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Falk EM, Staab EM, Deckard AN, Uranga SI, Thomas NC, Wan W, Karter AJ, Huang ES, Peek ME, Laiteerapong N. Effectiveness of Multilevel and Multidomain Interventions to Improve Glycemic Control in U.S. Racial and Ethnic Minority Populations: A Systematic Review and Meta-analysis. Diabetes Care 2024; 47:1704-1712. [PMID: 39190927 PMCID: PMC11362130 DOI: 10.2337/dc24-0375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/27/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Racial and ethnic disparities in type 2 diabetes outcomes are a major public health concern. Interventions targeting multiple barriers may help address disparities. PURPOSE To conduct a systematic review and meta-analysis of diabetes self-management education (DSME) interventions in minority populations. We hypothesized that interventions addressing multiple levels (individual, interpersonal, community, and societal) and/or domains (biological, behavioral, physical/built environment, sociocultural environment, and health care system) would have the greatest effect on hyperglycemia. DATA SOURCES We performed an electronic search of research databases PubMed, Scopus, CINAHL, and PsycINFO (1985-2019). STUDY SELECTION We included randomized controlled trials of DSME interventions among U.S. adults with type 2 diabetes from racial and ethnic minority populations. DATA EXTRACTION We extracted study parameters on DSME interventions and changes in percent hemoglobin A1c (HbA1c). DATA SYNTHESIS A total of 106 randomized controlled trials were included. Twenty-five percent (n = 27) of interventions were exclusively individual-behavioral, 51% (n = 54) were multilevel, 66% (n = 70) were multidomain, and 42% (n = 45) were both multilevel and multidomain. Individual-behavioral interventions reduced HbA1c by -0.34 percentage points (95% CI -0.46, -0.22; I2 = 33%) (-3.7 [-5.0, -2.4] mmol/mol). Multilevel interventions reduced HbA1c by -0.40 percentage points (95% CI -0.51, -0.29; I2 = 68%) (-4.4 [-5.6, -3.2] mmol/mol). Multidomain interventions reduced HbA1c by -0.39 percentage points (95% CI -0.49, -0.29; I2 = 68%) (-4.3 [-5.4, -3.2] mmol/mol). Interventions that were both multilevel and multidomain reduced HbA1c by -0.43 percentage points (95% CI -0.55, -0.31; I2 = 69%) (-4.7 [-6.0, -3.4] mmol/mol). LIMITATIONS The analyses were restricted to RCTs. CONCLUSIONS Multilevel and multidomain DSME interventions had a modest impact on HbA1c. Few DSME trials have targeted the community and society levels or physical environment domain. Future research is needed to evaluate the effects of these interventions on outcomes beyond HbA1c.
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Affiliation(s)
- Eli M. Falk
- University of Chicago Biological Sciences Division, University of Chicago, Chicago, IL
| | - Erin M. Staab
- University of Chicago Biological Sciences Division, University of Chicago, Chicago, IL
| | - Amber N. Deckard
- University of Chicago Biological Sciences Division, University of Chicago, Chicago, IL
| | - Sofia I. Uranga
- University of Chicago Biological Sciences Division, University of Chicago, Chicago, IL
| | - Nikita C. Thomas
- University of Chicago Biological Sciences Division, University of Chicago, Chicago, IL
| | - Wen Wan
- University of Chicago Biological Sciences Division, University of Chicago, Chicago, IL
| | | | - Elbert S. Huang
- University of Chicago Biological Sciences Division, University of Chicago, Chicago, IL
| | - Monica E. Peek
- University of Chicago Biological Sciences Division, University of Chicago, Chicago, IL
| | - Neda Laiteerapong
- University of Chicago Biological Sciences Division, University of Chicago, Chicago, IL
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Lee MHY, Li B, Feridooni T, Li PY, Shakespeare A, Samarasinghe Y, Cuen-Ojeda C, Verma R, Kishibe T, Al-Omran M. Racial and ethnic differences in presentation severity and postoperative outcomes in vascular surgery. J Vasc Surg 2023; 77:1274-1288.e14. [PMID: 36202287 DOI: 10.1016/j.jvs.2022.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 08/24/2022] [Accepted: 08/29/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND We assessed the effect of race and ethnicity on presentation severity and postoperative outcomes in those with abdominal aortic aneurysms (AAAs), carotid artery stenosis (CAS), peripheral arterial disease (PAD), and type B aortic dissection (TBAD). METHODS MEDLINE, Embase, and Cochrane Central Register of Controlled Trials from inception until December 2020. Two reviewers independently selected randomized controlled trials and observational studies reporting race and/or ethnicity and presentation severity and/or postoperative outcomes for adult patients who had undergone major vascular procedures. They independently extracted the study data and assessed the risk of bias using the Newcastle-Ottawa scale. The meta-analysis used random effects models to derive the odds ratios (ORs) and risk ratios (RRs) and their corresponding 95% confidence intervals (CIs). The primary outcome was presentation severity stratified by the proportion