Impact of a diabetes control and management intervention on health care utilization in American Samoa

Abstract

Objectives To examine the impact of a successful 12 month behavioral intervention to improve diabetes control on healthcare utilization in American Samoa. Methods A cluster randomized design was used to assign 268 diabetes patients to a nurse-community health worker (CHW) intervention or usual care. Hospitalizations, emergency department (ED) and primary care physician (PCP) visits were collected retrospectively for one year prior to, and during, the intervention to assess changes in healthcare utilization. The association of utilization changes with change in HbA1c during the intervention was assessed. Results Adjusted incidence rate ratios (RR) for PCP visits were significantly higher in the CHW relative to the usual care group (RR= 1.71; 95% CI, 1.25–2.33). There was no main intervention effect on ED utilization, but visits in the prior year modified the intervention effect on ED visits. Increased PCP utilization was associated with greater decreases in HbA1c (b=−0.10, se=0.04, p=0.01). Conclusions A culturally adapted CHW diabetes intervention in American Samoa significantly increased PCP visits, and decreased ED visits among those with high ED usage in the prior year. These changes suggest important and beneficial impacts on health system utilization from the diabetes intervention in a low resource and high-risk population.

Annual review of Asian American Psychology, 2014.

“…( n = 6; e.g., K. M. Oh et al, 2014; Sentell et al, 2014), while one study used an experimental design (intervention; Hamid et al, 2014). …”

Annual review of Asian American Psychology, 2013.

“…All studies had quantitative designs, the majority of which were correlational: cross-sectional designs using analytical methods such as logistic regressions, analyses of variance, t-tests, etc. (n = 6; e.g., K. M. Sentell et al, 2014), while one study used an experimental design (intervention; Hamid et al, 2014).…”

“…Healthcare beliefs, practices, and utilization: In this year's review, we continue using Wei et al's (2014) category to cover healthcare-related topics (n = 7), including health literacy (Sentell, Zhang, Davis, Baker, & Braun, 2014) Tan, Davis, & Mau, 2014), and healthcare utilization (Hamid et al, 2014;Hawley et al, 2014). Participants in these studies were distributed across a wide range of developmental periods, from emerging adulthood to older adulthood.…”

“…All studies had quantitative designs, the majority of which were correlational: cross-sectional designs using analytical methods such as logistic regressions, analyses of variance, t-tests, etc. (n = 6; e.g., K. M. Sentell et al, 2014), while one study used an experimental design (intervention; Hamid et al, 2014).In their study on the influence of immigration status on Korean American adults' health information seeking behaviors, K. M. found that Korean Americans were three times more likely than native Koreans residing in South Korea to trust health information from newspapers or magazines and eleven times more likely to read the health sections of newspapers and magazines, but were three times less likely to look for health information from TV. The authors called for more reliable and valid health information from printed Korean language magazines or newspapers, so as to increase awareness and screening behaviors among Korean Americans.…”

Diabetes training for community health workers on an American Indian reservation

“…In the management of diabetes, nurse/CHW teams helped clients address housing issues and access to community resources while reducing inpatient and emergency room utilization (Esperat et al., ). Other nurse/CHW partnerships accomplished significant reductions in HgA1c by focusing on the promotion of self‐management activities and the development of self‐management skills (Depue et al., ; Hamid et al., ; Lorig, Ritter, Villa, & Armas, ).…”