Navigating Diabetes Care Inequities: A Longitudinal Study Linking Chronic Care Model's Structure Indicators to Process and Outcome

Katrien Danhieux, Philippe Bos, Josefien Van Olmen, Edwin Wouters, Veerle Buffel

Keywords: Diabetes care, Chronic care Model, Primary Care, Quality of Care.

Introduction:

Diabetes is one of the fastest growing global health issues, with current health systems inadequately meeting the needs of those affected. Also in Belgium, a notable contrast in unmet medical needs emerges. Donabedian’s landmark model describes three dimensions of quality of care: structure, process and outcome, which can be measured using specific indicators. The Chronic Care Model (CCM) aims to enhance quality of care. However, limited observational research exists that assesses the impact of the CCM and its elements on both process and outcome indicators, overlooking considerations of health inequities.

Method:

A unique hierarchically structured longitudinal database, consisting of self-collected data on structural indicators of T2D care at the level of primary care practices, individual-level health insurance and medical lab data on the process and outcome indicators was used.

Results:

The sample comprises 58 primary care practices, with 7593 patients at the health insurance level and 4549 at the lab level. There was a significant positive association between the total ACIC score and both process indicators. A higher score for community linkages and clinical information system was significantly associated with higher odds having your HbA1c tested twice a year. Socio-economic vulnerable patients exhibit lower likelihoods of HbA1c follow-up in practices with low total ACIC scores, but this difference disappeared in practices with high total ACIC scores.

Conclusions:

The observational design of the study allowed studying the association between process and outcome indicators. Our findings might support the social capital pathway, arguing that the CCM will be especially beneficial for vulnerable patients, but could also support the materialist-structural pathway, since the associations regarding inequity where not found for every quality indicator. Using the ACIC questionnaire to measure quality of care in small to medium-sized primary care practices was feasible and could be promising to study the interplay between practice organization and health inequities further.

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