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The cost-effectiveness of improving diabetes care in U.S. federally qualified community health centers.

ABSTRACT: To estimate the incremental cost-effectiveness of improving diabetes care with the Health Disparities Collaborative (HDC), a national collaborative quality improvement (QI) program conducted in community health centers (HCs).Data regarding the impact of the Diabetes HDC program came from a serial cross-sectional follow-up study (1998, 2000, 2002) of the program in 17 Midwestern HCs. Data inputs for the simulation model of diabetes came from the latest clinical trials and epidemiological studies.We conducted a societal cost-effectiveness analysis, incorporating data from QI program evaluation into a Monte Carlo simulation model of diabetes.Data on diabetes care processes and risk factor levels were extracted from medical charts of randomly selected patients.From 1998 to 2002, multiple processes of care (e.g., glycosylated hemoglobin testing [HbA1C] [71-->92 percent] and ACE inhibitor prescribing [33-->55 percent]) and risk factor levels (e.g., 1998 mean HbA1C 8.53 percent, mean difference 0.45 percent [95 percent confidence intervals -0.72, -0.17]) improved significantly. With these improvements, the HDC was estimated to reduce the lifetime incidence of blindness (17-->15 percent), end-stage renal disease (18-->15 percent), and coronary artery disease (28-->24 percent). The average improvement in quality-adjusted life year (QALY) was 0.35 and the incremental cost-effectiveness ratio was $33,386/QALY.During the first 4 years of the HDC, multiple improvements in diabetes care were observed. If these improvements are maintained or enhanced over the lifetime of patients, the HDC program will be cost-effective for society based on traditionally accepted thresholds.

SUBMITTER: Huang ES

PROVIDER: S-EPMC2151395 | biostudies-literature | 2007 Dec

REPOSITORIES: biostudies-literature

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The cost-effectiveness of improving diabetes care in U.S. federally qualified community health centers.

Huang Elbert S ES Zhang Qi Q Brown Sydney E S SE Drum Melinda L ML Meltzer David O DO Chin Marshall H MH

Health services research 20071201 6 Pt 1

<h4>Objective</h4>To estimate the incremental cost-effectiveness of improving diabetes care with the Health Disparities Collaborative (HDC), a national collaborative quality improvement (QI) program conducted in community health centers (HCs).<h4>Data sources/study setting</h4>Data regarding the impact of the Diabetes HDC program came from a serial cross-sectional follow-up study (1998, 2000, 2002) of the program in 17 Midwestern HCs. Data inputs for the simulation model of diabetes came from th ...[more]

PMID: 17995559

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Project description:INTRODUCTION:During the 2018-2019 influenza season, vaccination coverage among U.S. children was 62.6%. The purpose of this study was to estimate the prevalence of influenza vaccinations among pediatric patients seen in U.S. health centers, and to explore potential disparities in vaccination coverage among subpopulations. Funded by the Health Resources and Services Administration (HRSA) within the U.S. Department of Health and Human Services, these health centers provide primary and preventive care to underserved and vulnerable individuals and families in order to reduce health disparities based on economic, geographic, or cultural barriers. METHODS:Cross-sectional data, analyzed in 2019, came from the most recent waves of the Health Center Patient Survey (2009, 2014). The sample consisted of children ages 2-17 years receiving care from HRSA-funded health centers. The outcome of interest was self- or parent-reported receipt of influenza vaccine in the past year. Multivariable logistic regression was used to estimate the adjusted prevalence rate ratios for the association between demographic characteristics (age, sex, race/ethnicity, poverty level, urban/rural residence, geographic region), health-related variables (receipt of well-child check-up, asthma diagnosis), and influenza vaccination. RESULTS:Influenza vaccination coverage among pediatric health center patients increased from 46.6% in 2009 to 67.8% in 2014. In the adjusted model for 2014, there were few statistically significant differences in vaccination coverage among subpopulation groups, however American Indian/Alaska Native children had 31% increased vaccination coverage compared with non-Hispanic White children (aPRR: 1.31, 95% CI: 1.02-1.60) and children living in the South had 26% decreased vaccination coverage compared with those living in the Northeast (aPRR: 0.74, 95% CI: 0.54-0.93). CONCLUSIONS:Influenza vaccination coverage among pediatric health center patients in 2014 exceeded the national average (as of 2018-2019), and few differences were found among at-risk subpopulations. HRSA-funded health centers are well-positioned to further increase the vaccination rate among children living in underserved communities.

Dataset Information

The cost-effectiveness of improving diabetes care in U.S. federally qualified community health centers.

Publications

The cost-effectiveness of improving diabetes care in U.S. federally qualified community health centers.

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