The Humboldt Diabetes Project
The Humboldt Diabetes Project (HDP) began in 2003. It was funded in part by a grant from California HealthCare Foundation (CHCF), and the International Diabetes Center (IDC). The Project (including a research study) was designed in consultation with the medical community and diabetes counselors. It utilized a "point-of-care" internet based registry system (which has since been upgraded and is still in use today). Twenty-six Humboldt county practices participated in the initial project. Provider offices downloaded registry flow sheets to use during the visit and faxed them to the IPA with the patient visit information and lab results. The data was then entered in the IPA's computerized patient registry. Providers and offices could, at any time, download their patients' past results directly through the password protected website. Offices could also download standardized forms designed to streamline patient referrals pertaining to diabetes care.
Between September 2003 and September 2004, the IPA periodically sent reminders to the practices when patients became due for an exam or a regular office visit. Study patients were also mailed reminders. Most of the patients completed a survey and had current lab work completed pre- and post-study.
Before the program began, Humboldt County patients ranked below the national average every aspect of health measured for people with diabetes on a patient quality of life survey. After the program, patients were above the national average in every measure but one, chronic pain, although it had improved. The patient studied also reported a great increase in the frequency of routine examinations that are important to patients with diabetes. Before the project, only 32 percent of the patients reported that they had received an eye exam within the past year. Afterwards, 68 percent of the patients reported that they had been examined. Additionally only 32 percent of patients had had their feet examined in the year before the test began. Afterwards, 72 percent had been checked. Outcome measures also steadily improved. The percentage of patients with an HbA1c < 7.0 rose from 52% to 59%, while the percentage of patients with an HbA1c > 9.0 decreased from 5.9% to 5.2%. The percentage of patients with BP < 130/80 rose from 32% to 37% and LDL < 100 rose from 32% to 48%.
The HDP led to community-wide accreditation under NCQA's Diabetes Physician Recognition Program, the first community to achieve this in the United States. Also of importance was the American Diabetes Association's certification of the Health Education Alliance, a program set up by the IPA in response to the communities' need for diabetes education. The HDP has provided a successful model for community-wide chronic care. These efforts are continuing.