of patients with advanced disease, including ruptured vs nonruptured AAA, symptomatic vs asymptomatic CAS, chronic limb-threatening ischemia vs claudication, and complicated vs uncomplicated TBAD. The secondary outcomes included postoperative all-cause mortality and disease-specific outcomes. RESULTS A total of 81 studies met the inclusion criteria. Black (OR, 4.18; 95% CI, 1.31-13.26), Hispanic (OR, 2.01; 95% CI, 1.85-2.19), and Indigenous (OR, 1.97; 95% CI, 1.39-2.80) patients were more likely to present with ruptured AAAs than were White patients. Black and Hispanic patients had had higher symptomatic CAS (Black: OR, 1.20; 95% CI, 1.04-1.38; Hispanic: OR, 1.32; 95% CI, 1.20-1.45) and chronic limb-threatening ischemia (Black: OR, 1.67; 95% CI, 1.14-2.43; Hispanic: OR, 1.73; 95% CI 1.13-2.65) presentation rates. No study had evaluated the effect of race or ethnicity on complicated TBAD. All-cause mortality was higher for Black (RR, 1.23; 95% CI, 1.01-1.51), Hispanic (RR, 1.90; 95% CI, 1.57-2.31), and Indigenous (RR, 1.24; 95% CI, 1.12-1.37) patients after AAA repair. Postoperatively, Black (RR, 1.54; 95% CI, 1.19-2.00) and Hispanic (RR, 1.54; 95% CI, 1.31-1.81) patients were associated with stroke/transient ischemic attack after carotid revascularization and lower extremity amputation (RR, 1.90; 95% CI, 1.76-2.06; and RR, 1.69; 95% CI, 1.48-1.94, respectively). CONCLUSIONS Certain visible minorities were associated with higher morbidity and mortality across various vascular surgery presentations. Further research to understand the underpinnings is required.
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Affiliation(s)
- Michael Ho-Yan Lee
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Ben Li
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Tiam Feridooni
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Pei Ye Li
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Audrey Shakespeare
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Yasith Samarasinghe
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Cesar Cuen-Ojeda
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Raj Verma
- Royal College of Surgeons Ireland, Dublin, Ireland
| | - Teruko Kishibe
- Health Sciences Library, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Mohammed Al-Omran
- Division of Vascular Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada; Department of Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
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3
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Roth SE, Gronowski B, Jones KG, Smith RA, Smith SK, Vartanian KB, Wright BJ. Evaluation of an Integrated Intervention to Address Clinical Care and Social Needs Among Patients with Type 2 Diabetes. J Gen Intern Med 2023; 38:38-44. [PMID: 36864267 PMCID: PMC9980858 DOI: 10.1007/s11606-022-07920-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 10/31/2022] [Indexed: 03/04/2023]
Abstract
BACKGROUND The Providence Diabetes Collective Impact Initiative (DCII) was designed to address the clinical challenges of type 2 diabetes and the social determinants of health (SDoH) challenges that exacerbate disease impact. OBJECTIVE We assessed the impact of the DCII, a multifaceted intervention approach to diabetes treatment that employed both clinical and SDoH strategies, on access to medical and social services. DESIGN The evaluation employed a cohort design and used an adjusted difference-in-difference model to compare treatment and control groups. PARTICIPANTS Our study population consisted of 1220 people (740 treatment, 480 control), aged 18-65 years old with a pre-existing type 2 diabetes diagnosis who visited one of the seven Providence clinics (three treatment and four control) in the tri-county area of Portland, Oregon, between August 2019 and November 2020. INTERVENTIONS The DCII threaded together clinical approaches such as outreach, standardized protocols, and diabetes self-management education and SDoH strategies including social needs screening, referral to a community resource desk, and social needs support (e.g., transportation) to create a comprehensive, multi-sector intervention. MAIN MEASURES Outcome measures included SDoH screens, diabetes education participation, HbA1c, blood pressure, and virtual and in-person primary care utilization, as well as inpatient and emergency department hospitalization. KEY RESULTS Compared to patients at the control clinics, patients at DCII clinics saw an increase in diabetes education (15.5%, p<0.001), were modestly more likely to receive SDoH screening (4.4%, p<0.087), and had an increase in the average number of virtual primary care visits of 0.35 per member, per year (p<0.001). No differences in HbA1c, blood pressure, or hospitalization were observed. CONCLUSIONS DCII participation was associated with improvements in diabetes education use, SDoH screening, and some measures of care utilization.
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Affiliation(s)
- Sarah E Roth
- Center for Outcomes Research & Education (CORE), Providence St. Joseph Health, 5251 NE Glisan Street, Portland, OR, 97213, USA.
