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Pursuing Health Equity: Our Journey to Improve Diabetes Control With Our Hispanic/Latino Population at Kaiser Permanente in Indio, California


Frank Flowers, MD; Jose Fernandez, MD; Robert Blair, MPH;
Patrick Calasan, BSN RN MHA


Abstracts from the Kaiser Permanente 2018 National Quality Conference

From Southern California

Background: Diabetes is worsening in our vulnerable populations in areas that are struggling to maintain the necessary health care and resources needed for glycemic control. Kaiser Permanente (KP) race and ethnicity data show a significant disparity gap of 16% between Hispanic/Latino and white/Caucasian members with diabetes. Indio, CA, has a large population of Hispanic/Latino KP members with Spanish being the second most preferred/spoken language at the Indio Medical Office Building (MOB). The Indio MOB was one of the first KP clinics in the area. There was limited awareness of cultural needs and a necessity for an internal quality improvement framework focusing on education of staff and employer groups, and complete care management.
Methods: We stratified our selection criteria based on the disparity gap between Hispanic/Latino and white populations from KP Indio Healthcare Effectiveness Data and Information Set (HEDIS) data. This finding led to the identification of 38% of Indio Hispanic/Latino members with uncontrolled diabetes. We implemented patient-centered diabetes support groups. In these groups, members shared personal stories, struggles, and advice on their own experiences with diabetes. We also included a manager leadership group to give its feedback and opportunities to help improve quality of care. We intend to employ telephone appointment visits, increase remote glucose monitoring utilization, implement a diabetes “One Stop Shop” model, and enhance community engagement.
Results: Our results indicate that successful outcomes are crucial in making change happen. Here are several ways in which the team will review and create interventions to help decrease the disparity gap: Educate members on culturally sensitive food options; increase medication titration by improving provider inertia changes; engage members to check their blood sugars and offer new technology with the remote glucose monitoring; and increase diabetes quality composite scores by being proactive with foot exams, retinal photos, and medication adherence.
Discussion: Overall, the health equity challenge in Indio, CA, is very important to KP and its capacity to help address the social determinants of our disparity populations. This will help us to learn how to perform better with patient-centered focused outcomes. Some lessons along the way in our journey are: Knowing and understanding the population of interest; developing lead and lag metrics for successful outcomes; availability of resources and tools needed; communicating plans to the member, staff, and community; and using interdisciplinary teams such as leadership, physician groups, and frontline staff.

Abstracts from the Kaiser Permanente 2018 National Quality Conference


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