PROJECT SUMMARY / ABSTRACT
A collaborative network of research teams from Stanford, Harvard, The Ohio State University, and
Impactivo, LLC propose practice-relevant research focused on diabetes care in federally qualified health
centers (FQHCs). Some 37.3 million Americans have type 2 diabetes and significant racial and socioeconomic
disparities persist in care quality and patient safety. FQHCs serve 1 in 7 U.S. racial/ethnic minorities and
shoulder a higher prevalence of diabetes (21% FQHC, 11% U.S.), offering a promising venue for innovating in
equity-focused diabetes care. The iPATH project will refine and implement an approach to practice
transformation originally conceived to support FQHCs’ pursuit of National Committee for Quality Assurance
recognition as patient-centered medical homes. A pilot demonstrated significant decreases (average 31%
reduction) in poorly controlled diabetes (A1c>9%) among patients at 7 clinics affiliated with an FQHC in Puerto
Rico in 2017-20. Improvements in patients’ diabetes control were sustained pre- to post- Covid-19 pandemic.
Aim 1. Refine the iPATH implementation approach by identifying organizational conditions and
processes at FQHCs that promoted or impeded the effectiveness of type 2 diabetes care for NIH-
designated U.S. health disparity populations pre- and post-pandemic. Research teams will
simultaneously conduct 12 in-depth regional case studies, enabling contrast between FQHCs considered high-
performing and low-performing for diabetes control. Teams will identify actionable, how-to implementation
factors for ensuring chronic, preventive, and acute care for patients with diabetes. Employing an innovative
Rapid Data Collection and Reporting methodology, teams will rapidly collect, analyze, and share data to
accelerate dissemination of customized feedback to FQHC leaders and to inform adaptation and
implementation of the iPATH practice transformation.
Aim 2. Implement a multi-level, multi-component, technology-enabled practice transformation
strategy to improve type 2 diabetes for patients at 8 multi-clinic FQHCs. Teams will adapt, tailor,
implement, test, and spread an equity-focused practice transformation strategy across FQHCs located in
California, Massachusetts, Ohio, and Puerto Rico. The iPATH implementation approach will be modularized
and customizable to accommodate organizational readiness, patient needs, and social contexts, tailoring
practice transformation efforts to each unique FQHC.
Aim 3. Comprehensively evaluate the iPATH implementation approach with a hybrid type 2 study,
including a stepped wedge cluster randomized trial. Including formative, process, and summative
evaluation elements guided by the Exploration-Preparation-Implementation-Sustainment model, the study will
evaluate impact of practice transformation and identify process elements affecting implementation
effectiveness. Analyses will leverage FQHC data by race and ethnicity to examine health disparities.
