Improving diabetes care and outcomes with community health workers

Kane, Erin P; Collinsworth, Ashley; Schmidt, Kathryn; Brown, Rachel M.; Snead, Christine A.; Barnes, Sunni A.; Fleming, Neil; Walton, James W.

doi:10.1093/fampra/cmw055

Cited by 43 publications

(48 citation statements)

References 15 publications

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“…Patients trust CHWs who understand their sociocultural barriers, provide social support, speak the same language, and can increase the relevancy of disease self‐management for individuals who are often struggling to manage competing priorities. Importantly, mounting evidence suggests that CHW involvement can contribute to improvement in diabetes self‐management as well as significant decreases in HbA1C that have ranged from 0.5–0.9% …”

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confidence: 99%

“…Importantly, mounting evidence suggests that CHW involvement can contribute to improvement in diabetes self-management as well as significant decreases in HbA1C that have ranged from 0.5-0.9%. [10][11][12][13][14] A pilot study partnering clinical pharmacists with CHWs to serve minority patients with poorly controlled type 2 diabetes mellitus demonstrated the feasibility of this collaborative approach. 15 In the pilot, nine Latino patients with HbA1C values of 8% or higher were recruited from within a general medicine clinic.…”

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confidence: 99%

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Community Health Workers Supporting Clinical Pharmacists in Diabetes Management: A Randomized Controlled Trial

et al. 2017

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OBJECTIVES To evaluate the effectiveness of clinical pharmacists and community health workers (CHWs) in improving glycemic control within a low-income ethnic minority population. METHODS In a two-arm 2-year crossover trial, 179 African-American and 65 Hispanic adult patients with uncontrolled diabetes mellitus (hemoglobin A 1c [HbA1C] of 8% or higher) were randomized to CHW support either during the first or second year of the study. All participants received clinical pharmacist support for both years of the study. The primary outcome was change in HbA1C over 1 and 2 years. RESULTS Similar HbA1C declines were noted after receiving the 1 year of CHW support: À0.45% (95% confidence interval [CI] À0.96 to 0.05) with CHW versus À0.42% (95% CI À0.93 to 0.08) without CHW support. In addition, no differences were noted in change on secondary outcome measures including body mass index, systolic blood pressure, high-density lipoprotein and low-density lipoprotein cholesterol, quality of life, and perceived social support. A difference in diastolic blood pressure change was noted: 0.80 mm Hg (95% CI À1.92 to 3.53) with CHW versus À1.85 mm Hg (95% CI À4.74 to 1.03) without CHW support (p=0.0078). Patients receiving CHW support had more lipid-lowering medication intensifications (0.39 [95% CI 0.27-0.52]) compared with those without CHW support (0.26 [95% CI 0.14-0.38], p<0.0001). However, no significant differences in intensification of antihyperglycemic and antihypertensive medications were observed between patients receiving CHW support and those without CHW support. Patients with low health literacy completed significantly more encounters with the pharmacist and CHW than those with high health literacy, although outcomes were comparable. CONCLUSIONS No significant differences were noted between a clinical pharmacist-CHW team and clinical pharmacist alone in improving glycemic control within a low-income ethnic minority population.

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confidence: 99%

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confidence: 99%

Community Health Workers Supporting Clinical Pharmacists in Diabetes Management: A Randomized Controlled Trial

et al. 2017

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“…Progress in delineating roles of CHWs (e.g., patient care, education, support for care delivery provided by other health professionals, care coordination, and social support) and training in scopes of practice for CHWs have been deemed elements of effective CHW use [54]. In addition to community-based provider service delivery, models of integration of CHW’s within healthcare teams [57, 58] have evidence of effectiveness in improving healthcare-related outcomes.…”

Section: Evidence-based Intervention Programs Across the Population Hmentioning

confidence: 99%

The Case for Diabetes Population Health Improvement: Evidence-Based Programming for Population Outcomes in Diabetes

et al. 2017

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Purpose of Review The goal of this review is to describe diabetes within a population health improvement framework and to review the evidence for a diabetes population health continuum of intervention approaches, including diabetes prevention and chronic and acute diabetes management, to improve clinical and economic outcomes. Recent Findings Recent studies have shown that compared to usual care, lifestyle interventions in prediabetes lower diabetes risk at the population-level and that group-based programs have low incremental medial cost effectiveness ratio for health systems. Effective outpatient interventions that improve diabetes control and process outcomes are multi-level, targeting the patient, provider, and healthcare system simultaneously and integrate community health workers as a liaison between the patient and community-based healthcare resources. A multi-faceted approach to diabetes management is also effective in the inpatient setting. Interventions shown to promote safe and effective glycemic control and use of evidence-based glucose management practices include provider reminder and clinical decision support systems, automated computer order entry, provider education, and organizational change. Summary Future studies should examine the cost-effectiveness of multi-faceted outpatient and inpatient diabetes management programs to determine the best financial models for incorporating them into diabetes population health strategies.

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“…What is often replicated is an interdisciplinary model representing the skillsets of nurses, social workers, pharmacists, rehabilitative therapists, physicians, and other health professionals, such as psychologists, coaches, navigators, educators, “case managers,” and health technicians. Community health workers are an increasingly important and recognized resource as we gain precision and clarity about essential clinical processes and the roles best suited to performing those processes . Overall, these interdisciplinary approaches reflect the complexities of need of our oldest, frailest patients.…”

Section: Consolidated Framework For Implementation Researchmentioning

confidence: 99%

“…Community health workers are an increasingly important and recognized resource as we gain precision and clarity about essential clinical processes and the roles best suited to performing those processes. 7,[15][16][17] Overall, these interdisciplinary approaches reflect the complexities of need of our oldest, frailest patients. Robust protocols and supporting infrastructure, enhanced by health information technology, informatics, engineering, and human factors, reduce or accommodate certain complexities, and the ensuing organizational programmatic structure can increase the likelihood of success.…”

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confidence: 99%

Implementing Models of Geriatric Care—Behind the Scenes

Chodosh

Weiner

2017

J American Geriatrics Society

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Innovative geriatric clinical programs have proliferated in the 21st century, and many have been highlighted in the Journal of the American Geriatrics Society (JAGS). The Affordable Care Act has supported the accelerated innovation of publicized and unpublicized program development, adaptation, and implementation. Many JAGS articles report work conducted in programs with significant improvements in quality; high satisfaction for patients and providers; and for some, reductions in costs. Despite considerable detail, enabling implementers to attempt to adopt reported programs or adapt them to local environments, much less is typically conveyed about the subtleties of the implementation process that led to a successful outcome. Moreover, where we have been given a window into successful initiatives, far less is known about those that failed and even less about why some succeeded but others failed. With a focus on our shared needs as a geriatrics community, to foster the exchange of more-comprehensive models of successful and failed implementation, we propose publications that address implementation itself-a second layer of reporting about the "hidden" elements that may have been decisive factors in taking an efficacious test, treatment, or model and putting it into real-world practice. We propose a new platform for sharing a broader range of healthcare quality improvement initiatives-successes and failures. We include several salient characteristics that could be measured and described in support of dynamic, sustainable, evidence-based implementation of geriatrics programs.

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Improving diabetes care and outcomes with community health workers

Cited by 43 publications

References 15 publications

Community Health Workers Supporting Clinical Pharmacists in Diabetes Management: A Randomized Controlled Trial

Community Health Workers Supporting Clinical Pharmacists in Diabetes Management: A Randomized Controlled Trial

The Case for Diabetes Population Health Improvement: Evidence-Based Programming for Population Outcomes in Diabetes

Implementing Models of Geriatric Care—Behind the Scenes

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