| | - Ben Gronowski
- Center for Outcomes Research & Education (CORE), Providence St. Joseph Health, 5251 NE Glisan Street, Portland, OR, 97213, USA
| | - Kyle G Jones
- Center for Outcomes Research & Education (CORE), Providence St. Joseph Health, 5251 NE Glisan Street, Portland, OR, 97213, USA
| | - Rachel A Smith
- Community Health Division, Providence Health and Services, Portland, OR, USA
| | | | - Keri B Vartanian
- Center for Outcomes Research & Education (CORE), Providence St. Joseph Health, 5251 NE Glisan Street, Portland, OR, 97213, USA
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Chen Y, Zhou X, Bullard KM, Zhang P, Imperatore G, Rolka DB. Income-related inequalities in diagnosed diabetes prevalence among US adults, 2001-2018. PLoS One 2023; 18:e0283450. [PMID: 37053158 PMCID: PMC10101461 DOI: 10.1371/journal.pone.0283450] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 03/01/2023] [Indexed: 04/14/2023] Open
Abstract
AIMS The overall prevalence of diabetes has increased over the past two decades in the United States, disproportionately affecting low-income populations. We aimed to examine the trends in income-related inequalities in diabetes prevalence and to identify the contributions of determining factors. METHODS We estimated income-related inequalities in diagnosed diabetes during 2001-2018 among US adults aged 18 years or older using data from the National Health Interview Survey (NHIS). The concentration index was used to measure income-related inequalities in diabetes and was decomposed into contributing factors. We then examined temporal changes in diabetes inequality and contributors to those changes over time. RESULTS Results showed that income-related inequalities in diabetes, unfavorable to low-income groups, persisted throughout the study period. The income-related inequalities in diabetes decreased during 2001-2011 and then increased during 2011-2018. Decomposition analysis revealed that income, obesity, physical activity levels, and race/ethnicity were important contributors to inequalities in diabetes at almost all time points. Moreover, changes regarding age and income were identified as the main factors explaining changes in diabetes inequalities over time. CONCLUSIONS Diabetes was more prevalent in low-income populations. Our study contributes to understanding income-related diabetes inequalities and could help facilitate program development to prevent type 2 diabetes and address modifiable factors to reduce diabetes inequalities.
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Affiliation(s)
- Yu Chen
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Xilin Zhou
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Kai McKeever Bullard
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Deborah B Rolka
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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5
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Cohen DJ, Wyte-Lake T, Bonsu P, Albert SL, Kwok L, Paul MM, Nguyen AM, Berry CA, Shelley DR. Organizational Factors Associated with Guideline Concordance of Chronic Disease Care and Management Practices. J Am Board Fam Med 2022:jabfm.2022.AP.210502. [PMID: 36113991 PMCID: PMC10515112 DOI: 10.3122/jabfm.2022.ap.210502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/08/2022] [Accepted: 06/27/2022] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Guidelines for managing and preventing chronic disease tend to be well-known. Yet, translation of this evidence into practice is inconsistent. We identify a combination of factors that are connected to guideline concordant delivery of evidence-informed chronic disease care in primary care. METHODS Cross-sectional observational study; purposively selected 22 practices to vary on size, ownership and geographic location, using National Quality Forum metrics to ensure practices had a ≥ 70% quality level for at least 2 of the following: aspirin use in high-risk individuals, blood pressure control, cholesterol and diabetes management. Interviewed 2 professionals (eg, medical director, practice manager) per practice (n = 44) to understand staffing and clinical operations. Analyzed data using an iterative and inductive approach. RESULTS Community Health Centers (CHCs) employed interdisciplinary clinical teams that included a variety of professionals as compared with hospital-health systems (HHS) and clinician-owned practices. Despite this difference, practice members consistently reported a number of functions that may be connected to clinical chronic care quality, including: having engaged leadership; a culture of teamwork; engaging in team-based care; using data to inform quality improvement; empaneling patients; and managing the care of patient panels, with a focus on continuity and comprehensiveness, as well as having a commitment to the community. CONCLUSIONS There are mutable organizational attributes connected-guideline concordant chronic disease care in primary care. Research and policy reform are needed to promote and study how to achieve widespread adoption of these functions and organizational attributes that may be central to achieving equity and improving chronic disease prevention.
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Affiliation(s)
- Deborah J Cohen
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS).
| | - Tamar Wyte-Lake
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Pamela Bonsu
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Stephanie L Albert
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Lorraine Kwok
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Margaret M Paul
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Ann M Nguyen
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Carolyn A Berry
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
| | - Donna R Shelley
- From Department of Family Medicine, Oregon Health & Science University, Portland, OR (DJC, TWL); Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, North Hills, CA (TWL); Department of Population Health, New York University Grossman School of Medicine, New York, NY (SLA, LK, MMP, CAB); Center for State Health Policy, Rutgers University, New Brunswick, NJ (AMN); School of Global Public Health, New York University, New York, NY (DRS)
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Forman R, Sheth K. Race/Ethnicity Considerations in the Prevention and Treatment of Stroke. Curr Treat Options Neurol 2021. [DOI: 10.1007/s11940-021-00684-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Talavera GA, Castañeda SF, Mendoza PM, Lopez-Gurrola M, Roesch S, Pichardo MS, Garcia ML, Muñoz F, Gallo LC. Latinos understanding the need for adherence in diabetes (LUNA-D): a randomized controlled trial of an integrated team-based care intervention among Latinos with diabetes. Transl Behav Med 2021; 11:1665-1675. [PMID: 34057186 DOI: 10.1093/tbm/ibab052] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
We developed and tested a culturally appropriate, team-based, integrated primary care and behavioral health intervention in low income, Spanish-speaking Latinos with type 2 diabetes, at a federally qualified health center. This pragmatic randomized controlled trial included 456 Latino adults, 23-80 years, 63.7% female, with diabetes [recruitment glycosylated hemoglobin (HbA1c) ≥ 7.0%/53.01 mmol/mol)]. The Special Intervention occurred over 6 months and targeted improvement of HbA1c, blood pressure, and lipids. The intervention included: (i) four, same-day integrated medical and behavioral co-located visits; (ii) six group diabetes self-management education sessions addressing the cultural dimensions of diabetes and lifestyle messages; (iii) and care coordination. Usual Care participants received primary care provider led standard diabetes care, with referrals to health education and behavioral health as needed. HbA1c and lipids were obtained through electronic health records abstraction. Blood pressure was measured by trained research staff. Multi-level models showed a significant group by time interaction effect (B = -0.32, p < .01, 95% CI -0.49, -0.15), indicating statistically greater improvement in HbA1c level over 6 months in the Special Intervention group (ΔHbA1c = -0.35, p = <.01) versus Usual Care (ΔHbA1c = -0.02, p = .72). Marginally significant group by time interactions were also found for total cholesterol and diastolic blood pressure, with significant improvements in the Special Intervention group (p < .05). This culturally appropriate model of highly integrated care offers strategies that can assist with self-management goals and disease management for Latinos with diabetes in a federally qualified health center setting.
