|CARIDIAB: Caribbean Diabetes Project|
CARIDIAB—Guiding and supporting national quality improvement initiatives for diabetes in less well-served parts of the world: a proof-of-concept project in the Caribbean. Part of the Caribbean Chronic Care Collaborative (CCCC).
Participating Countries from the English-Speaking Caribbean: Antigua and Barbuda, Anguilla, Barbados, Belize, Grenada, Guyana, Jamaica, St. Lucia, Suriname, and Trinidad and Tobago.
Project Goal: To improve the quality of life of people with diabetes.
Project Objective: Achieve real and sustained improvement in the quality of diabetes care and outcomes in 10 Caribbean countries.
While acknowledging the scarcity of resources for diabetes care in less developed parts of the world, there are interventions for the prevention of diabetes-related complications that are both highly cost-effective and feasible in such settings, including moderate blood glucose and blood pressure control and foot care. There is much evidence to show, however, that such interventions are at best poorly implemented. The overall goal of this initiative is to provide guidance and support to Ministries of Health and health care providers in less well-served parts of the world in the design, implementation, and evaluation of quality improvement initiatives for diabetes care.
The specific goal of the project described here is to achieve real and sustained improvements in diabetes care in 10 Caribbean countries. Three key personnel from each of these countries , including a healthcare planner and two diabetes care providers, will be supported by a faculty of mentors (experts in different aspects of diabetes care and quality improvement initiatives) to design an intervention for improving diabetes care in their country. This team will train local clinics and coordinate the implementation and evaluation of interventions, all with continuing review and support from the faculty of mentors.
Resources are sought to support the process from intervention design to evaluation. Resources are not sought for the costs of the interventions themselves, which will be met from the health budgets of the countries concerned. Outcomes of this project will be initiatives to improve the quality of diabetes care in 10 Caribbean countries and the development of materials as well as an approach to initiating and supporting quality improvement that will be used in other parts of the world.
There is very good evidence that, through the provision of good diabetes care and the empowerment of people with diabetes, a substantial proportion of diabetes-related complications are preventable. Many of the interventions to improve outcomes are highly cost-effective. The widely-known publication Disease Control Priorities in Developing Countries (2nd Edition) promotes moderate blood glucose control, moderate blood pressure control, and good foot care as both feasible and potentially cost-saving within low- and middle-income countries (1). Interventions aimed at improved blood glucose control, blood pressure control, and foot care can reduce complications of diabetes and the associated medical costs.
There is evidence from many settings, including the Caribbean, that there remains substantial room for improvement in diabetes care. "Collaborative quality improvement" provides a tried and tested approach that involves the health care providers in developing and implementing changes to improve the quality of health care. For example, this model was applied and shown to result in improved diabetes control in an innovative project in primary health care in Veracruz, Mexico (the VIDA project).
The project proposed here builds upon the commitment of the Caribbean countries who were part of the PAHO-led Institutional Response to Diabetes in the Caribbean (IRDC), which consisted of a series of three workshops and reviewed issues around quality of diabetes care and approaches to its improvement, and Belize, which is part of the PAHO-led Central American Diabetes Initiative (CAMDI). This proposal is designed to provide practical guidance and ongoing support to the design, implementation and evaluation of quality improvement measures.
Regional Office for the Americas of the World Health Organization