Quality Care Improvement Program in a Community-Based Participatory Research Project: DISCUSSION

diabetes

This evaluation of Project DIRECT showed that at the end of the four-year study period, 40% of enrolled providers still participated in the program.

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Quality Care Improvement Program in a Community-Based Participatory Research Project: RESULTS

Provider Retention

Forty-seven healthcare providers practicing alone or in a group in 15 institutions were recruited to participate in the CQIP program (Table 1). All but two providers were physicians. These providers were a physician assistant affiliated with a practice that dropped out at the end of the first year and a nurse practitioner with a practice that stayed three years in the program. No new practice entered the project after it started. However, following expansion of one practice in 1999-2000, four new physicians were enrolled. The biggest drop-out occurred at the end of the first intervention year because of disbandment of three practices with 14 providers that were owned by the same group (the medical director for these practices left and the providers discontinued their participation) and withdrawal of one provider. Thereafter, the drop-out rate remained constant (12-14%), with about 40% of providers still participating at the end of the fourth year. On a year-to-year basis, however, the project objective of retaining 70% of providers was met (83%, 88%, and 82% the last three study years, respectively). It is of interest to note that single practitioners were more likely to stay in the program. The reasons for withdrawing varied. Only one single-practitioner practice truly declined CQIP participation; others left for migration out of Raleigh (n=2 practices with six providers), retirement (two providers in a practice that remained in the program), and practice disbandment or reorganization (n=6 practices with 21 providers).

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Quality Care Improvement Program in a Community-Based Participatory Research Project: OUTCOMES DEFINITION AND MEASUREMENT

Process Outcome

Retention plan. The plan was evaluated by the annual number of contacts with primary care providers recorded on DC practice records. These contacts were defined as a continuous variable and used to assess the objective’s implementation by the DIRECT staff. Overall attendance at education events was monitored, but attendance of specific CQIP providers was not transcribed.

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Quality Care Improvement Program in a Community-Based Participatory Research Project: METHODS

The CQIP used a one-group pre- and post-test design. The target population included African-American residents of southeast Raleigh, the historical center of Raleigh’s African-American community. The DC component was initiated in August 1996; the ongoing intervention is at its institutionalization phase. The North Carolina State University, Wake Forest University, and CDC Institutional Review Boards approved Project DIRECT protocols during the study.

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Quality Care Improvement Program in a Community-Based Participatory Research Project

diabetes tream

INTRODUCTION

The complex set of health status determinants, the disproportionate disease burden experienced in marginalized communities, and the limited effectiveness of traditional prevention research, particularly in minority communities, have increased the demand for more comprehensive and participatory approaches to public health research and practice. In 1985, the Secretary of Health and Human Services Task Force on Black and Minority Health identified diabetes as a major contributor to mortality among minorities in the United States. To respond to the excessive, unnecessary burden of diabetes among African Americans, the Centers for Disease Control and Prevention (CDC) led the development, implementation, and evaluation of Project DIRECT (Diabetes Interventions Reaching and Educating Communities Together) in southeast Raleigh, NC.

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Bronchioloalveolar Carcinoma in African Americans: DISCUSSION

bronchioloalveolar carcinoma

In our study, all patients were African Americans, therefore we had the opportunity to review the clinical and pathophysiological features of ВАС exclusively in this ethnic group. ВАС was the least common lung tumor in our series and accounted for only 3% of cases. This is in accordance with the literature reporting the incidence of ВАС at 1-9%. Women accounted for one-third of our patient population similar to the 40% of previously reported ВАС. ВАС is a unique patho­logical entity that is distinct from pulmonary adenocarcinoma. Although histological feaures may overlap, ВАС demonstrates a growth pattern along preexisting lung architecture without invasive or destructive growth. The association of ВАС with scarring has been recognized for years.

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Bronchioloalveolar Carcinoma in African Americans: RESULTS

Eight-hundred-thirty-five cases of lung cancers were diagnosed between 1984 and 1999 at this hospital. ВАС constituted 3% (27) of lung and 10.5% of adenocarcinomas. The most common neoplasm was adenocarcinoma, accounting for 256 cases (30.7%) followed by squamous-cell carcinoma in 228 cases (27.3%), small-cell carcinoma in 88 cases (10.5%), large-cell carcinoma in 57 cases (6.8%) and other (including metastatic) carcinomas in 179 cases (21.4%). In other series in which ВАС was described separately, its incidence ranged from 1.1% to 6.5%. When described as subtype of adenocarcinoma, it accounted for 15-20% of cases.

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