Improving access to diabetes care in an inner-city community-based outpatient health center with a monthly open-access multistation group visit program.

摘要

OBJECTIVE: To describe the development and implementation of a multifaceted program in an inner-city healthcare center designed to improve access to care and empower patients to take a more active role in managing diabetes. PROCEDURES: AHC is one of 30 outpatient health centers in the Ambulatory and Community Health Network of the Cook County Bureau of Health Services. AHC serves a predominantly African-American population with four full-time-equivalent primary care providers treating approximately 700 diabetes patients with >450 waitlisted patients, many with diabetes. Budget constraints limit capacity to add providers. In January 2005, open-access, multi-station group visits were implemented to improve access to care and empower patients to take a more active role in managing diabetes. The program is called Diabetic Rewards Issued Via Everyone (DRIVE) Day. Elements include: 1. group visits held monthly; 2. patient-selected activities, including diabetes education, nutrition, exercise, group discussions and Q&A sessions; 3. provider support, including implementation of evidence-based guidelines for glycemic, lipid and hypertension management, retinal screening, foot exams and medication adjustment; and 4. web-based patient registry FINDINGS: Of the clinic's 737 diabetes patients, 294 (40%) have attended > or =1 DRIVE Days, for a total of 775 patient encounters between January 2005 and October 2006. CONCLUSIONS: In an environment with limited resources, DRIVE Day has improved access to care, provided an opportunity for diabetes patients to take a more active role in their care and enabled providers to see a higher volume of patients and offer efficient, comprehensive care.