Ashley W. Collinsworth Sc.D.

Collinsworth, A. W. and A. L. Masica (2016). “Authors’ response.” J Intensive Care Med 31(7): 494-495.

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Use of “care bundles” has been advocated as a means to accelerate the adoption of multiple care processes into routine clinical practice, benchmark performance, and improve patient outcomes. We recently implemented the Awakening and Breathing Coordination, Delirium Monitoring, and Early Mobility (ABCDE) bundle in 12 Baylor Scott and White Health ICUs and found that bundling these care processes was associated with improved adherence to the individual care processes for delirium prevention and mitigation within the bundle and improved patient outcomes. Although some sites participated in structured educational workshops during the early phases of bundle implementation, we found that the greatest improvement in bundle uptake occurred after we modified the electronic health record (EHR) to facilitate clinical workflow around bundle delivery and documentation.3 This finding suggests that establishing tools that facilitate integration of delirium prevention measures into clinical workflow, such as structured forms for documentation of bundle elements within the EHR, should be the first step in the implementation process followed by educational sessions on the importance of delirium prevention and use of the tools.

Kane, E. P., A. W. Collinsworth, K. L. Schmidt, R. M. Brown, C. A. Snead, S. A. Barnes, N. S. Fleming and J. W. Walton (2016). “Improving diabetes care and outcomes with community health workers.” Fam Pract: 2016 Jul [Epub ahead of print].

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BACKGROUND: Type II diabetes continues to be a major health problem in USA, particularly in minority populations. The Diabetes Equity Project (DEP), a clinic-based diabetes self-management and education program led by community health workers (CHWs), was designed to reduce observed disparities in diabetes care and outcomes in medically underserved, predominantly Hispanic communities. OBJECTIVE: The purpose of this study was to evaluate the impact of the DEP on patients’ clinical outcomes, diabetes knowledge, self-management skills, and quality of life. METHODS: The DEP was implemented in five community clinics from 2009 to 2013 and 885 patients completed at least two visits with the CHW. Student’s paired t-tests were used to compare baseline clinical indicators with indicators obtained from patients’ last recorded visit with the CHW and to assess differences in diabetes knowledge, perceived competence in managing diabetes, and quality of life. A mixed-effects model for repeated measures was used to examine the effect of DEP visits on blood glucose (HbA1c), controlling for patient demographics, clinic and enrolment date. RESULTS: DEP patients experienced significant (P < 0.0001) improvements in HbA1c control, blood pressure, diabetes knowledge, perceived competence in managing diabetes, and quality of life. Mean HbA1c for all DEP patients decreased from 8.3% to 7.4%. CONCLUSION: Given the increasing prevalence of diabetes in USA and documented disparities in diabetes care and outcomes for minorities, particularly Hispanic patients, new models of care such as the DEP are needed to expand access to and improve the delivery of diabetes care and help patients achieve improved outcomes.