Integrated Community-Healthcare Diabetes Interventions to Reduce Disparities
- 1.4k Downloads
Racial and ethnic minorities suffer disproportionately from diabetes-related morbidity and mortality. With the creation of Accountable Care Organizations (ACOs) under the Affordable Care Act, healthcare organizations may have an increased motivation to implement interventions that collaborate with community resources and organizations. As a result, there will be an increasing need for evidence-based strategies that integrate healthcare and community components to reduce diabetes disparities. This paper summarizes the types of community/health system partnerships that have been implemented over the past several years to improve minority health and reduce disparities among racial/ethnic minorities and describes the components that are most commonly integrated. In addition, we provide our recommendations for creating stronger healthcare and community partnerships through enhanced community support.
KeywordsDiabetes Disparities Integration Community Health systems Healthcare Quality improvement Patient education Culturally tailored Providers Care coordination Interventions
This research was supported by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (Grant No. R18DK083946), the Chicago Center for Diabetes Translation Research (Grant No. P30 DK092949-01) and the Alliance to Reduce Disparities in Diabetes of the Merck Foundation. Monica Peek was supported by the Mentored Patient-Oriented Career Development Award of the NIDDK (Grant No. K23 DK075006) and the Robert Wood Johnson Foundation. Marshall Chin is supported by an NIDDK Midcareer Investigator Award in Patient-Oriented Research (Grant No. K24 DK071933).
Compliance with Ethics Guidelines
Conflict of Interest
Monica E. Peek declares that she has no conflict of interest. Molly Ferguson declares that she has no conflict of interest. Nyahne Bergeron declares that she has no conflict of interest. Debra Maltby declares that she has no conflict of interest. Marshall H. Chin declares that he has no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of outstanding importance
- 2.Agency for Healthcare Research and Quality (AHRQ). Diabetes disparities among racial and ethnic minorities. 02nd ed. Rockville: Agency for Healthcare Research and Quality; AHRQ Publication; 2001. p. P007.Google Scholar
- 3.National Diabetes Information Clearinghouse (NDIC). National diabetes statistics, 2011. Bethesda, Maryland: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; NIH Publication No. 11-3892. 2011.Google Scholar
- 8.•DePue JD, Dunsiger S, Seiden AD, et al. Nurse-community health worker team improves diabetes care in American Samoa. Diabetes Care. 2013;36:1947–53. This intervention utilized a nurse-CHW team to provide self-management education and care coordination for patients in the underserved area of American Samoa.PubMedCrossRefGoogle Scholar
- 9.Gary TL, Batts-Turner M, Yeh HC, et al. The effects of a nurse case manager and a community health worker team on diabetic control, emergency department visits, and hospitalizations among urban African Americans with type 2 diabetes mellitus. Arch Intern Med. 2009;19:1788–94.Google Scholar
- 10.••Jenkins C, Pope C, Magwood G, et al. Expanding the chronic care framework to improve diabetes management: the REACH case study. Prog Community Health Partnership. 2010;4:65–79. This article outlines the expansion of the Chronic Care Model (CCM) to the Community CCM, which integrates community and health systems components and was informed by the REACH Charleston and Georgetown Diabetes Coalition.CrossRefGoogle Scholar
- 12.••Peek ME, Wilkes AE, Roberson TS, et al. Early lessons from an initiative on Chicago’s South Side to reduce disparities in diabetes care and outcomes. Health Aff. 2012;31:177–86. This multi-faceted intervention integrated patient education, clinician involvement, quality improvement, and community linkages, and provided enhanced support in the community through education, screening, and outreach. This intervention also provided a link from the community to the healthcare system by connecting community members without a medical home to a regular source of care.CrossRefGoogle Scholar
- 13.•Rosal MC, Ockene IS, Restrepo A, et al. Randomized trial of a literacy-sensitive, culturally tailored diabetes self-management intervention for low-income Latinos. Diabetes Care. 2011;34:838–44. This intervention integrated culturally-tailored patient education in community-based settings with community-health center clinician involvement.PubMedCentralPubMedCrossRefGoogle Scholar
- 14.•Spencer MS, Rosland AM, Kieffer EC, et al. Effectiveness of a community-health worker intervention among African American and Latino adults with type 2 diabetes: a randomized controlled trial. Am J Public Health. 2011;101:2253–60. This intervention utilized CHWs to provide education and care coordination in community-based settings, conducted a joint patient visit with CHWs and primary care providers, and provided enhanced community support through healthy eating and exercise activities as well as a local farmer’s market.PubMedCentralPubMedCrossRefGoogle Scholar
- 15.•Thompson JR, Horton C, Flores C. Advancing diabetes self-management in the Mexican American population: a community health worker model in a primary care setting. Diabetes Educ. 2007;33 Suppl 6:159S–65. This study outlines the value of community health workers to improve diabetes education and management, reduce health disparities, foster improved patient-provider communication, and act as navigators to needed care services and resources for Mexican-American patients in a primary care setting.PubMedCrossRefGoogle Scholar
- 16.•Walton JW, Snead CA, Collinsworth AW, Schmidt KL. Reducing diabetes disparities through the implementation of a community-health worker-led diabetes self-management education program. Fam Community Health. 2012;25:161–71. This intervention integrated CHWs into a primary care system, and created a web-based diabetes registry and management system for use by CHWs and clinicians.CrossRefGoogle Scholar
