in how primary care physicians deliver care to their patients are likely to reduce disparities in Type 2 diabetes (hereafter referred to as diabetes) outcomes for vulnerable adults. While providers may offer good technical quality of care (i.e., the clinical services provided and therapeutic recommendations made), there are known deficits in how providers make those services accessible to patients, how well two-way communication occurs with patients about complex management regimens, and how care is coordinated with other providers caring for the patients'condition. These deficits are particularly acute for vulnerable adults-racial/ethnic minorities, those with low socioeconomic status and those who rely on the nation's safety net health care system-and are likely to contribute to disparities in diabetes outcomes. The goal of the proposed research is to understand whether the way in which primary care services are delivered to diabetic adults influences what clinical services are ultimately received by patients and how well patients adhere to providers'recommendations to successfully manage their condition. We think, and there is a body of evidence to suggest, that delivering care in accordance with a "medical home model" helps to improve patient experiences and may improve patients'receipt of, and response to, appropriate care. A medical home should be widely accessible, facilitate a continuous relationship with patients including effective two-way communication, provide comprehensive services, help to coordinate services when needed, and account for family context and cultural background throughout. 'Specific Objective 1: To test the hypothesis that better medical home performance increases the receipt of recommended diabetes care, improves patient physiologic measures associated with better management of the condition, and reduces adverse health care utilization. 'Specific Objective 2: To explore whether the practice setting in which primary care is delivered (i.e., community health centers, group practices, and solo practices) affects the medical home performance of physicians and, as a result, the response of patients to diabetes care.
The proposed research will provide critical information about different approaches to delivering primary health care that can improve the successful care and outcomes of diabetes among vulnerable adults. With rates of diabetes at epidemic levels, the results will help inform how to best improve quality and reduce disparities in diabetes management and outcomes.