# Understanding Infrastructure Transformation Effects on Diabetes (The UNITED Study)

> **NIH NIH R18** · UNIVERSITY OF MINNESOTA · 2021 · $289,458

## Abstract

Abstract
 This study leverages a natural experiment resulting when legislative action in Minnesota established state
standards for patient-centered medical homes (PCMH) and mandated quality reporting. The initial UNITED
study was the first to identify the specific care management processes implemented through PCMH redesign
that are associated with significant improvements in diabetes performance measures. Our qualitative work
informed a new understanding of transformational stages and highlighted the importance of workforce
challenges in primary care. In this continuation, we expand our evaluation of primary care redesign to add
changes in workforce models to the initial focus of changes in care management processes, and extend our
observation window through 2024. The Minnesota experiment continues to evolve. Analysis of changing care
delivery and outcomes provides an unparalleled opportunity to evaluate how redesign of primary care delivery
influences diabetes care and to provide decision-makers with evidence for introducing effective models of care.
 Through our data partnerships we observe: (a) Patient-level clinical measures captured in statewide,
mandatory performance reporting of diabetes outcomes. (b) Detailed health plan administrative data from two
of the three largest health plans in the state from which we develop patient-level measures of health care
utilization for the majority of Minnesota adults with diabetes. (c) Practice-level descriptors of the primary care
workforce resources from surveys providers must complete during annual licensure. To these data sources we
add another two rounds of practice-level measures of care management processes in place from our biennial
survey of practices (greater than 70% response rate in 2017 and 2019). In 2021 and 2023 these surveys will
be expanded to include new measures of team roles and functions.
 We leverage this rich dataset (2014-2024) and qualitative inquiry to accomplish the following specific aims:
 1. Determine the impact of changing care management processes in primary care on measures of optimal
diabetes care and health care utilization.
 2. Identify the characteristics of the health care professional workforce that most effectively improve
measures of optimal diabetes care and health care utilization in a primary care practice.
 3. Qualitatively identify practice-specific factors, organizational factors, and social determinants not
observable in the quantitative data that are associated with improvement in optimal diabetes care.
 Our team has a history of collaboration and use of the data sources on which this work relies. The team
has extensive clinical experience, strong relationships with clinical practices in the state, an understanding of
methodologies that control for the lack of randomization in natural experiments, extensive experience
manipulating claims data, and expertise in collecting and analyzing qualitative data. We have expertise in the
best practices of disseminat...

## Key facts

- **NIH application ID:** 10102343
- **Project number:** 2R18DK110732-06
- **Recipient organization:** UNIVERSITY OF MINNESOTA
- **Principal Investigator:** CAROLINE S CARLIN
- **Activity code:** R18 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $289,458
- **Award type:** 2
- **Project period:** 2016-07-16 → 2022-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10102343

## Citation

> US National Institutes of Health, RePORTER application 10102343, Understanding Infrastructure Transformation Effects on Diabetes (The UNITED Study) (2R18DK110732-06). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10102343. Licensed CC0.

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