Evaluation of an Enhanced Primary Care Team Model to Improve Diabetes Care

Article Figures & Data

Table 1.

Patient Characteristics by Practice Group

Characteristic	EPCD Staff (n = 5,761)	EPCD Trainee (n = 1,887)	Non-EPCD Staff (n = 10,079)
Age, y
Mean (SD)	60 (12)	60 (11)	60 (12)
Median (IQR)	62 (53-69)	63 (54-69)	63 (54-69)
Range	18-75	20-75	18-75
Gender, No. (%)
Female	2,885 (50.1)	886 (47.0)	4,872 (48.3)
Male	2,876 (49.9)	1001 (53)	5,207 (51.7)
Race, No. (%)
White	4,907 (85.2)	1,574 (83.4)	9,140 (90.7)
Asian	274 (4.8)	73 (3.9)	165 (1.6)
Black or African American	301 (5.2)	133 (7.0)	253 (2.5)
Other/unknown/chose not to disclose	279 (4.8)	107 (5.7)	521 (5.2)
Ethnicity, No. (%)
Hispanic or Latine	80 (1.4)	44 (2.3)	416 (4.1)
Not Hispanic or Latine	5,462 (94.8)	1,782 (94.4)	9,353 (92.8)
Unknown/chose not to disclose	219 (3.8)	61 (3.2)	310 (3.1)
Diabetes type, No. (%)
Type 1	477 (8.3)	150 (7.9)	697 (6.9)
Type 2	5,284 (91.7)	1,737 (92.1)	9,382 (93.1)
Limited English proficiency, No. (%)
No	5,523 (95.9)	1,749 (92.7)	9,765 (96.9)
Yes	238 (4.1)	138 (7.1)	314 (3.1)

EPCD = Enhanced Primary Care Diabetes; IQR = interquartile range.
Note: Values are those obtained at the start of EPCD implementation (postimplementation period).

Table 2.

Summary of Patients Meeting Diabetes Quality Indicators by EPCD Period

Group and Indicator	Preimplementation: Patients Meeting Indicator			Postimplementation: Patients Meeting Indicator			P Value^{^b}
Group and Indicator	Aug 2018, %	Feb 2019, %	IRR^{^a} (P Value)	May 2019, %	Mar 2020, %	IRR^{^a} (P Value)	P Value^{^b}
EPCD staff
D5 indicator	42.7	42.3	0.995 (.11)	42.9	45.0	1.005 (.001)	.01
Glycemic control	67.9	67.8	0.997 (.26)	66.8	67.3	1.001 (.75)	.45
BP control	74.7	70.8	0.989 (<.001)	70.8	73.6	1.005 (<.001)	<.001
LDL-C control	90.4	90.7	1.001 (.84)	90.7	91.9	1.002 (.18)	.61
Aspirin use	94.4	94.9	1.000 (.89)	92.7	94.5	0.998 (.65)	.73
Tobacco free	86.0	87.9	1.002 (.36)	87.8	85.3	0.997 (.03)	.05
EPCD trainee
D5 indicator	36.9	37.0	0.999 (.86)	38.9	42.0	1.011 (.003)	.14
Glycemic control	64.5	64.1	0.997 (.38)	62.7	64.6	1.003 (.27)	.29
BP control	70.4	68.2	0.992 (.02)	69.4	73.0	1.006 (.01)	.01
LDL-C control	90.8	91.2	0.998 (.81)	90.6	92.7	1.003 (.24)	.52
Aspirin use	95.1	96.1	0.999 (.75)	94.7	96.3	1.002 (.78)	.79
Tobacco free	81.0	83.8	1.003 (.44)	83.9	82.6	0.998 (.73)	.38
Non-EPCD staff
D5 indicator	35.4	35.2	1.001 (.79)	36.2	35.5	0.994 (<.001)	.05
Glycemic control	62.8	62.6	1.002 (.39)	63.3	60.8	0.995 (<.001)	.01
BP control	70.4	67.9	0.995 (.01)	68.6	69.5	1.000 (.91)	.02
LDL-C control	86.6	86.8	1.000 (.82)	87.0	89.0	1.002 (.04)	.40
Aspirin use	91.7	91.3	1.000 (.93)	91.4	92.8	1.001 (.78)	.91
Tobacco free	79.4	80.2	1.003 (.10)	81.3	79.1	0.997 (<.001)	.01

BP = blood pressure; D5 = all 5 diabetes components (glycemic control, BP control, LDL-C control, aspirin use if indicated, and tobacco-free status); EPCD = Enhanced Primary Care Diabetes; IRR = incident rate ratio; LDL-C = low-density lipoprotein cholesterol.
↵a The IRR is the change in slope (monthly change in percentage of patients meeting the indicator).
↵b For comparison of IRRs between periods.

Table 3.

Direct Comparison of Groups on Patients Meeting D5 Quality Indicator

Group Comparison	Difference Between Groups, IRR (P Value)
Group Comparison	Preimplementation Slope^{^a}	Postimplementation Slope^{^a}	Change in Slope^{^a}
EPCD staff vs EPCD trainee	0.996 (.44)	0.996 (.28)	1.000 (>.99)
EPCD staff vs non-EPCD staff	0.995 (.07)	1.013 (<.001)	1.017 (<.001)
EPCD trainee vs non-EPCD staff	0.998 (.75)	1.017 (<.001)	1.017 (.03)

D5 = all 5 diabetes components (glycemic control, blood pressure control, low-density lipoprotein cholesterol control, aspirin use if indicated, and tobacco-free status); EPCD = Enhanced Primary Care Diabetes; IRR = incidence rate ratio.
↵a Slope is the monthly change in percentage of patients meeting all 5 quality indicators, represented by the incidence rate ratio.