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Affiliation(s)
- Gregory A Talavera
- South Bay Latino Research Center, Chula Vista, CA, USA.,Department of Psychology, San Diego State University, San Diego, CA, USA
| | | | | | | | - Scott Roesch
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Margaret S Pichardo
- College of Medicine, Howard University, Washington, DC, USA.,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Melawhy L Garcia
- Center for Latino Community Health, Evaluation, and Leadership Training, Department of Health Science, California State University Long Beach, Long Beach, CA, USA
| | - Fatima Muñoz
- Department of Research, San Ysidro Health, San Diego, CA, USA
| | - Linda C Gallo
- South Bay Latino Research Center, Chula Vista, CA, USA.,Department of Psychology, San Diego State University, San Diego, CA, USA
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Development of a novel social incubator for health promoting initiatives in a disadvantaged region. BMC Public Health 2020; 20:898. [PMID: 32522166 PMCID: PMC7285712 DOI: 10.1186/s12889-020-08990-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 05/27/2020] [Indexed: 12/04/2022] Open
Abstract
Background Bottom-up approaches to disparity reduction present a departure from traditional service models where health services are traditionally delivered top-down. Raphael, a novel bottom-up social incubator, was developed in a disadvantaged region with the aim of ‘hatching’ innovative health improvement interventions through academia-community partnership. Methods Community organizations were invited to submit proposals for incubation. Selection was made using the criteria of innovation, population neediness and potential for health impact and sustainability. Raphael partnered with organizations to pilot and evaluate their intervention with $5000 seed-funding. The evaluation was guided by the conceptual framework of technological incubators. Outcomes and sustainability were ascertained through qualitative and quantitative analysis of records and interviews at 12 months and 3–5 years, and the Community Impact of Research Oriented Partnerships (CIROP) questionnaire was administered to community partners. Results Ninety proposals were submitted between 2013 and 2015 principally from non-governmental organizations (NGOs). Thirteen interventions were selected for ‘incubation’. Twelve successfully ‘hatched’: three demonstrated sustainability with extension locally or nationally through acquiring external competitive funding; six continued to have influence within their organizations; three failed to continue beyond the pilot. Benefits to the organisations included acquisition of skills including advocacy, teaching and health promotion, evaluation skills and ability to utilize acquired knowledge for implementation. CIROP demonstrated that individuals’ research skills were reported to improve (mean ± sd) 4.80 ± 2.49 along with confidence in being able to use knowledge acquired in everyday practice (5.50 ± 1.38) and new connections were facilitated (5.33 ± 2.25). Conclusions Raphael, devised as a ‘social incubator’, succeeded in nurturing novel ideas engendered by community organizations that aimed to impact on health disparities. Judging by success rates of technological incubators its goals were realized to a considerable degree.
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Liu R, Santana T, Schillinger D, Hecht FM, Chao MT. "It Gave Me Hope" Experiences of Diverse Safety Net Patients in a Group Acupuncture Intervention for Painful Diabetic Neuropathy. Health Equity 2020; 4:225-231. [PMID: 32462104 PMCID: PMC7247034 DOI: 10.1089/heq.2020.0004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 02/04/2023] Open
Abstract
Purpose: To explore the experiences of living with painful diabetic neuropathy (PDN) and with a group acupuncture intervention in a sample of low-income, diverse patients. Methods: We conducted a randomized clinical trial of a 12-week group acupuncture intervention for PDN. Data included validated measures of patient-reported outcomes, including pain and quality of life (QOL), as well as semistructured qualitative interviews about participants' experiences with PDN and the intervention. Interview transcripts were coded and analyzed using an inductive thematic framework. Results: We recruited 40 participants from diverse racial/ethnic backgrounds from a public hospital and conducted in-depth qualitative interviews with a subset of 17 participants. Participants randomized to acupuncture experienced greater decreases in pain compared with usual care as well as improved QOL. In interviews, they described a myriad of socioeconomic and personal life stressors that compounded the significant suffering and disability brought on by PDN. Those who received acupuncture were able to decrease reliance on pain medication, improve their sleep and daily function, reduce stress, and engage more with their own self-care. They noted that the acupuncture intervention also gave them hope in the face of their chronic disease. Conclusion: Acupuncture is a valuable adjunct treatment for low-income and marginalized populations with PDN. In addition to reducing pain and improving QOL, acupuncture may offer powerful benefits by increasing patient activation and hope.
