Diabetes Care Delivery and Outcomes by Race and Ethnicity: Evaluation of an Enhanced Primary Care Practice Model in the US Upper Midwest.

Abstract

The Enhanced Primary Care Diabetes (EPCD) model is nurse led and leverages interdisciplinary support to improve diabetes quality indicators. The model has been found to be effective overall; however, because narrowing health disparities is a key objective, we aimed to assess differential effectiveness of the model among various racial and ethnic groups. This retrospective cohort study compared the time to meeting the D5, a publicly reported quality measure (composite indicator of glycemic and blood pressure control, aspirin use for secondary prevention of cardiovascular disease, statin use, and documented abstinence from tobacco use), after enrollment in the EPCD program by Black, Hispanic/Latine, and Asian patients compared with White patients with diabetes (age 18-75 years) receiving care at 13 primary care practices by multivariable Cox proportional hazards regression. Patients enrolled in the program from January 1, 2020 to December 31, 2020; the study period end date was August 1, 2022. The EPCD program enrolled 1,749 patients (none of whom met the D5 at entry) and 1,061 (60.7%) met the D5 during the study period. Black patients were less likely to meet the D5 compared with White patients (adjusted hazard ratio 0.68; 95% CI, 0.52-0.90; <i>P</i> = .007); there was no difference among Asian and Hispanic patients compared with White patients. Compared with White patients (median 1.1/year; interquartile range [IQR] 0.4, 2.7), Asian patients had fewer nurse touch points (median 0.8/year; IQR 0, 1.4) during the study period, whereas Black patients had more (median 2.2/year; IQR 0.6, 4.0) and Hispanic patients showed no significant difference. Time to meeting the D5 was longer for Black patients compared with White patients in the EPCD model, despite greater engagement with the care team. Further research is needed to identify factors driving these disparities.