After reviewing your MONAHRQ-generated information for diabetes, you may be ready to take steps to improve the quality of care of diabetes in your area.
The MyQI Improving Diabetes Care Quality portal provides a framework, action steps, and resources for planning and implementing initiatives to improve the quality of diabetes care in the community, thereby reducing hospitalizations for diabetes patients.
The goals of improving the quality of diabetes care are to close gaps between current and best medical practice, improve access to care, and eliminate disparities.
Resources and links in this portal answer these questions:
Why is Quality Diabetes Care Important?
The quality of diabetes care can vary widely across communities and population groups. Gaps in care can lead to complications or death and can increase costs.
Information from government agencies illustrates why diabetes has been a target for quality improvement efforts:
 The prevalence has been increasing.
Obesity increases the risk for diabetes. Over the past 20 years, obesity has dramatically increased in the U.S.
 There are wide racial and ethnic disparities in diabetes diagnosis, treatment, and outcomes (after linking to the NHQR report, see page 50 for diabetes information).
Diabetes can be effectively treated and controlled.
Poorly controlled diabetes is costly. 
Diabetes complications are preventable.
More information on the importance of improving the quality of care for diabetes is available from AHRQ.
Diabetes is a disease in which blood sugar levels are too high because the body does not produce or properly use insulin. Effective blood sugar management can delay the onset of diabetes.
Persons with diabetes are at risk for serious complications, including blindness, leg amputations, kidney failure, and premature death. A growing number of people are affected by diabetes each year, but it can take several years before the warning signs are noticed and the disease is diagnosed.
Learn more by following the links below.
The National Institute of Diabetes and Digestive and Kidney Diseases describes how diabetes is diagnosed and treated, differences between types 1 and 2, and ways to manage the disease.
Link to resources on diabetes prevention, risk factors, and complications from the NIH's MedlinePlus.
 Prevalence, risk factors, symptoms, and control of diabetes are discussed in this diabetes podcast from the Centers for Disease Control and Prevention (CDC).
Link to other CDC podcasts by entering "diabetes" as a search term.
 This CDC video features simple steps that can delay or prevent type 2 diabetes.
More than 23 million people in the U.S. suffer from diabetes.
Follow these links for additional diabetes statistics from the CDC:
Diabetes prevalence, incidence, mortality, costs, and complications
State and national trends, county level estimates, national surveillance data, and national estimates on diabetes-related complications
Information about health disparities in diabetes among minority populations
How Can I Plan for Diabetes Quality Improvement?
Steps Toward Improving Health Care Quality
Step 1. Create a vision and provide leadership for quality improvement
Collect information
Select a state in AHRQ’s State Snapshots "Focus on Diabetes" tool to explore the quality of diabetes care.
Characteristics of hospital stays for patients with diabetes in 2008 are described in this HCUP Statistical Brief.
Find data on diabetes prevalence and trends from the CDC’s Behavioral Risk Factor Surveillance System
- Click on "Chronic Disease Indicators" to view state diabetes rates compared to national benchmarks. Then:
- Select state/area of interest
- Enter comparison state of interest
- Select indicator category "diabetes"
Information on state laws and programs, coverage regulations, and federal funding related to diabetes is available from the National Conference on State Legislators.
- Use their interactive map to learn about private insurance diabetes coverage requirements in your state.
This Commonwealth Fund Field Report analyzes how disease management programs lead to cost savings.
The Economic Costs of Diabetes in the U.S. in 2007 measures the economic burden of the disease.
Research into the impacts of the Chronic Care Model on disease management costs is reviewed in this article in the Journal of the American Medical Association. Diabetes care programs are discussed.
The Center for Health Care Strategies developed an ROI Calculator for Medicaid Quality Initiatives for several conditions, including diabetes. Although based on limited data, users may find the calculator a good starting point.
A User Guide is available.
Access information on hospital care for diabetes using AHRQ’s HCUPnet, a free, online query system.
An advisory council to the Indiana Diabetes Prevention and Control Program helped develop their statewide initiative for improving diabetes care quality through data surveillance and community outreach.
Tools and strategies for planning and assessing clinic-community partnerships for diabetes care are available in this report funded by the Robert Wood Johnson Foundation.
Click here for a report summary.
This article in the American Journal of Public Health shows how interventions designed through community partnerships can positively affect diabetes outcomes among population subgroups. The AHRQ Community Quality Collaborative provides organizations with tools for identifying and collaborating with stakeholders to improve the delivery of healthcare in a community.
