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Evolution of a Diabetes Quality Improvement Program at an Urban Community Health Center

The first 20% of the full text of this article appears below.

	Introduction

 
La Clinica de la Raza is a community health center in the San Francisco Bay Area of California that serves a predominantly low-income, monolingual Spanish-speaking population. We have nine primary care clinics in three separate counties (Alameda, Contra Costa, and Solano), as well as multiple ancillary service sites and five school-based health centers. Approximately 46% of our patients have no health insurance, 48% have publicly funded insurance, and 6% have private insurance. Among the challenges of our patient population are a very low health literacy level and a high rate of chronic disease, especially diabetes. Our patients' high burden of illness has long made diabetes quality improvement (QI) work a priority at La Clinica. Our diabetes program has evolved in several distinct phases, and continues to be a dynamic work in progress.

	Phase 1: Formation of the Collaborative

 
In 1999, La Clinica became one of the first community health centers nationally to join the Bureau of Primary Health Care's Health Disparities Collaborative (HDC). Before 1999, an interdisciplinary team had been meeting at La Clinica on a regular basis to try to improve outcomes in patients with diabetes, culminating in adopting Staged Diabetes Self-Management, a program of the International Diabetes Center in Minneapolis, Minn. The HDC introduced us to several key concepts and models from the QI world. These included the chronic care model, PDSA (Plan-Do-Study-Act) cycles, and the importance of an interdisciplinary team with a "provider champion," senior leadership, and management support. These concepts continue to provide a framework . . . [Full Text of this Article]

	Phase 2: Collaborative Spread

 

	Phase 2: A Focus on Outcomes

 

	Phase 3: A Move to Prevention

 

	Lessons Learned and Future Goals

 

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