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Affiliation(s)
- Rhianon Liu
- UCSF Osher Center for Integrative Medicine, UCSF, San Francisco, California, USA
| | - Trilce Santana
- UCSF Osher Center for Integrative Medicine, UCSF, San Francisco, California, USA
| | - Dean Schillinger
- Division of General Internal Medicine, UCSF, San Francisco, California, USA
| | - Frederick M Hecht
- UCSF Osher Center for Integrative Medicine, UCSF, San Francisco, California, USA.,Division of General Internal Medicine, UCSF, San Francisco, California, USA
| | - Maria T Chao
- UCSF Osher Center for Integrative Medicine, UCSF, San Francisco, California, USA.,Division of General Internal Medicine, UCSF, San Francisco, California, USA
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Marquez I, Calman N, Crump C. A Framework for Addressing Diabetes-Related Disparities in US Latino Populations. J Community Health 2020; 44:412-422. [PMID: 30264184 DOI: 10.1007/s10900-018-0574-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Despite national efforts to redress racial/ethnic disparities, Latino Americans continue to share a disproportionate burden of diabetes-related morbidity and mortality. A better understanding of underlying causes and influencing factors is needed to guide future efforts to eliminate racial/ethnic disparities in diabetes control. The objectives of this review are: (1) to summarize our understanding of determinants and modifiable predictors of glycemic control; (2) to provide an overview of existing strategies to reduce diabetes-related disparities; and (3) to identify gaps in the literature regarding whether these interventions effectively address disparities in US Latino populations. Key findings include evidence that diabetes care services can be designed to accommodate heterogeneity within the Latino American community by addressing key modifiable predictors of poor glycemic control, including insurance status, diabetes care utilization, patient self-management, language access, culturally appropriate care, and social support services. Future research efforts should evaluate the effect of structurally tailored interventions that address these key modifiable predictors by targeting patients, providers, and health care delivery systems.
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Affiliation(s)
- Ivan Marquez
- Icahn School of Medicine at Mount Sinai, 1425 Madison Ave, Suite L5-40, New York, NY, 10029, USA.
| | - Neil Calman
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- The Institute for Family Health, New York, NY, USA
| | - Casey Crump
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Thornton PL, Kumanyika SK, Gregg EW, Araneta MR, Baskin ML, Chin MH, Crespo CJ, de Groot M, Garcia DO, Haire-Joshu D, Heisler M, Hill-Briggs F, Ladapo JA, Lindberg NM, Manson SM, Marrero DG, Peek ME, Shields AE, Tate DF, Mangione CM. New research directions on disparities in obesity and type 2 diabetes. Ann N Y Acad Sci 2019; 1461:5-24. [PMID: 31793006 DOI: 10.1111/nyas.14270] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/18/2019] [Indexed: 12/12/2022]
Abstract
Obesity and type 2 diabetes disproportionately impact U.S. racial and ethnic minority communities and low-income populations. Improvements in implementing efficacious interventions to reduce the incidence of type 2 diabetes are underway (i.e., the National Diabetes Prevention Program), but challenges in effectively scaling-up successful interventions and reaching at-risk populations remain. In October 2017, the National Institutes of Health convened a workshop to understand how to (1) address socioeconomic and other environmental conditions that perpetuate disparities in the burden of obesity and type 2 diabetes; (2) design effective prevention and treatment strategies that are accessible, feasible, culturally relevant, and acceptable to diverse population groups; and (3) achieve sustainable health improvement approaches in communities with the greatest burden of these diseases. Common features of guiding frameworks to understand and address disparities and promote health equity were described. Promising research directions were identified in numerous areas, including study design, methodology, and core metrics; program implementation and scalability; the integration of medical care and social services; strategies to enhance patient empowerment; and understanding and addressing the impact of psychosocial stress on disease onset and progression in addition to factors that support resiliency and health.
