# Optimizing Diabetes Care Quality for Low-Income Patients

> **NIH NIH K23** · UNIVERSITY OF MINNESOTA · 2021 · $198,936

## Abstract

This K23 award will establish the candidate, Dr. Elizabeth Rogers, as an independent physician-investigator
with expertise in development, implementation, and evaluation of patient-centered primary care interventions
that are strategically designed to address patient complexity – both medical and social – to optimize care for
low-income patients with multiple chronic diseases. Most of the 29.1 million Americans with type 2 diabetes
mellitus (T2DM) have at least one additional chronic condition, but existing management guidelines fail to
account for patient complexity. Despite evidence of effective clinic-based interventions, diabetes care quality
remains low, particularly in safety net settings serving patients with low incomes, who are disproportionately
racial and ethnic minorities, and who carry a larger burden of chronic disease. Until patient complexity factors
are meaningfully addressed with specific, pragmatic interventions, patients with comorbid T2DM will remain at
risk for poor-quality care. To address this critical need, Dr. Rogers's K23 project will identify key clinic and
patient influences on care quality by using a “cumulative complexity model” as a framework. This model
focuses on patients' experiences of (1) “workload” (disease-specific work such as attending appointments and
self-care, plus “life” demands such as job, family, and transportation) and (2) “capacity” (e.g. fatigue and
physical symptoms, plus factors such as literacy, finances, and social support). The project will be conducted
in urban Minnesota clinics that are certified Patient-Centered Medical Homes and part of the Hennepin County
Medical Center's safety net care system. After stratifying clinics by diabetes care quality, researchers will
administer clinician and staff surveys in 3 high- and 3 low-scoring clinics to identify clinic resources associated
with optimal diabetes care quality (Aim 1). They will conduct surveys and in-depth interviews with “at-risk”
patients from these sites to discern their perspectives on social vulnerabilities that impede their engagement in
care and specific clinic resources that are helpful in overcoming these obstacles (Aim 2). They will apply these
results using the multiphase optimization strategy (MOST, used to design effective and efficient interventions)
to develop and pilot test a clinic-based, multi-component behavioral intervention – one engineered to reduce
patient workload, augment patient capacity, and thereby optimize patient-centered care for complex patients
with T2DM and depression (Aim 3). A robust training plan, closely aligned with the research plan, will support
the development of Dr. Rogers's expertise in patient-centered outcomes research, mixed methodology, and
clinic-based intervention development and evaluation. She will be supported by a multidisciplinary team of
mentors with expertise in these areas as well as in diabetes, depression, and multimorbidity, and with strong
links to community stakeholders. T...

## Key facts

- **NIH application ID:** 10240312
- **Project number:** 5K23DK118207-04
- **Recipient organization:** UNIVERSITY OF MINNESOTA
- **Principal Investigator:** Elizabeth A Rogers
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $198,936
- **Award type:** 5
- **Project period:** 2018-09-01 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10240312

## Citation

> US National Institutes of Health, RePORTER application 10240312, Optimizing Diabetes Care Quality for Low-Income Patients (5K23DK118207-04). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10240312. Licensed CC0.

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