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Pathways to Better Diabetes Care
FQHC Learning Collaborative

Purpose 
In partnership with the Center for Accelerating Care Transformation (ACT Center), the Washington Association for Community Health will convene the Pathways to Better Diabetes Care Collaborative for interdisciplinary FQHC teams to implement strategies to improve diabetes outcomes. Over 15 months, participants will share best practices, test new approaches to care, and learn from peers and subject matter experts. The Collaborative will emphasize clinical quality improvement (QI) for diabetes care and implementation and testing of evidence-based strategies. If you are interested, please fill out the interest form by November 13th. 

Goals
Action Goal: By the end of the Collaborative, every participating health center team will implement and test at least one diabetes improvement initiative tailored to their population. 

 Outcome Goal: By the end of the Collaborative, participating centers will collectively achieve measurable improvement on the UDS Glycemic Status Assessment for Patients with Diabetes Measure. We will determine a numeric goal after collecting baseline data.  

Learning Objectives
Through participation in the Pathways to Better Diabetes Care Collaborative, health center teams will: 

  • Gain and share knowledge of current evidence-based best practices for improving diabetes care in FQHC settings. 
  • Identify strategies for improving and implementing diabetes care (e.g., standardized care pathways, team-based care models, patient education, GLP-1 therapies, CGMs, insulin pumps). 
  • Develop and test at least one intervention in their organization (e.g., workflow change, care team model shift).  
  • Track and evaluate progress and impact using key measures (e.g., A1C, time-in-range, medication initiation/adherence/deprescription, CGM use, patient engagement). 
  • Participate in, and utilize ideas from, a learning community including colleagues and subject matter experts.  

Up to 10 Washington health centers will be selected to participate. Thanks to the generous support of the ACT Center, enrolled health centers will receive $40,000 to support engagement in the learning collaborative and travel to in-person events.  

Curriculum
The Collaborative will provide a curriculum that is designed to meet the needs of participating FQHCs. The content of meetings will be responsive to selected focus topics from each health center; however, the general process will look similar for each organization: 

Steps 

Actions 

Identify areas for improvement 
  • Use data to identify gaps
  • Engage leaders, clinicians, care teams, and patients to understand pain points 

Set clear goals 
  • Define measurable objectives 
  • Align goals with health system priorities 

Analyze root causes 
  • Use QI tools like key driver diagrams, fishbone diagrams, and flowcharts to visualize and understand underlying issues 

Design and test interventions 
  • Create action plans 
  • Use Plan-Do-Study-Act (PDSA) cycles to test ideas (e.g., new care pathway, staff training, EHR enhancement) 

Measure impact and sustain improvements 
  • Track key performance indicators; gather both qualitative and quantitative data 
  • Expand across sites; embed changes into systems (e.g., policies, workflows, trainings) 

We will also capture systemic barriers and elevate them to inform policy and advocacy efforts. 

Fill Out Interest Form

Health Center Requirements

Commitment
Each health center will commit to: 

  • Actively participate in the following over 15 months:  
  • 5-6 virtual learning sessions with all enrolled FQHCs (~90 minutes, every other month). 
  • Monthly coaching/technical assistance calls with WACH and the ACT Center. 
  • 2 in-person convenings in Seattle-area (send at least 2 team members to participate).  
  • Meet as a team internally on a regular basis to implement the work of the collaborative. 
  • Set an improvement goal and regularly share progress toward that goal. 
  • Implement at least one diabetes care pathway or improvement initiative. 
  • Submit aggregate data on a monthly basis, including glycemic status data. 

 

Eligibility
Due to limited resources, the Collaborative will include the first 10 FQHCs to complete all enrollment materials, including the interest form below and a Memorandum of Agreement signed by executive leadership.  

  • Have confirmed leadership and care team commitment to pursue diabetes improvement initiatives during the 15-month learning collaborative.
  • Have a designated team of 3-5 individuals to champion and implement the work, with at least two team members attending each learning session. Teams should be interdisciplinary and could include clinical leadership, primary care providers, pharmacists, care managers, behavioral health staff, community health workers/health educators, care coordinators, QI staff, and data/informatics staff. 
  • Have the ability to report aggregate data on glycemic status and other measures selected by the participating FQHC. 

This one-page summary document can be used to share information about the Pathways to Better Diabetes Care Learning Collaborative with your leadership and co-workers.

 

Timeline for key activities and payment: 

Activities 

2026 

2027 

 

Jan  

Feb  

Mar 

Apr  

May 

Jun  

Jul 

Aug 

Sep 

Oct 

Nov 

Dec 

Jan 

Feb 

Mar 

Apr 

Orientation meetings & data collection 

X 

X 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Virtual learning sessions 

 

 

X 

 

 

 

X 

 

X 

 

X 

 

 

 

X 

 

In-person summits 

 

 

 

 

X 

 

 

 

 

 

 

 

X 

 

 

 

Stipend payments 

 

X 

 

 

 

 

 

 

 

X 

 

 

 

 

 

 

Coaching & TA 

 

 

X 

X 

X 

X 

X 

X 

X 

X 

X 

X 

X 

X 

X 

 

Evaluation Interviews 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

X 

X 

 

For More Information 
Email Brianne Probasco, Senior Coordinator.  

Fill Out Interest Form