Measures of individual and group changes in ordered categorical data: application to the ADL staircase

BACKGROUND: Diabetes mellitus is a serious public health concern. Approximately 7.8 million Americans have been diagnosed with the disease. Researchers estimate an additional 6 to 7 million individuals currently have the disease, but remain undiagnosed. Diabetes is the leading cause of new blindness in Americans 20 to 74 years of age. Disproportionately high rates of diabetes exist within Native American, Hispanic, and black populations. METHODS: This process review documents the experiences of a collaborative primary care team approach to the prevention and treatment of ocular complications of diabetes in patients receiving care at the White Earth Indian Health Center, Bemidji Area Indian Health Service. The White Earth Indian Health Center was one of four primary care clinics that pilot-tested the Minnesota Department of Health Diabetes Control Program. RESULTS: The rate of diabetic eye examination increased to 86% of all individuals diagnosed with diabetes. CONCLUSIONS: This article describes the experiences of the White Earth Indian Health Center in establishing priorities, selecting guidelines, and implementing and monitoring a pilot-project for the prevention of ocular complications of diabetes. Application or modifications of this model may be of benefit to other programs that use the primary care team approach in the care and management of diabetes and other chronic disease entities.