Diabetes is the seventh leading cause of death in the United States. It is a major cause of non traumatic amputations, blindness, and end stage kidney disease, and is a significant risk factor for coronary heart disease and stroke. California ranks 25th in the nation for adult diabetes levels, 33rd for rates of hypertension and is one of 31 states where obesity rates rose in the past year. Every state in the U.S. still exceeds the government's national goal to reduce obesity rates to 15 percent by the year 2010.

In 2001 the UCLA Center on Health Policy Research conducted the California Health Interview Survey, an extensive study and data analysis on the prevalence of diabetes in California. The survey found that more than 1.4 million California adults and 12,000 adolescents have been diagnosed with diabetes, and another 1.8 million adults not diagnosed with diabetes are at serious risk for developing the disease because of poor nutrition and lack of physical activity. Diabetes is found to be significantly more common in adults living below 100% of the poverty line, illustrating the effect of systemic disparities in access to care for the most vulnerable members of California’s patient population. The study also pointed to an alarming number of case in which diabetes is not appropriately managed and revealed insufficient efforts at prevention and education. Diabetes rates in California translate into personal suffering, death, and public costs. Early diagnosis and effective management limit the extent of complications, but to effectively manage this chronic disease, the patient requires consistent medical attention and a connection to a regular source of quality health care.

The California HealthCare Foundation (CHCF) recognizes that many patients still do not receive the care and support they need to most effectively manage their conditions, and supports Better Chronic Disease Care to improve the quality of care for Californians with chronic disease. CHCF established several key initiatives to further this goal including the California Improvement Network, a formal partnership with CHCF and selected improvement programs, designed to improve chronic disease care in California by expanding the number of primary care providers who use clinical data to drive improvements in care. In the summer of 2006, the Regional Associations of California (clinic consortiums), the California Primary Care Association, and the California Healthcare Foundation began discussing a statewide quality improvement initiative to spread the collection and use of clinical data measures for patients with diabetes through electronic data reporting systems. Accelerating Quality Improvement through Collaboration (AQIC), was designed to spur the adoption of quality improvement methods, use of electronic data, and standardized data collection and reporting by California’s community health centers and clinics in order to improve diabetes care (and ultimately other chronic diseases) for low-income patients. The project will draw on successes from other regional models in order to:

• Identify populations with common characteristics and gaps in care;
• Track process and outcome measures;
• Formalize performance measures and;
• Encourage patient communication and consumer engagement.

Northern Sierra Rural Health Network is one of fourteen California regional clinic associations participating in the AQIC project. In 2006 NSRHN conducted a comprehensive assessment to identify how health information technology could improve health care delivery systems across their nine-county Northeastern California membership area. NSHRN member safety net providers identified diabetes management as one of three health information exchange priorities which formed the basis of a Health Information Exchange (HIE) project and Regional Disease Management and Registry pilot that will leverage the AQIC goals and objectives to expand quality improvement processes to eight member clinics and four hospital based outpatient centers in the NSRHN region. This group will gather and report on a set of population-based diabetic clinical measures and outcomes, and facilitate and support the coordination of clinic activities and electronic health records systems for the accomplishment of the following AQIC project objectives over the next two years:

• Assess each site’s capacity and identify resources needed to begin data collection;
• Assess current quality improvement processes and identify training needs;
• Monitor each clinic site for readiness and effective use for adoption of electronic disease registry systems and establish necessary training requirements;
• Spread the Quality Improvement Process work plan model to all clinic sites; and
• Develop a reporting system using common definitions and methodologies for the selected diabetes data measures for quarterly reporting to the CPCA.

NSRHN will expand current activities and focus on building/enhancing the capacity for data collection and quality improvement across all clinics in the first year. In year 2, NSRHN will build capacity to aggregate disease registry data from participating clinics. This experience will inform the development of a standard definition of data collection methodologies to assure data validity and a standardized system for regular reporting on performance. A clinical quality consultant will be available to meet individually with health center teams to develop appropriate quality improvement strategies and make any necessary changes in work flow and clinical practice to improve diabetic health outcomes. Quality improvement spread design will be used to strengthen and spread quality improvement to processes, outcomes, patient satisfaction, and streamlined care delivery processes.

NSRHN’s Regional Disease Management Registry pilot is managed by NSRHN, with assistance from Mannatt and Illumisys, and funding from the Blue Shield of California Foundation. A Health Information Exchange Committee including representatives from across the region will advisethe program. Pilot program participants include:

Siskiyou Family Health, Karuk Tribe of California, Canby Family Practice Clinic, Miners Family Health Clinic, Sierra Family Medical Clinic, Southern Trinity Health Services, Warner Mountain Indian Health, Western Sierra Medical Clinic, Fairchild Medical Center, Surprise Valley District Hospital, Seneca Healthcare District, and Tahoe Forest Health Services.