The iPATH trial, one of the newest additions to the NIH Collaboratory Trials portfolio, is testing the implementation of a practice transformation strategy for patients with type 2 diabetes in federally qualified health centers (FQHCs) in California, Massachusetts, Ohio, and Puerto Rico.
In the iPATH (Implementing Scalable, Patient-Centered Team-Based Care for Adults With Type 2 Diabetes and Health Disparities) project, a network of research teams from Stanford, Harvard, the Ohio State University, and Impactivo LLC is working to refine and implement an an approach to practice transformation originally conceived to support FQHCs’ pursuit of National Committee for Quality Assurance recognition as patient-centered medical homes.
Some 37.3 million Americans have type 2 diabetes and significant racial and socioeconomic disparities persist in care quality and patient safety. FQHCs serve 1 in 7 U.S. racial/ethnic minorities and shoulder a higher prevalence of diabetes (21% FQHC, 11% U.S.), offering a promising venue for innovating in equity-focused diabetes care, the researchers say. The study is funded by the National Institute on Minority Health and Health Disparities (NIMHD).
A pilot demonstrated significant decreases (average 31% reduction) in poorly controlled diabetes (A1c>9%) among patients at seven clinics affiliated with an FQHC in Puerto Rico in 2017-20. Improvements in patients’ diabetes control were sustained pre- to post- Covid-19 pandemic.
Sara Singer, M.B.A., P.H.D., a professor of health policy and medicine at Stanford School of Medicine and professor of organizational behavior (by courtesy) at Stanford Graduate School of Business, serves as principal investigator on the study. In a Q&A published on the NIH Collaboratory website, she said that in the first phase of this project, they are conducting a multiple case comparison study of 12 FQHCs to understand how they care for patients with type 2 diabetes and to identify recent innovations. “We will use these findings to refine and implement a modularized, customized practice transformation intervention in 8 FQHCs, in a stepped-wedge, randomized controlled trial,” she said.
One goal of the project is to identify organizational conditions and processes at FQHCs that promoted or impeded the effectiveness of type 2 diabetes care for NIH-designated U.S. health disparity populations pre- and post-pandemic. Research teams will simultaneously conduct 12 in-depth regional case studies, enabling contrast between FQHCs considered high- performing and low-performing for diabetes control. Teams will identify actionable, how-to implementation factors for ensuring chronic, preventive, and acute care for patients with diabetes.
Researchers plan to implement a multi-level, multi-component, technology-enabled practice transformation strategy to improve type 2 diabetes for patients at 8 multi-clinic FQHCs. Teams will adapt, tailor, implement, test, and spread an equity-focused practice transformation strategy across FQHCs located in California, Massachusetts, Ohio, and Puerto Rico. The iPATH implementation approach will be modularized and customizable to accommodate organizational readiness, patient needs, and social contexts, tailoring practice transformation efforts to each unique FQHC.
“We hope that the lessons learned from our multiple case comparison study and iPATH practice transformation intervention will provide evidence for improving diabetes care in FQHCs and reducing health disparities across the nation and help FQHCs achieve goals that enable them to receive incentive pay,” Singer said.
