Document Type



Purpose This report is an evaluation of the Indian Health Service (IHS) diabetes model projects. Two primary purposes of the evaluation included project descriptions and an examination of their effect on two patient health outcomes - blood sugar control and hospitalizations. Methods This evaluation made use of 634 patient medical records, four focus groups and 20 informant interviews. Two multivariate statistical models were created to evaluate the protective effect of the diabetes projects against poor blood sugar control and risk of a first hospitalization with a diabetes diagnosis. Results Patients followed at diabetes project sites experienced lower rates of poor blood sugar control than patients followed at usual care sites. The diabetic care model for poor sugar control had three care components that were indicative of a protective effect: 1) having seen a dietitian in the first year after diagnosis; 2) having a hemoglobin A1c test performed one or more times in two years; and 3) being seen for foot care in the first year following diagnosis. Patients that were at risk for a first diabetes-related hospitalization were: 1) those who were in very poor control at baseline; 2) those who were prescribed insulin or insulin combined with oral agents; and 3) those who were at comorbidity severity level 2 or who were prescribed antihypertensives before diagnosis. Conclusion The recommendations of this evaluation fall into two categories: 1) general recommendations for improving and maintaining quality of diabetes care in the Indian Health Service and 2) specific recommendations for improving the quality of diabetes care in the individual service units involved in the evaluation.

Publication Date



Indian Health Service, Staff Office of Planning, Evaluation and Research, Rockville, MD 20857 (E-126).