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Low-cost diabetes education programs that target Mexican Americans are essential to reduce the observed health disparities in this population. A culturally appropriate intervention was developed as the centerpiece of the Community Diabetes Education (CoDE) program. This article describes the structure, patient acceptance, and costs of this one-to-one educational model delivered in 7 patient contact hours by a community health worker over 12 months in a community clinic serving the uninsured. A total of 162 patients-predominantly female, Spanish-speaking Mexican American patients with type 2 diabetes of mean duration of 6.5 years-enrolled in the program, and a dropout rate of 22% was observed during the 12-month period. Preliminary analysis indicated that program capacity was 120 patients per month, and the annual direct medical expenditure per CoDE participant was $461. The hemoglobin A(1c) was significantly reduced in patients who participated in the program for 12 months. Sustainable, low-cost, community-based programs like CoDE and long-term patient participation will help reduce the burden of diabetes in the underserved Hispanic population.

The results reported here suggest that this child centered psychosocial intervention promoted positive adaptation by actively supporting families and children while a parent/primary caregiver coped with a cancer diagnosis. Future research is planned utilizing a randomized controlled study design to formally evaluate the effectiveness and preventative impact of this manualized six-week curriculum. Copyright © 2016 John Wiley & Sons, Ltd.

The feasibility of a newly designed Community Diabetes Education (CoDE) intervention was evaluated in preparation for the development of a pilot study of this program. A comparison between CoDE and similar culturally appropriate diabetes management programs developed specifically for Hispanic Americans demonstrates its unique features. Patient insurance status, duration of the intervention, delivery in individual and/or group settings, the characteristics of the diabetes educator(s), the other professional resources involved in these interventions, the associated costs, and the reported health outcomes were used in the comparison. The significant improvement in hemoglobin A1c observed in patients who completed one year of CoDE suggests that a community health worker can serve as the primary patient educator in the absence of more highly educated personnel required by American Diabetes Association–certified diabetes education programs. This low-cost model can be reproduced de novo in community health centers or inserted into existing diabetes management interventions.

The objective of this article is to quantify quality improvement using data from a randomized controlled trial that tested the effectiveness of a community health worker in the primary role of diabetes educator in a clinic serving uninsured Mexican Americans. The intervention group received 7 hours of diabetes education/case management in excess of usual medical care. Of 16 process and outcome measures evaluated, the intervention group was significantly more likely to have received a dilated retinal examination, and 53% achieved a hemoglobin A1c below 7% compared with 38% of the control group participants. Composite quality measures were similar in magnitude with published practice-based benchmarks at study conclusion. This suggests that the overall diabetes care delivered in this clinic serving uninsured patients was comparable to the levels of excellence achieved in other primary care settings. Quantitative measurements of quality improvement can inform health policy regarding the relative effectiveness of diabetes interventions.

Increased stake of boards in the leadership of the hospitals makes them play a significant role in the financial health of their institutions. Understanding of the correct approach to successfully fulfill this purpose is critical for preparing their organizations for positioning adequately in the health care market. Governmental agencies and public companies, including insurers, will be interested in the extent to which hospital boards have adopted the provisions of accounting reform laws like those introduced by the SarbanesOxley Act. It will remain for the boards to balance their oversight role for financial performance with the pressures of financial accountability.

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