Community-Created Programs: Can They Be the Basis of Innovative Transformations in Our Health Care Practice? Implications from 15 Years of Testing, Translating, and Implementing Community-Based, Culturally Tailored Diabetes Management Programs

Diabetes prevalence is predicted to rise dramatically during the next 20 years, and associated spending is expected to increase threefold.13 Cultural barriers contribute to this burden by preventing optimal care among diverse ethnic groups that are at elevated risk for high-cost complications.410 Culturally appropriate, clinically sound, and cost-effective models are needed to respond to the growing and diverse populations affected by diabetes worldwide.

Chronic disease now accounts for 75% of the $2 trillion in annual medical costs in the Untied States, and adherence to prescription regimens among those with chronic conditions is estimated to range from 20 to 50%.11,12 Nonadherence to medications accounts for ~ $100 billion in annual health care costs.13,14 Health care reform is a driving force to identify low-cost and clinically effective interventions to improve health care quality and reduce costs.

Nontraditional care management models, innovative technologies to improve patient adherence to prescribed medical regimens, and use of adherence-enhancing strategies in clinical practice would greatly enhance the health impact of efficacious treatments and prevention efforts and consequently reduce the burden of nonadherence-related health care costs.

The most recognized approach for improving care through the current health care delivery system is the Chronic Care Model (CCM) developed by Ed Wagner et al.1518 This model recognizes that a substantial portion of chronic care management takes place outside of formal health delivery settings. Patient self-management, delivery system design (including information systems and decision-support tools), and community resources are crucial components of this model. The CCM has been used successfully in staff-model health maintenance organizations, large group practices, and community health clinics, and its implementation has been shown in numerous studies to improve care in diabetes and other chronic diseases.19

The medical home model …

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