Examining implementation and effects of a comprehensive community intervention addressing type 2 diabetes among high-risk minority patients in Durham County, NC

A randomized clinical trial of a collaborative home-based diabetes intervention to reduce emergency department visits and hospitalizations in black individuals with diabetes

The prevalence of diabetes mellitus (DM) in black individuals (blacks) is twice that of white individuals (whites), and blacks are more likely to have worse glycemic control, less optimal medication regimens, and higher levels of mistrust in the medical system. These three factors account for higher rates of acute medical care use in blacks with DM. To address this disparity, we developed DM I-TEAM (Diabetes Interprofessional Team to Enhance Adherence to Medical Care), a home-based multidisciplinary behavioral intervention that integrates care from a community health worker (CHW), the participant's primary care physician (PCP), a DM nurse educator, and a clinical pharmacist. Treatment is delivered during 9 sessions over 1 year, and includes diabetes education and goal setting, telehealth visits with participants' PCP and a DM nurse educator, and comprehensive medication reviews by a pharmacist. We describe the rationale and methods for a randomized controlled trial to test the efficacy of DM I-TEAM to reduce emergency department (ED) visits and hospitalizations. We are enrolling 200 blacks with DM during an ED visit. Participants are randomized to DM I-TEAM or Usual Medical Care (UMC). Follow-up assessments are conducted at 6 and 12 months. The primary outcome is the number of ED visits and hospitalizations over 12 months, and is measured by participant self-report and medical record review. Secondary outcomes include hemoglobin A1c (HbA1c), number of potentially inappropriate medications (PIMs), and trust in health care.

Social inequality: Challenges, consequences, and action; introduction to the issue

In the current paper, we introduce the third edition in a series on Social Inequalities, and highlight the impact of social inequalities and provide evidence-based research to support effective programs for change. One of the primary foci of the current issue is on the reduction of inequalities through targeted interventions and community involvement. The collection of articles spans diverse communities and varying placements within the evaluation of interventions, from pointing to potential areas of intervention to the formative or summative evaluation of multiyear programs. The current issue highlights the intersection of community involvement and social inequalities.