Table 2.
Comparison of implementers vs. non-implementers by organizational capacity domain.
| Non-implementers N = 22 | SDPI implementers N = 8 | All N = 30 | Significant difference (p-value)a | ||||
|---|---|---|---|---|---|---|---|
| Workforce and human resources | |||||||
| Number of staff employed, Mean SD | 53.5 | 63.8 | 117.0 | 86.9 | 68.8 | 73.7 | 0.02 |
| Number of physicians (MDs/DOs) employed, Mean SD | 2.2 | 4.1 | 4.3 | 4.5 | 2.8 | 4.2 | 0.03 |
| Number of non-physician clinicians (PAs/NPs) employed, Mean SD | 2.1 | 2.8 | 4.1 | 2.9 | 2.7 | 2.9 | 0.03 |
| Certified diabetes educator, N % | 8 | 36.4% | 5 | 62.5% | 13 | 43.3% | 0.24 |
| Registered dietitian, N % | 12 | 54.6% | 8 | 100.0% | 20 | 66.7% | 0.03 |
| Physical activity specialist, N % | 8 | 36.4% | 3 | 37.5% | 11 | 36.7% | 1.00 |
| Health educator/Lifestyle counselor, N % | 14 | 66.7% | 7 | 87.5% | 21 | 72.4% | 0.38 |
| Community health worker, N % | 13 | 59.1% | 6 | 75.0% | 19 | 63.3% | 0.67 |
| Nurses (RN, BSN, or MSN), N % | 15 | 68.2% | 8 | 100.0% | 23 | 76.7% | 0.14 |
| Public health or epidemiology, N % | 8 | 36.4% | 2 | 28.6% | 10 | 34.5% | 1.00 |
| Existing vacancies that affect patient care, N % | 16 | 72.7% | 6 | 75.0% | 22 | 73.3% | 1.00 |
| Fiscal and economic resources | |||||||
| Total revenue in thousandsb, Median IQR | 2,519 | 1,433–7,169 | 9,830 | 5,807–20,453 | 3,378 | 1,825–10,939 | 0.01 |
| Revenue less expenses in thousandsb, Median IQR | 112 | 2–312 | 244 | 33–880 | 112 | 26–576 | 0.53 |
| Operating marginb, Median IQR | 4.1% | 0.2–10.7% | 1.3% | 0.9–6.0% | 3.7% | 0.8–10.7% | 0.73 |
| Percent of revenue from government grantsb, Median IQR | 75.7% | 52.4–91.8% | 56.8% | 39.0–69.9% | 68.8% | 52.4–91.4% | 0.22 |
| Percent revenue from program servicesb, Median IQR | 16.2% | 3.7–57.6% | 37.2% | 27.4–57.7% | 23.3% | 3.7–57.6% | 0.24 |
| Available funding for diabetes prevention and care, N % | 17 | 77.3% | 7 | 87.5% | 24 | 80.0% | 1.00 |
| Funding specifically dedicated for diabetes prevention and care, N % | 18 | 81.8% | 6 | 75.0% | 24 | 80.0% | 0.65 |
| Sufficient funding for my organization's diabetes programs, N % | 9 | 40.9% | 4 | 50.0% | 13 | 43.3% | 0.70 |
| Physical infrastructure | |||||||
| Space to facilitate group education classes on-site, N % | 21 | 95.5% | 8 | 100.0% | 29 | 96.7% | 1.00 |
| Equipment for nutrition education (e.g., kitchen), N % | 15 | 68.2% | 6 | 75.0% | 21 | 70.0% | 1.00 |
| Physical activity equipment on-site, N % | 13 | 59.1% | 5 | 62.5% | 18 | 60.0% | 1.00 |
| Laboratory collection and testing equipment, N % | 17 | 77.3% | 8 | 100.0% | 25 | 83.3% | 0.29 |
| Pharmacy, N % | 4 | 18.2% | 3 | 37.5% | 7 | 23.3% | 0.34 |
| Data and informational resources | |||||||
| Use an EHR system, N % | 22 | 100.0% | 8 | 100.0% | 30 | 100.0% | NA |
| Reliable access to the internet, N % | 22 | 100.0% | 8 | 100.0% | 30 | 100.0% | NA |
| Uses paper charts, N % | 15 | 68.2% | 4 | 50.0% | 19 | 63.3% | 0.42 |
| Current registry that identifies and tracks patients with type 2 diabetes, N % | 21 | 95.5% | 7 | 87.5% | 28 | 93.3% | 0.47 |
| Ability to systematically identify patients who have pre-diabetes, N % | 16 | 76.2% | 8 | 100.0% | 24 | 82.8% | 0.28 |
| EHR provides historical reports on patients' lab results, N % | 16 | 72.7% | 7 | 87.5% | 23 | 76.7% | 0.64 |
| EHR provides reports on preventive health measures (e.g., physical activity, diet), N % | 16 | 72.7% | 6 | 75.0% | 22 | 73.3% | 1.00 |
