MPH, CHES and
Janice C. Zgibor, RPh, PhD
From the University of Pittsburgh, Pennsylvania.
Correspondence to Linda M. Siminerio, RN, PhD, CDE, Department of Medicine,
Division of Endocrinology, University of Pittsburgh, Kaufman Building, Suite
601, 3571 Fifth Avenue, Pittsburgh, PA 15213
(simineriol{at}msx.dept-med.pitt.edu).
Purpose
The purpose of this pilot study was to determine the impact of implementing
elements of the chronic care model (CCM; decision support, self-management,
and delivery system redesign) on providers' diabetes care practices and
patient outcomes in a rural practice setting.
Methods
In this pilot study, 104 patients with type 2 diabetes and 6 providers in a
rural primary care practice were involved in an intervention that included a
certified diabetes educator (CDE) who educated and supported providers on
diabetes management and adherence to the American Diabetes Association (ADA)
Standards of Care over the year of the project. The CDE also provided diabetes
self-management education (DSME) at the office site for 29 of the 104 patients
who received their care in the practice. The following variables were
evaluated: provider perceived barriers to care and adherence to ADA standards
of care and patient A1C, blood pressure, cholesterol, knowledge, and
empowerment levels.
Results
Provider adherence to ADA Standards of Care increased significantly across
all process measures. Patients who received DSME at point of service in the
primary care practice setting gained improvements in knowledge, empowerment,
A1C, and high-density lipoprotein cholesterol levels.
Conclusions
Implementing systems to support decision support, self-management
education, and delivery system redesign has a positive influence on practices
and patient outcomes in outlying rural communities.
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