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Affiliation(s)
- Pamela L Thornton
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, Maryland
| | - Shiriki K Kumanyika
- Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Edward W Gregg
- Epidemiology and Statistics Branch, Division of Diabetes Translation, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Maria R Araneta
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Monica L Baskin
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Carlos J Crespo
- Oregon Health and Science University and Portland State University Joint School of Public Health, Portland, Oregon
| | - Mary de Groot
- Indiana University School of Medicine, Indianapolis, Indiana
| | - David O Garcia
- Department of Health Promotion Sciences, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona
| | - Debra Haire-Joshu
- Washington University in St. Louis, School of Medicine and the Brown School, St. Louis, Missouri
| | | | - Felicia Hill-Briggs
- Johns Hopkins School of Medicine and Welch Center for Prevention, Epidemiology & Clinical Research, Baltimore, Maryland
| | - Joseph A Ladapo
- David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, California
| | | | | | | | | | - Alexandra E Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Deborah F Tate
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Carol M Mangione
- David Geffen School of Medicine at the University of California, and UCLA Fielding School of Public Health, Los Angeles, Los Angeles, California
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12
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A risk-based intervention approach to eliminate diabetes health disparities. Prim Health Care Res Dev 2018; 19:518-522. [PMID: 29415785 DOI: 10.1017/s1463423618000075] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Type 2 diabetes plays a major role in racial/ethnic health disparities. We conducted the first study to examine whether multifaceted interventions targeting patients with poorly controlled diabetes (HgbA1c >9%) can reduce racial/ethnic disparities in diabetes control. Among 4595 patients with diabetes at a Federally Qualified Health Center in New York, a higher percentage of blacks (32%) and Hispanics/Latinos (32%) had poorly controlled diabetes than whites (25%) at baseline (prevalence ratio, 1.28; 95% CI, 1.14-1.43; P<0.001). After four years, this percentage was reduced in all groups (blacks, 21%; Hispanics/Latinos, 20%; whites, 20%; P<0.001 for each relative to baseline). Disparities in diabetes control also were significantly reduced (change in disparity relative to whites: blacks, P=0.03; Hispanics/Latinos, P=0.008). In this diverse population, interventions targeting patients with poorly controlled diabetes not only improved diabetes control in all racial/ethnic groups, but significantly reduced disparities. This approach warrants further testing and may help reduce disparities in other populations.
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13
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Spitzer-Shohat S, Shadmi E, Goldfracht M, Kay C, Hoshen M, Balicer RD. Reducing inequity in primary care clinics treating low socioeconomic Jewish and Arab populations in Israel. J Public Health (Oxf) 2017; 39:395-402. [PMID: 27165669 DOI: 10.1093/pubmed/fdw037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background An organization-wide inequity-reduction quality improvement (QI) initiative was implemented in primary care clinics serving disadvantaged Arab and Jewish populations. Using the Chronic Care Model (CCM), this study investigated the types of interventions associated with success in inequity reduction. Methods Semi-structured interviews were conducted with 80 staff members from 26 target clinics, and information about intervention types was coded by CCM and clinical domains (e.g. diabetes, hypertension and lipid control; performance of mammography tests). Relationships between type and number of interventions implemented and inequity reduction were assessed. Results Target clinics implemented 454 different interventions, on average 17.5 interventions per clinic. Interventions focused on Decision support and Community linkages were positively correlated with improvement in the composite quality score (P < 0.05). Conversely, focusing on a specific clinical domain was not correlated with a higher quality score. Conclusions Focusing on training team members in selected QI topics and/or tailoring interventions to meet community needs was key to the interventions' success. Such findings, especially in light of the lack of association between QI and a focus on a specific clinical domain, support other calls for adopting a systems approach to achieving wide-scale inequity reduction.
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Affiliation(s)
- S Spitzer-Shohat
- Faculty of Social Welfare and Health Sciences, University of Haifa, Room 2104 Eshkol Tower, 99 Aba Khoushy Ave., Mount Carmel 31905, Israel
| | - E Shadmi
- Faculty of Social Welfare and Health Sciences, University of Haifa, Room 2104 Eshkol Tower, 99 Aba Khoushy Ave., Mount Carmel 31905, Israel.,Clalit Research Institute, Chief Physician's Office, Clalit Health Services, 42 Zamenhoff St., Tel Aviv, Israel
| | - M Goldfracht
- Clalit Community Division, Clalit Health Services, 101 Arlozorov St., Tel Aviv, Israel
| | - C Kay
- Clalit Community Division, Clalit Health Services, 101 Arlozorov St., Tel Aviv, Israel
| | - M Hoshen
- Clalit Research Institute, Chief Physician's Office, Clalit Health Services, 42 Zamenhoff St., Tel Aviv, Israel
| | - R D Balicer
- Clalit Research Institute, Chief Physician's Office, Clalit Health Services, 42 Zamenhoff St., Tel Aviv, Israel.,Epidemiology Department, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheva, Israel
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14
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Insurance, racial/ethnic, SES-related disparities in quality of care among US adults with diabetes. J Immigr Minor Health 2016; 16:565-75. [PMID: 24363118 PMCID: PMC4097336 DOI: 10.1007/s10903-013-9966-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Diabetes-related quality improvement initiatives are typically aimed at improving outcomes and reducing complications. Studies have found that disparities in quality persist for certain racial/ethnic and socioeconomically disadvantaged groups; however, results are mixed with regard to insurance-based differences. The purpose of this study is to investigate the independent associations between type of health insurance coverage, race/ethnicity, and socioeconomic status (SES), and quality of care, as measured by benchmark indicators of diabetes-related primary care. This study used the Diabetes Care Survey of the 2010 Medical Expenditure Panel Survey. Bivariate and multivariate logistic regressions were used to examine the association between quality of diabetes care and type of insurance coverage, race/ethnicity, and SES. Multivariate analyses also controlled for additional demographic and health status characteristics. Respondents with insurance coverage (particularly those with private insurance or with Medicare and Medicaid coverage) were more likely to receive quality diabetes care than uninsured individuals. Few significant disparities based on race/ethnicity or SES persisted in subsequent multivariate analyses. Findings suggest that insurance coverage may make the greatest impact in ensuring equitable distribution of quality diabetes care, regardless of race/ethnicity or socioeconomic status. With the implementation of Affordable Care Act under which more people could potentially gain access to insurance, policymakers should next track insurance-based diabetes care disparities.
