Effectiveness of an interprofessional ambulatory care model on diabetes: evaluating clinical markers in a low-income patient population

ABSTRACT

The purpose of this study was to determine whether a new ambulatory care model, interprofessional collaborative care–coordinated team model (interprofessional model), based on the Wagner Care Model improved clinical indicators in a low-income population. This study was a retrospective 12-month pre-post (n = 204) and propensity matched (n = 171) comparative study of the interprofessional model in a primary clinic for patients with type 2 diabetes. Secondary data were collected from June 2014to February 2017 in an academic medical centre in a large Midwestern city. Findings demonstrated statistically and clinically significant improvement in A1C in both the pre/post arm of the study (↓ 0.8%) and the intervention/propensity matched arm (↓ 0.53%). Within the intervention group, there was a significant decrease in weight in the pre/post arm with 55% of cases losing weight, whereas 45% did not lose weight (p = .02). Diastolic blood pressure less than 90 also significantly improved in the pre/post arm of the study (10.1% n = 18, versus 3.9%, n = 7, p = .04). The interprofessional model showed that an ambulatory healthcare redesign incorporating an interprofessional team approach to optimise the health of this type 2 diabetes patient population can be effective. This study demonstrates the importance of using interprofessional collaborative practice teams to guide healthcare and improve patient outcomes.

KEYWORDS:

• Ambulatory care
• type 2 diabetes
• patient care team
• continuity of patient care
• collaborative care
• collaborative practice

Declaration of Interest statement

The author has no conflicts to disclose.

Additional information

Funding

This research was made possible through the generous support of the Health Resources and Services Administration (HRSA) grant #UD7HP26040 (PI Vlasses)Health Resources and Services Administration [#UD7HP26040]; Special thanks to the Jonas Nursing and Veterans Healthcare for their generous support through the Jonas Nursing Scholars Program.

Notes on contributors

Nancy Madsen

Nancy Madsen [PhD, RN] is a visiting assistant professor at Northern Illinois University in DeKalb, Illinois.  This research is her dissertation research completed at Loyola University Chicago, Marcella Niehoff School of Nursing. She was a 2016-2018 Jonas Scholar. 

Cara Joyce

Cara Joyce [PhD, MS, BS] is an applied statistician and Director of the Biostatistics Core at Loyola University Chicago.  She leads a team of statisticians who provide consulting services for research projects conducted by students, residents, fellows, and faculty members in medicine, nursing, and health sciences.  Her interests include collaborative clinical and translational research to reduce health disparities and improve health outcomes.

Frances Vlasses

Frances R  Vlasses [PhD, RN, ANEF, FAAN] is a professor at the Marcella Niehoff School of Nursing in the Department of Health Systems and Adult Health Nursing as well as a professor in the Department of Family Medicine at Loyola University Chicago Stritch School of Medicine.  She is Co-Director of the Institute for Transformative Interprofessional Education at Loyola.  She received funding for this research under the Health Resources and Services Administration (HRSA).

Lisa Burkhart

Lisa Burkhart (PhD, RN, ANEF) is Associate Professor, Marcella Niehoff School of Nursing, Loyola University Chicago, primarily teaching and mentoring doctoral students, and holds a joint appointment as a Research Health Scientist in the Center of Innovation for Complex Chronic Healthcare at Edward Hines, Jr. Veteran's Administration Hospital.  She is a health services researcher with primary interests in ambulatory care, preventive care associated with chronic conditions (diabetes, spinal cord injury), holistic care, and interprofessional collaborative practice.