- 24.Gary TL, Bone LR, Hill MN, Levine DM, McGuire M, Saudek C, et al. Randomized controlled trial of the effects of nurse case manager and community health worker interventions on risk factors for diabetes related complications in urban African Americans. Prev Med. 2003;37:23–32.PubMedCrossRefGoogle Scholar
- 25.Allen JK, Dennison-Himmelfarb CR, Szanton SL, et al. COACH Trial: a randomized controlled trial of nurse practitioner/community health worker cardiovascular disease risk reduction in urban community health centers. Circ Cardiovasc Qual Outcomes. 2011;4:595–602.PubMedCentralPubMedCrossRefGoogle Scholar
- 26.Philis-Tsimikas A, Gilmer TP, Schultz J, Walker C, Fortmann AL, Gallo LC. Community-created programs: can they be the basis of innovative transformations in our health care practice? Implications from 15 years of testing, translating, and implementing community-based, culturally tailored diabetes management programs. Clin Diabetes. 2012;30:156–63.Google Scholar
- 30.Gerber BS, Rapacki L, Castillo A, Tilton J, Touchette DR, Mihailescu D, et al. Design of a trial to evaluate the impact of clinical pharmacists and community health promoters working with African-American and Latinos with diabetes. BMC Public Health. 2012;12:891.PubMedCentralPubMedCrossRefGoogle Scholar
- 31.•Kahn LS, Tumiel-Berhalter L, D’Aniello R, et al. The impacts of “Growing Our Own”: a pilot project to address health disparities by training health professionals to become certified diabetes educators in safety net practices. Diabetes Educ. 2012;38:86–93. The article outlines the evaluation of a certified diabetes educators (CDE) training initiative, the impact of CDEs on patient diabetes outcomes, and the integration of the CDEs into a primary care practice team in an effort to improve diabetes management and education among minority patients in Buffalo, New York.PubMedCrossRefGoogle Scholar
- 33.•Geller JS, Orkaby A, Gleghorn GD. Impact of a group medical visit program on Latino health-related quality of life. Exploration. 2011;7:94–9. This intervention utilized a medical home and group medical visit model to improve quality of life measures, mental health, and diabetes management among Latinos with diabetes.Google Scholar
- 38.Willard-Grace R, DeVore D, Chen EH, Hessler D, Bodenheimer T, Thom DH. The effectiveness of medical assistant health coaching for low-income patients with uncontrolled diabetes, hypertension, and hyperlipidemia: protocol for a randomized controlled trial and baseline characteristics of the study population. BMC Fam Pract. 2013;14:27.Google Scholar
- 40.••Jenkins C, Myers P, Kelechi TJ, et al. Efforts to decrease diabetes-related amputation in African Americans by the Racial and Ethnic Approaches to Community Health Charleston and Georgetown Diabetes Coalition. Fam Community Health. 2011;34 Suppl 1:S63–78. This article outlines successful strategies to reduce disparities in diabetes-related amputations for African Americans, including improvements in diabetes messaging in the community and diabetes care, and improved diabetes-related policies.PubMedCrossRefGoogle Scholar
- 42.•Fawcett SB, Collie-Akers V, Schultz JA, et al. Community-based participatory research within the Latino Health for All Coalition. J Prev Interv Community. 2013;41(3):142–54. This intervention was supported by a community-academic partnership and utilized the Health for All Model in alignment with key principles of community-based participatory research (CBPR) to promote healthy nutrition, physical activity, and access to health services among Latinos.PubMedCrossRefGoogle Scholar
- 43.••Clark NM, Brenner J, Johnson P, et al. Reducing disparities in diabetes: the Alliance Model for health care improvements. Diabetes Spectr. 2011;24:226–30. The Alliance Model emphasizes the importance of patient self-management education, health systems change, education for providers, and stakeholder engagement as key components of reducing disparities in diabetes.CrossRefGoogle Scholar
- 44.Goddu AP, Roberson TS, Raffel KE, et al. (2014) Food Rx: a community-university partnership to prescribe healthy eating on the South Side of Chicago. J Prevent Intervent Comm.Google Scholar
- 45.•McCann E. Building a community-academic partnership to improve health outcomes in an underserved community. Public Health Nurs. 2010;27:32–40. The article outlines the creation of a sustainable community-academic partnership aiming to provide comprehensive health care services and improve health outcomes for underserved residents of the East Garfield Park community in Chicago, IL.PubMedCrossRefGoogle Scholar
- 46.••Grigg-Saito D, Toof R, Silka L, et al. Long-term development of a “whole community” best practice model to address health disparities in the Cambodian refugee and immigrant community of Lowell, Massachusetts. Am J Public Health. 2010;100:2026–9. Through a partnership with a federally qualified health center, this intervention involved a multifactorial, culturally-centered approach that utilized community-based collaborations, care coordination, and a range of health care services to address the health needs of a Cambodian refugee and immigrant population.PubMedCentralPubMedCrossRefGoogle Scholar
- 47.••Rice D, Bain TM, Collinsworth A, Boyer K, Fleming NS, Miller E. Effective strategies to improve the management of diabetes: case illustration from the Diabetes Health and Wellness Institute. Prim Care Clin Off Pract. 2012;39:363–79. This intervention aimed to reduce health disparities within an underserved minority population through the formation of community-based partnerships, development of interprofessional teamwork and care coordination, and improvement of the patient health care experience in order to improve diabetes management within the primary care setting of a large-scale urban health care system in Dallas, TX. Google Scholar
- 48.Community Research Partners. Available at: www.communityresearchpartners.net. Accessed September 9, 2013.