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15
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Lopez JMS, Bailey RA, Rupnow MFT. Demographic Disparities Among Medicare Beneficiaries with Type 2 Diabetes Mellitus in 2011: Diabetes Prevalence, Comorbidities, and Hypoglycemia Events. Popul Health Manag 2015; 18:283-9. [PMID: 25647516 DOI: 10.1089/pop.2014.0115] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
This study describes demographic characteristics, comorbidities, and hypoglycemia events in patients with type 2 diabetes mellitus (T2DM) identified using 2011 Medicare 5% Standard Analytical Files. Among 1,913,477 Medicare beneficiaries, 367,602 (19.2%) had T2DM. T2DM prevalence increased with age and was higher in blacks (26.4%) and Hispanics (25.5%) than in whites (18.0%); and in Medicare/Medicaid dual-eligible versus non-dual-eligible patients (28.0% vs 17.2%, respectively). Compared with whites, diagnosed hypertension and diabetic retinopathy were more common in blacks and Hispanics, and lipid metabolism disorders and atrial fibrillation were less common. Hypoglycemia requiring health care services was more common in blacks (4.7%) and Hispanics (3.6%) compared with whites (2.9%). T2DM, related comorbidities, and hypoglycemia are burdensome to the Medicare population. Differences in these endpoints were observed based on race/ethnicity, age, and dual-eligible status, highlighting the importance of demographic factors when determining T2DM management strategies.
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16
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Joseph JM, Johnson PJ, Wholey DR, Frederick ML. Assessing Diabetes Care Disparities with Ambulatory Care Quality Measures. Health Serv Res 2014; 50:1250-64. [PMID: 25523494 DOI: 10.1111/1475-6773.12277] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To identify and describe racial/ethnic disparities in overall diabetes management. DATA SOURCE/STUDY SETTING Electronic health record data from calendar year 2010 were obtained from all primary care clinics at one large health system in Minnesota (n = 22,633). STUDY DESIGN We used multivariate logistic regression to estimate the odds of achieving the following diabetes management goals: A1C <8 percent, LDL cholesterol <100 mg/dl, blood pressure <140/90 mmHg, tobacco-free, and daily aspirin. PRINCIPAL FINDINGS Blacks and American Indians have higher odds of not achieving all goals compared to whites. Disparities in specific goals were also found. CONCLUSIONS Although this health system has above-average diabetes care quality, significant disparities by race/ethnicity were identified. This underscores the importance of stratifying quality measures to improve care and outcomes for all.
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Affiliation(s)
- Jennifer M Joseph
- School of Public Health, Division of Health Policy & Management, University of Minnesota, 420 Delaware St. SE, MMC 729, Minneapolis, MN, 55455.,Division of Applied Research, Allina Health, Minneapolis, MN
| | - Pamela Jo Johnson
- Center for Spirituality and Healing, University of Minnesota, Minneapolis, MN.,Medica Research Institute, Minneapolis, MN
| | - Douglas R Wholey
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN
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17
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Peek ME, Ferguson M, Bergeron N, Maltby D, Chin MH. Integrated community-healthcare diabetes interventions to reduce disparities. Curr Diab Rep 2014; 14:467. [PMID: 24464339 PMCID: PMC3956046 DOI: 10.1007/s11892-013-0467-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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18
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Forjuoh SN, Bolin JN, Huber Jr JC, Vuong AM, Adepoju OE, Helduser JW, Begaye DS, Robertson A, Moudouni DM, Bonner TJ, McLeroy KR, Ory MG. Behavioral and technological interventions targeting glycemic control in a racially/ethnically diverse population: a randomized controlled trial. BMC Public Health 2014; 14:71. [PMID: 24450992 PMCID: PMC3909304 DOI: 10.1186/1471-2458-14-71] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 12/09/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Diabetes self-care by patients has been shown to assist in the reduction of disease severity and associated medical costs. We compared the effectiveness of two different diabetes self-care interventions on glycemic control in a racially/ethnically diverse population. We also explored whether reductions in glycated hemoglobin (HbA1c) will be more marked in minority persons. METHODS We conducted an open-label randomized controlled trial of 376 patients with type 2 diabetes aged ≥18 years and whose last measured HbA1c was ≥7.5% (≥58 mmol/mol). Participants were randomized to: 1) a Chronic Disease Self-Management Program (CDSMP; n = 101); 2) a diabetes self-care software on a personal digital assistant (PDA; n = 81); 3) a combination of interventions (CDSMP + PDA; n = 99); or 4) usual care (control; n = 95). Enrollment occurred January 2009-June 2011 at seven regional clinics of a university-affiliated multi-specialty group practice. The primary outcome was change in HbA1c from randomization to 12 months. Data were analyzed using a multilevel statistical model. RESULTS Average baseline HbA1c in the CDSMP, PDA, CDSMP + PDA, and control arms were 9.4%, 9.3%, 9.2%, and 9.2%, respectively. HbA1c reductions at 12 months for the groups averaged 1.1%, 0.7%, 1.1%, and 0.7%, respectively and did not differ significantly from baseline based on the model (P = .771). Besides the participants in the PDA group reporting eating more high-fat foods compared to their counterparts (P < .004), no other significant differences were observed in participants' diabetes self-care activities. Exploratory sub-analysis did not reveal any marked reductions in HbA1c for minority persons but rather modest reductions for all racial/ethnic groups. CONCLUSIONS Although behavioral and technological interventions can result in some modest improvements in glycemic control, these interventions did not fare significantly better than usual care in achieving glycemic control. More research is needed to understand how these interventions can be most effective in clinical practice. The reduction in HbA1c levels found in our control group that received usual care also suggests that good routine care in an integrated healthcare system can lead to better glycemic control. TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT01221090.
