Determinants of diabetes care and outcomes: a multi-level analysis across the continuum of care.

Type 2 Diabetes (T2D) is one of the leading causes of death in the world (3.7 million deaths/year). In Belgium, 6.1% of the population is diagnosed with diabetes. Effective treatment exits and is relatively straightforward from a technical point of view, but T2D care is socially and organizationally complex. It requires lifelong follow-up and self-management along a continuum of care: patients need to be diagnosed, treated, followed-up, and supported to achieve glycaemic control. Unfortunately, people (especially vulnerable groups) are lost at each of these steps, leading to complications and avoidable hospitalizations. Knowledge is urgently needed on the determinants of these leakages in the care continuum. In accordance with the socioecological model, we aim to disentangle the determinants of drop-out at 3 levels (patient, health system & community level) through an innovative multilevel Cascade-of-Care approach. The Cascade-of-Care visualizes the drops between the steps of the care continuum while our multilevel analyses will attempt to explain each drop using determinants at the 3 levels. We will build a unique dataset combining (1) individual health insurance and medical lab data, (2) organizational data of primary care practices and (3) administrative and self-gathered data of neighborhoods. Spatial multilevel analysis will allow us to assess (1) the relative impact of and (2) interaction between the determinants at these 3 levels on each step of the continuum of care.

Keywords:COMMUNITY HEALTH

Disciplines:Health management, Public health care not elsewhere classified, Sociology of health