Purpose: The Enhanced Primary Care Diabetes (EPCD) model is an innovative nurse-led care delivery model which leverages multidisciplinary support including clinical pharmacist expertise which has been previously found to improve diabetes quality indicators. The purpose of our study was to assess the effectiveness and engagement of the EPCD model among different minority groups.
Methods: We utilized a retrospective cohort design to evaluate the time to meeting a publicly reported diabetes care quality measure (D5) following enrollment into the EPCD model for different minority groups. We included adult patients (18-75) with diabetes from 13 primary care practices in an integrated health care system that were enrolled in the model from 1/1/2020 to 12/31/2020 and followed through 8/1/2022. Associations with meeting D5 criteria were assessed using survival methods.
Results: The EPCD program enrolled 1,749 patients and 1,061 patients (60.7%) met the composite D5 outcome. Black patients were significantly less likely to meet the D5 composite measure compared to white patients (adjusted HR 0.68, CI 0.52-0.90; P= 0.007). There were no other statistically significant differences among other race/ethnicities compared to white patients. White patients had fewer nurse touch points per year (median 1.1; IQR 0.4, 2.7) compared to non-white patients (median 1.5; IQR 0.5, 3.4) (P= 0.003).
Conclusions: Overall time to meeting D5 indicators was longer for black patients compared to white patients in the EPCD model, despite more engagement in non-white patients. Further research is warranted to identify driving factors for these disparities and solutions to improve performance in the black population.
J. Herges: None. K. Cole: None. R.G. McCoy: Research Support; American Diabetes Association. Other Relationship; American Diabetes Association. Consultant; Wolters Kluwer Health. Research Support; National Institutes of Health, Patient-Centered Outcomes Research Institute. Consultant; Yale New Haven Health System.