| EHR is able to generate reminders about diabetes care targeted at the provider, N % | 16 | 72.7% | 6 | 75.0% | 22 | 73.3% | 1.00 |
| System boundaries and size | |||||||
| UIHO is a FQHC, N % | 5 | 22.7% | 5 | 62.5% | 10 | 33.3% | 0.08 |
| Approximate number of patients served in a fiscal year, Mean SD | 4,540 | 6,627 | 8,382 | 7,644 | 5,638 | 7,013 | 0.04 |
| Approximate number of patients receiving care with type 2 diabetesc, Mean SD | 272 | 280 | 593 | 513 | 362 | 378 | 0.05 |
| Percentage of patients that identify as AI/ANc, Mean SD | 71.9% | 33.5% | 53.9% | 34.4% | 67.2% | 34.0% | 0.15 |
| Percentage of patients that prefer a language other than Englishc, Mean SD | 7.0% | 11.1% | 13.7% | 24.3% | 8.7% | 15.3% | 0.48 |
| Location of my facility is accessible to patients, N % | 22 | 100.0% | 8 | 100.0% | 30 | 100.0% | NA |
| Assist patients with transportation costs, N % | 18 | 81.8% | 8 | 100.0% | 26 | 86.7% | 0.55 |
| Agreements with other community-based organizations for patients to use relevant services not available at the clinic (e.g., nutrition/meals, physical activity, housing, financial needs, etc.), N % | 17 | 77.3% | 7 | 87.5% | 24 | 80.0% | 1.00 |
| Policies and procedures are in place for identifying specialty referrals, N % | 22 | 100.0% | 8 | 100.0% | 30 | 100% | NA |
| Inter-organizational relationships, governance and decision-making structure | |||||||
| Organization is in regular communication with the Indian Health Service, N % | 21 | 95.5% | 8 | 100.0% | 29 | 96.7% | 1.00 |
| Organization has a working relationship with its Board of Directors, N % | 21 | 95.5% | 7 | 87.5% | 28 | 93.3% | 0.47 |
| Community stakeholders participate in the organization's decision-making process, N % | 15 | 68.2% | 8 | 100.0% | 23 | 76.7% | 0.14 |
| Organization uses patient/family feedback to improve the quality of our services, N % | 22 | 100.0% | 8 | 100.0% | 30 | 100.0% | NA |
| Organizational culture | |||||||
| Staff at my organization have high morale, N % | 18 | 81.8% | 8 | 100.0% | 26 | 86.7% | 0.55 |
| Clinic leadership is supportive of diabetes care and prevention services, N % | 22 | 100.0% | 8 | 100.0% | 30 | 100.0% | NA |
| Most staff are AI/AN, N % | 16 | 72.7% | 4 | 50.0% | 20 | 66.7% | 0.38 |
| Programs and departments often collaborate, N % | 22 | 100.0% | 8 | 100.0% | 30 | 100.0% | NA |
| Organization leadership is visible and accessible, N % | 21 | 95.5% | 8 | 100.0% | 29 | 96.7% | 1.00 |
| Organization is trusted by patients, N % | 21 | 95.5% | 7 | 87.5% | 28 | 93.3% | 0.47 |
| Family members/care givers are encouraged to participate in health education activities, N % | 21 | 95.5% | 7 | 87.5% | 28 | 93.3% | 0.47 |
SD, Standard Deviation; IQR, Inter-quartile range; MD, Doctor of Medicine; DO, Doctor of Osteopathic Medicine; PA, Physician Assistant; NP, Nurse Practitioner; RN, Registered Nurse; BSN, Bachelor of Science in Nursing; MSN, Master of Science in Nursing; EHR, Electronic Health Record; FQHC, Federally Qualified Health Center.
a
Fisher's exact tests and Kruskal-Wallis exact tests were used for identifying significant differences across groups for binary and continuous variables, respectively. Tests were not computed for questions for which all UIHOs answered identically.
b
Data come from the IRS Form 990 for whichever reporting period contains April-May 2017.
c
Question had 3–5 organizations with a missing response.