Diabetes Quality Improvement Initiative

The management of patients with diabetes, like other chronic conditions, is complicated, requiring care that addresses medical, social and behavioral aspects of individuals, along with pro-active population management. But diabetes poses a unique challenge for the HRSA Health Center Program. At least one out of every seven health center patients has a diagnosis of diabetes.1  Furthermore, diabetes disproportionately affects Pacific Islanders, American Indian/Alaska Native, Native Hawaiian, Black/African American, and Hispanic or Latino patients.

In 2017, 67% of health center patients’ blood sugar levels were reported as controlled (A1C < 9%).2 That is higher than the national average of 59%, where 1 in 10 people have diabetes.3  However, there continue to be disparities across race and ethnicity in diabetes control.4  Looking at trend data over the last several years, the Health Center Program has not moved the needle on diabetes control. Poorly controlled diabetes can lead to multiple complications, poor health outcomes, and reduced quality of life.

Controlled Diabetes Among Health Center Patients in 2017

While the priority is healthy patients, diabetes also has health care cost implications. Medical expenditures of people with diabetes are approximately 2.3 times higher than expected costs if they did not have diabetes in 2017.5 Controlling diabetes saves health care dollars. If health center patients with uncontrolled diabetes reduced their HbA1c by 1.25%, there is a potential to save more than $3.44 billion over a three-year span.6

Health centers are specially-equipped to improve diabetes outcomes. As patient-centered medical homes that integrate behavioral, oral, and primary health care and address social determinants of health, health centers can support patients with diabetes while managing co-occurring physical and behavioral conditions such as mental illness, substance use disorder (SUD), and addressing other socioeconomic challenges. Providers can also help children and adults to prevent diabetes by monitoring their weight and managing and preventing obesity.

To improve diabetes outcomes and lower health care costs, HRSA has launched a Health Center Program Diabetes Quality Improvement (QI) Initiative. The Initiative leverages the resources of multiple HRSA partners, which includes, health centers, health center controlled networks, Primary Care Associations (PCAs), technical assistance and training partners, and others. By working in a coordinated fashion, utilizing principles of QI and data driven decision making, and sharing promising practices and lessons learned, HRSA is building a continuous, learning health system that will reap improvement in diabetes control for health center patients. 

The goals of the Health Center Program Diabetes QI Initiative are:

    1. Improve diabetes treatment and management;
    2. Increase diabetes prevention efforts; and
    3. Reduce health disparities.

The measures of the Health Center Program Diabetes QI Initiative are:

    1. Reduce by 5% the number of patients who develop diabetes by year 2020.
    2. Reduce by 5% the number of patients with diabetes with an HbA1c value greater than 9% by year 2020.
    3. Increase by 5% the number of adult patients who receive weight screenings and counseling by year 2020.
    4. Increase by 5% the number of pediatric patients who receive weight screenings and counseling by year 2020.
    5. Reduce by 1% the disparities gap between racial and ethnic groups with the highest and lowest rates of diabetes by year 2020.

HRSA also aims to by 2020, increase the number of health centers that meet the Healthy People 2020 goals for uncontrolled diabetes for each racial/ethnic group.

The following HRSA resources support health centers in achieving the Health Center Program Diabetes QI Initiative measures:

Operational Site Visits & Diabetes

Health center Operational Site Visits (OSVs) now include diabetes performance improvement. During a health center’s site visit, HRSA consultants will conduct an analysis to assist health centers with understanding the factors that affect diabetes clinical delivery and patient health care outcomes. In addition to OSVs, approximately 50 health centers without a scheduled OSV were selected to participate in diabetes technical assistance to support performance improvement. The OSVs and technical assistance activities will result in diabetes action plans to help health centers identify goals and activities to support diabetes quality improvement and identify areas for further technical assistance. For more information, view the Site Visit Protocol (PDF - 1 MB) and The Operational Site Visit (OSV): Answers to commonly asked questions (Video) HRSA BPHC Exit Disclaimer.

HRSA Diabetes Quality Improvement Initiative Webinars (2017-2018)

Health Center Resource Clearinghouse

HRSA and the National Association of Community Health Centers (NACHC) developed the Health Center Resource Clearinghouse HRSA BPHC Exit Disclaimer, which highlights diabetes as a priority topic and has an up-to-date selection of current, high-quality resources about diabetes and its public health impact. Resources cover screening and treatment with a special focus on successful outreach to special and vulnerable populations. Resources were chosen specifically based on their relevance and helpfulness to health centers.

1. 2017 Uniform Data System (UDS)

2. 2017 Uniform Data System (UDS)

3.Comprehensive Diabetes Care HRSA BPHC exit disclaimer, Medicaid-HMO 2017, National Committee for Quality Assurance

4. 2017 Uniform Data System (UDS)

5. American Diabetes Association. 2017. Economic Costs of Diabetes in the U.S.

6. Fitch, K. B Pyenson, K Iwasaki. 2013 “Medical Claim Cost Impact of Improved Diabetes Control for Medicare and Commercially Insured Patients with Type 2 Diabetes.” J Manage Care Pharm. 19(8)

Date Last Reviewed:  May 2019

Promising Practices and Diabetes Management Leaders

Diabetes Resources

Agency for Healthcare Research and Quality:
Improving Diabetes Care Quality website

American Diabetes Association:

Diabetes Pro Clinical Corner HRSA BPHC Exit Disclaimer

2019 Diabetes Standards of Medical Care HRSA BPHC Exit Disclaimer

Centers for Disease Control and Prevention:
The National Diabetes Prevention Program

National Institutes of Health: 
Guiding Principles for the Care of People with or at Risk for Diabetes