Efficacy of a One-on-One Approach in Improving A1c and Blood Pressure in Unresponsive Diabetic and Hypertensive Patients


Impact Statement: 
An example of bridging health and health care in rural Nebraska: In order to improve critical health outcomes of “hard to reach” patients with diabetes and high blood pressure, a local health department and a community health center partnered to use the PDSA model and best practices to provide effective ways to help these patients manage their chronic conditions. As a results, patients improved their health status—a first step toward decreasing chronic disease rates in that region.

This quality improvement (QI) initiative was a multidisciplinary team project using staff from East Central District Health Department (ECDHD) and the Good Neighbor Community Health Center (GNCHC). GNCHC is housed within ECDHD and has been struggling to improve A1c and blood pressure (BP) outcomes for several years. The condensed aim statement was to improve targeted health outcomes in patients who had not shown improvement using usual medical clinic practices. The team used the Plan, Do, Study, Act (PDSA) methodology to try to improve health outcomes for 20 GNCHC patients who fit the criteria. The team used QI tools to determine the suspected root causes, then they reviewed potential interventions and used a priority grid to select those most likely to impact health outcomes. The top interventions were (1) medication access, (2) establishing a relationship with the patient, (3) a team approach to care, and (4) self-chosen health management goals.

The process focused on targeting patients using a bilingual community health worker who would explore medication use and provide education that focused on the patients' identified needs. An important factor for success was improved patient compliance with treatment. Education was completed in the manner most meaningful to the patient (videos, brochures, discussions). Family was involved in the visits whenever possible. Once the Plan portion of the PDSA was completed, the team implemented the plan (Do) to track individual GNCHC patients' A1c laboratory results and BP measurements (Study). The initiative resulted in improvement in 78% of the diabetic patients and 50% of the hypertensive patients who were not lost to follow-up. The PDSA method had limitations, including a small sample size, short study period, and general patient selection criteria.

Organization that conducted the QI initiative: 

Spindola, D. Public Health Quality Improvement Exchange. Efficacy of a One-on-One Approach in Improving A1c and Blood Pressure in Unresponsive Diabetic and Hypertensive Patients. Thu, 04/24/2014 - 18:13. Available at https://phqix.org/content/efficacy-one-one-approach-improving-a1c-and-blood-pressure-unresponsive-diabetic-and-0. Accessed April 14, 2024.

Submission Status: 
0 users have voted.


Submitted by dspindola on

This is our first attempt to submit a QI project to this website and it is important to remember that this is a PDSA and not an academic study.

0 users have voted.

D. Spindola

Submitted by shirleyterry on

Great job ECDHD!! I enjoyed reading about your results!!

0 users have voted.

Submitted by Carol Heier on

Small change and big success! Congratulations! I am going to share this with some of our staff working to achieve these same objectives. Thanks for sharing your story with us.

0 users have voted.

Submitted by lkent on

Great job on this QI project. Hat's off to the staff at ECDHD for tackling this. Keep up the good work.

0 users have voted.

Grace Gorenflo's picture
Submitted by Grace Gorenflo on
Thanks for sharing all of the rich details. It was especially helpful to understand how you chose the interventions to adopt. Nice work!
0 users have voted.
Link to the resource where this submission is also published: