ABSTRACT
BACKGROUND: Type II diabetes continues to be a major health problem in USA, particularly in minority populations. The Diabetes Equity Project (DEP), a clinic-based diabetes self-management and education program led by community health workers (CHWs), was designed to reduce observed disparities in diabetes care and outcomes in medically underserved, predominantly Hispanic communities. OBJECTIVE: The purpose of this study was to evaluate the impact of the DEP on patients' clinical outcomes, diabetes knowledge, self-management skills, and quality of life. METHODS: The DEP was implemented in five community clinics from 2009 to 2013 and 885 patients completed at least two visits with the CHW. Student's paired t-tests were used to compare baseline clinical indicators with indicators obtained from patients' last recorded visit with the CHW and to assess differences in diabetes knowledge, perceived competence in managing diabetes, and quality of life. A mixed-effects model for repeated measures was used to examine the effect of DEP visits on blood glucose (HbA1c), controlling for patient demographics, clinic and enrolment date. RESULTS: DEP patients experienced significant (P < 0.0001) improvements in HbA1c control, blood pressure, diabetes knowledge, perceived competence in managing diabetes, and quality of life. Mean HbA1c for all DEP patients decreased from 8.3% to 7.4%. CONCLUSION: Given the increasing prevalence of diabetes in USA and documented disparities in diabetes care and outcomes for minorities, particularly Hispanic patients, new models of care such as the DEP are needed to expand access to and improve the delivery of diabetes care and help patients achieve improved outcomes.
Subject(s)
Community Health Workers , Delivery of Health Care/standards , Diabetes Mellitus, Type 2/therapy , Health Knowledge, Attitudes, Practice , Adult , Female , Glycated Hemoglobin/analysis , Hispanic or Latino/statistics & numerical data , Humans , Male , Middle Aged , Prospective Studies , Quality of Life , Self Care/methods , Texas/epidemiology , Time Factors , Treatment Outcome , Vulnerable PopulationsABSTRACT
PURPOSE: The purpose of this study was to evaluate the effectiveness of a Community Health Worker (CHW)-led diabetes self-management education (DSME) program and to understand how CHWs and primary care providers (PCPs) work together to provide comprehensive diabetes care. METHODS: A quantitative pre- and postassessment of change in patients' blood glucose levels (A1C), blood pressure, and body mass index was performed to determine the clinical effectiveness of the program. Qualitative, semi-structured interviews with 5 CHWs and 7 PCPs were conducted to assess how CHWs were incorporated into clinical teams and their impact on care delivery and diabetes-related outcomes. RESULTS: Patients who participated in the program experienced a statistically significant decrease in mean A1C levels and systolic blood pressure readings 1 year post baseline. CHWs provided high-quality care and bridged the gap between patients and care providers through diabetes management support and education, medication assistance, access to community resources, and social support. CONCLUSIONS: CHWs play a variety of roles in helping patients overcome barriers to diabetes control and can be successfully integrated into a health care system's care coordination strategy.
Subject(s)
Community Health Workers , Diabetes Mellitus, Type 2/prevention & control , Health Behavior , Health Education , Medication Adherence/statistics & numerical data , Primary Health Care , Self Care , Adult , Blood Glucose/metabolism , Community Health Workers/organization & administration , Community Health Workers/standards , Cooperative Behavior , Delivery of Health Care , Diabetes Mellitus, Type 2/epidemiology , Female , Glycated Hemoglobin/metabolism , Health Education/organization & administration , Health Education/standards , Health Services Accessibility , Humans , Male , Middle Aged , Patient Education as Topic , Primary Health Care/organization & administration , Program Evaluation , Quality of Health Care , Social Support , Socioeconomic Factors , Surveys and Questionnaires , Texas/epidemiologyABSTRACT
Disparities in prevalence of type 2 diabetes and complications in underserved populations have been linked to poor quality of care including lack of access to diabetes management programs. Interventions utilizing community health workers (CHWs) to assist with diabetes management have demonstrated improvements in patient outcomes. Use of CHWs may be an effective model for providing care coordination and reducing disparities, but there is limited knowledge on how to implement this model on a large scale. This article describes how an integrated health care system implemented a CHW-led diabetes self-management education program targeting Hispanic patients and reports lessons learned from the first 18 months of operation.
