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Public Hospital Group Focusing on Diabetes Care

Public hospital systems face significant challenges: many of their patients are poor, lack health insurance, or have low health literacy. Yet, these "safety net" hospitals have a number of unique strengths. Because they typically offer inpatient, outpatient, and emergency care, they can provide comprehensive services for patients with chronic medical conditions.

With Commonwealth Fund support, seven large public hospitals recently joined with the National Public Health and Hospital Institute (NPHHI) to examine the quality of care they provide to chronically ill patients. The Consortium for Quality Improvement in Safety Net Hospitals and Health Systems focused first on diabetes—a disease that is especially prevalent in the poor communities served by public hospitals. The aim was to evaluate strategies for diabetes management and identify lessons that might apply to other chronic conditions.

According to NPHHI director Marsha Regenstein, lead author of the Fund report Caring for Patients with Diabetes in Safety Net Hospitals and Health Systems, diabetes outcomes for patients in the consortium hospitals are comparable to, and in some cases better than, national averages. The measures used were glycemic control and cholesterol levels.

Regenstein and her colleagues point to continuity of care and a range of services, such as special diabetes clinics and American Diabetes Association–certified classes, as contributing to this success.

Black patients were significantly less likely than white patients to have well-controlled diabetes. And, despite the consortium hospitals' attempts to mitigate financial barriers, uninsured patients received fewer services—including critically important outpatient care—than patients covered by Medicaid or Medicare. At the time of the study, more than two of five (41%) patients with diabetes at these hospitals were uninsured.

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