DRIVE for Health Equity: Tailoring Quality Improvement, Clinical Education, and Community Engagement to Improve Type 2 Diabetes (T2DM) Outcomes for Minoritized Communities in Oakland, California
Authors: Zuniga-Rivas Leslie , Nuss Henry , Lawrence Adewale , Hernandez Laura , Sultana Nushrat , Hobbs Kristen , Ruffin DeLorean , Nation Bishop , Choudhry Aneesa , Hal Laura 
Published: September 2024

Background: Type 2 Diabetes Mellitus (T2DM) is influenced by various factors, with racial and ethnic minorities experiencing higher prevalence. Existing diabetes management programs focus on primary prevention, often neglecting optimal hemoglobin A1C (HbA1c) management for individuals with prediabetes. Consistent HbA1c monitoring is crucial for comprehensive care. This study highlighted the need for secondary prevention and community collaboration to enhance health equity for individuals with T2DM. The DRIVE program, conducted by the National Minority Quality Forum's (NMQF) Center for Sustainable Health Care Quality and Equity (SHC), aimed to improve health outcomes for individuals with Type 2 Diabetes Mellitus (T2DM) in Oakland, CA. Building on prior successes in New Orleans, Los Angeles, and Queens, NY, DRIVE employs a flexible and sustainable approach that integrates quality improvement strategies at clinic sites, focusing on patient and community engagement. The study addressed barriers to medication adherence, provided Diabetes Self-Management Education and Support (DSMES), fostered community partnerships, and utilized culturally appropriate resources. The program's impact was evaluated through changes in HbA1c levels and community participation. Methods: A pre-and post-test design was used, targeting patients of Baywell Health, Oakland, CA, aged 18 and older with initial HbA1c levels greater than 9%. The intervention, developed using SHC’s DRIVE program, included components such as food distribution events, workflow enhancements, identification and mitigation of medication adherence barriers, rapid cycle improvement processes, community educational sessions, and the creation of patient resources. This two-year study implemented four Plan-Do-Study-Act (PDSA) cycles, each lasting 2-4 months, following a three-month planning phase. HbA1c levels were measured at baseline, six months after implementation, and again at 18-month follow-up. Statistical Analysis Univariate analyses described demographic data, while paired sample t-tests assessed changes in HbA1c levels. Independent sample t-tests and ANOVA with pairwise comparisons were used to determine group differences. Results: Among the 255 participants, 58% identified as female and 42% as male. The majority were Black/African American (64%) and 73% were Non-Hispanic/Latino/a, with a mean age of 55.4 years. HbA1c levels were significantly reduced from an average of 10.3±1.4 to 9.4±2.1 at follow-up. Participants who enrolled the longest showed greater reductions. Community initiatives reached over 600 individuals, demonstrating the program's effectiveness in building partnerships and sustainability. Conclusion: SHC’s DRIVE program improved T2DM outcomes through community involvement, quality improvement, and culturally tailored education. This initiative highlighted the importance of addressing health inequities and barriers in diabetes care through culturally sensitive techniques and sustained interventions. DRIVE effectively reduced disparities and promoted sustainable health outcomes among minority groups. Collaborative efforts enhanced trust and demonstrated the advancement of health equity through tailored interventions, with DRIVE providing a flexible and sustainable framework for tailoring interventions to community needs. These findings underscored the need for individualized, culturally competent diabetes care, continuous education, community engagement, and equitable resource access to support communities of color and ethnic minorities in managing T2DM effectively.