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Affiliation(s)
- Samuel N Forjuoh
- Department of Family & Community Medicine, Scott & White Healthcare, College of Medicine, Texas A&M Health Science Center, Temple, TX, USA
- Department of Epidemiology & Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA
- Department of Health Promotion & Community Health Sciences, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA
| | - Jane N Bolin
- Department of Health Policy & Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA
| | - John C Huber Jr
- Department of Epidemiology & Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA
| | - Ann M Vuong
- Department of Epidemiology & Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA
| | - Omolola E Adepoju
- Department of Health Policy & Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA
| | - Janet W Helduser
- Department of Health Policy & Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA
| | - Dawn S Begaye
- Department of Family & Community Medicine, Scott & White Healthcare, College of Medicine, Texas A&M Health Science Center, Temple, TX, USA
| | - Anne Robertson
- Department of Family & Community Medicine, Scott & White Healthcare, College of Medicine, Texas A&M Health Science Center, Temple, TX, USA
| | - Darcy M Moudouni
- Department of Health Policy & Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA
| | - Timethia J Bonner
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
| | - Kenneth R McLeroy
- Department of Health Promotion & Community Health Sciences, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA
| | - Marcia G Ory
- Department of Health Promotion & Community Health Sciences, School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA
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19
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Voss R, Gravenstein S, Baier R, Butterfield K, Epstein-Lubow G, Shamji H, Gardner R. Recruiting hospitalized patients for research: how do participants differ from eligible nonparticipants? J Hosp Med 2013; 8:208-14. [PMID: 23559503 DOI: 10.1002/jhm.2024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 01/07/2013] [Accepted: 01/16/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Randomized controlled trials provide strong evidence for guidelines and interventions. Yet, much of the eligible population declines to be studied. OBJECTIVE To identify differences between participants and eligible nonparticipants in (1) perceived stress, (2) self-efficacy, (3) recovery expectations, (4) discussing advance directives, and (5) understanding a standard prescription label (health literacy). DESIGN Quasi-experimental prospective cohort study in 5 acute-care hospitals. METHODS We approached 295 hospital inpatients as they were being recruited for a behavioral intervention and asked them to answer 5 screening questions. We matched respondents' answers to their acceptance of the behavioral intervention and to Medicare claims and enrollment data. We used multivariate logistic regression to compare consent rates based on screening-question responses. SETTING/PATIENTS Hospitalized fee-for-service Medicare patients. RESULTS Patients were less likely to consent to the behavioral intervention when they reported feeling unable to control important things in their lives (odds ratio [OR]: 0.35, 95% confidence interval [CI]: 0.14-0.92), had low recovery expectations (OR: 0.17, 95% CI: 0.06-0.45), or were confused by any question (OR: 0.11, 95% CI: 0.05-0.24). Conversely, individuals who answered the medication question incorrectly were more likely to consent to the behavioral intervention (OR: 3.82, 95% CI: 1.12-13.03). There were no significant differences in consent for patients who reported feeling overwhelmed or reported discussing advance care planning with family members or doctors. CONCLUSIONS Hospitalized eligible nonparticipants differ in constructs related to perceived stress, recovery expectation, and health literacy. Recognizing such characteristics may inform strategies to improve intervention recruitment in the hospital and representation in clinical trials.
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Affiliation(s)
- Rachel Voss
- Department of Health Services, Policy and Practice, Healthcentric Advisors, Providence, Rhode Island, USA
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20
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Peek ME, Wilkes AE, Roberson TS, Goddu AP, Nocon RS, Tang H, Quinn MT, Bordenave KK, Huang ES, Chin MH. Early lessons from an initiative on Chicago's South Side to reduce disparities in diabetes care and outcomes. Health Aff (Millwood) 2012; 31:177-86. [PMID: 22232108 DOI: 10.1377/hlthaff.2011.1058] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Interventions to improve health outcomes among patients with diabetes, especially racial or ethnic minorities, must address the multiple factors that make this disease so pernicious. We describe an intervention on the South Side of Chicago-a largely low-income, African American community-that integrates the strengths of health systems, patients, and communities to reduce disparities in diabetes care and outcomes. We report preliminary findings, such as improved diabetes care and diabetes control, and we discuss lessons learned to date. Our initiative neatly aligns with, and can inform the implementation of, the accountable care organization-a delivery system reform in which groups of providers take responsibility for improving the health of a defined population.
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Affiliation(s)
- Monica E Peek
- Department of Medicine, University of Chicago, Chicago, IL, USA.
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