Chapter 6. Summary
The AHRQ Diabetes Disparities Learning Network demonstrated that clinics can make significant progress in their patient goal-setting performance even when participating in shorter learning sessions (4 hours) over an abbreviated period of time (6 months). Observations suggest that the likelihood of success is greater if clinics have:
- Experience and understanding of the quality improvement process.
- Committed leadership.
- A clinic champion.
- Employed clinicians (as opposed to volunteer clinicians).
- A chronic disease registry.
- Clinician involvement in goal setting.
Further study is needed to determine if learning networks limited to a duration of 6 months have a comparable rate of sustainability to interventions lasting 12 to 18 months.
For this learning network the Action Plan was felt to be a helpful tool in the goal-setting process with Hispanic patients, but one clinic was successful without using the tool. The Activation Assessment Tool was felt to be beyond the literacy level of clinic patients.
Many lessons were learned relative to the Chronic Care Model and this goal-setting intervention that can apply to any community clinic setting. However, specific recommendations for improving health outcomes with Hispanics included:
- Inviting and recruiting family members to participate in care.
- Creating an environment in the clinic and diabetes classes that is comfortable for Latinos.
- Considering the low literacy level when planning materials for Latinos (e.g., using simple drawings and lower reading-level written materials).
- Recognizing that merely translating an English tool or educational materials into Spanish may be inadequate if the concepts are not understood by Latinos.
- Obtaining cell phone numbers for contact purposes and an emergency contact number.
- Understanding that food is important to this culture, and patients and their families need appetizing and healthy substitutes.
- Recognizing that a myth exists among Hispanics that insulin actually causes many of the complications of diabetes.
- Realizing that in the Hispanic culture the clinician is seen as an authority figure, the expert, and the one that tells patients what to do. This attitude may present a challenge for patient participation in interactive goal setting.
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Current as of March 2008
AHRQ Publication No. 08-0044-EF
Hispanic Diabetes Disparities Learning Network in Community Health Centers. AHRQ Publication No. 08-0044-EF, March 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/diabetesnetwork/