Step 2. Work in partnership with champions/stakeholders
Present the process
The Institute for Healthcare Improvement shows you how the Plan-Do-Study-Act model can accelerate quality improvement. It can be applied to diabetes initiatives.
Click on a link to learn from experiences of others in designing diabetes quality improvement initiatives targeted to specific populations. All projects are CDC-funded.
Translating Research Into Action for Diabetes
Native Diabetes Wellness Program
U.S. Mexico Border Diabetes Prevention and Control Project
The California Diabetes Program provides a comprehensive framework with checklists, flow charts, training presentations, care guidelines, and a patient diabetes health record card to assist clinicians and organizations.
Learn about the value that community health workers bring to diabetes management programs and how to best utilize this resource.
The CDC’s Taking Charge of Your Diabetes action plan can help patients and providers manage diabetes and its complications.
Resources and information on community-based diabetes programs are available from the American Diabetes Association.
Utilize the CDC's Diabetes Indicators and Data Sources Internet Tool to support surveillance, epidemiology, and program evaluation.
Step 3. Implement improvement through the partnership
Apply the intervention
Expand diabetes screening and health education to undiagnosed and at-risk people in your community with tools from the National Diabetes Education Program.
The Improving Diabetes Efforts Across Language and Literacy project is targeted to patients with low health literacy or limited English.
Health care workers can use the Training Manual to empower patients with effective diabetes management skills.
The Diabetes Prevention Program demonstrated the positive effects and long-term benefits of lifestyle changes in delaying or avoiding type 2 diabetes and reducing risk factors for cardiovascular disease.
Learn how a disease management program successfully decreased short-term costs and clinical outcomes for diabetes patients.
This Framework for Program Evaluation in Public Health from the CDC can be applied to diabetes care quality initiatives.
The Robert Wood Johnson Foundation provides this guide to help disease management programs aimed at Medicaid and high-risk patients measure their economic impact.
Improving Chronic Illness and Care, sponsored by The Robert Wood Johnson Foundation, shares strategies for coalitions to improve regional health care quality.
Link to expert medical advice, diabetes facts, and patient support materials from the New York City Health and Hospital Corporation at their Diabetes Wellness Center Website.
Develop skills to spread organizational change using frameworks from the Institute for Healthcare Improvement.
What Additional Diabetes Resources are Available?
State and public health planners
States can help create a vision for positive change, work with key stakeholders, create quality interventions, and assess the impacts.
The New York State Health Foundation has published reports on state-wide initiatives and policies for diabetes prevention and management.
Programs that promote diabetes risk reduction are featured.
Key facts and figures about diabetes and interesting resources about dietary sodium, physical activity and nutrition are available.
The Texas Diabetes Program/Council provides comprehensive tools for stakeholders and constituents involved with diabetes care.
Utah’s Diabetes Prevention and Control Program is a state-wide effort to improve awareness of diabetes risk factors, prevention, and disease control among high-risk populations.
Communities and coalitions
Quality improvement leaders cannot accomplish their task alone. Networks of support, including coalitions and advisory groups, are critical to successful diabetes quality improvement programs.
This article in the American Journal of Preventative Medicine shows how to complete a needs assessment in African-American communities at high-risk for developing diabetes.
Diabetes health educators can find recently revised national standards of diabetes management education in this article in the Diabetes Care journal.
The Wisconsin Collaborative Diabetes Quality Improvement Project can serve as a model for collaborative approaches. You can link to a wealth of resources, including:
Training ideas, webcasts and slides
Essential diabetes care guidelines in English and Spanish.
Information about promoting worksite wellness.
Diabetes quality improvement research
This study in Health Affairs measured the cost-effectiveness of Diabetes Disease Management programs.
An analysis of 66 studies in the Journal of the American Medical Association found that most quality improvement strategies for diabetes care improved glycemic control.
Other Useful Diabetes Resources
This AHRQ Resource Guide for Diabetes Care Quality Improvement can help states assess their quality of diabetes care and develop strategies for improvement.
Learn about the latest diabetes research from the National Institute of Diabetes and Digestive and Kidney Diseases.
The American Diabetes Association provides information, research funding, and community services to people living with or interested in diabetes.
The Diabetes Care Journal publishes articles on diabetes awareness, research, and health care quality.
This series of HCUP Statistical Briefs reports on data related to diabetes care in hospitals.
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