The DREAM Initiative: study protocol for a randomized controlled trial testing an integrated electronic health record and community health worker intervention to promote weight loss among South Asian patients at risk for diabetes

Abstract

BackgroundElectronic health record (EHR)-based interventions that use registries and alerts can improve chronic disease care in primary care settings. Community health worker (CHW) interventions also have been shown to improve chronic disease outcomes, especially in minority communities. Despite their potential, these two approaches have not been tested together, including in small primary care practice (PCP) settings. This paper presents the protocol of Diabetes Research, Education, and Action for Minorities (DREAM) Initiative, a 5-year randomized controlled trial integrating both EHR and CHW approaches into a network of PCPs in New York City (NYC) in order to support weight loss efforts among South Asian patients at risk for diabetes.Methods/designThe DREAM Initiative was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (National Institutes of Health). A total of 480 individuals at risk for type 2 diabetes will be enrolled into the intervention group, and an equal number will be included in a matched control group. The EHR intervention components include the provision of technical assistance to participating PCPs regarding prediabetes-related registry reports, alerts, and order sets. The CHW intervention components entail group education sessions on diabetes prevention, including weight loss and nutrition. A mixed-methods approach will be used to evaluate the feasibility, adoption, and impact (≥ 5% weight loss) of the integrated study components. Additionally, a cost effectiveness analysis will be conducted using outcomes, implementation costs, and healthcare claims data to determine the incremental cost per person achieving 5% weight loss.DiscussionThis study will be the first to test the efficacy of an integrated EHR–CHW intervention within an underserved, minority population and in a practical setting via a network of small PCPs in NYC. The study’s implementation is enhanced through cross-sector partnerships, including the local health department, a healthcare payer, and EHR vendors. Through use of a software platform, the study will also systematically track and monitor CHW referrals to social service organizations. Study findings, including those resulting from cost-effectiveness analyses, will have important implications for translating similar strategies to other minority communities in sustainable ways.Trial registrationThis study protocol has been approved and is made available on ClinicalTrials.gov by NCT 03188094 as of 15 June 2017.

Diabetes and hypertension among South Asians in New York and Atlanta leveraging hospital electronic health records

“…We derived a list of 12,907 South Asian surnames by compiling a list of names from Social Security Administration data [ 7 ], death certificate data [ 8 ], and prior studies conducted among South Asians [ 9 , 10 ]. For race/ethnicity as listed in the EHR, selection criteria included Asian Indian, Bangladeshi, Pakistani, or Sri Lankan.…”

Disaggregating Asian Race Reveals COVID-19 Disparities among Asian Americans at New York City’s Public Hospital System

“…Owing to known deficiencies in completeness of recorded race and ethnicity within the NYC H+H EHR, race, ethnicity, and language data in the EHR and validated Asian surname lists ( Supplement Table 1 ) were used to classify individuals into one of three Asian ethnic groups (South Asian [Afghani, Bangladeshi, Indian, Nepalese, Pakistani, Sri Lankan], Chinese, and all other Asian). 17,18,19 Because of the large overlap between Filipino and Hispanic surnames, we did not categorize any surnames as Filipino; however, Filipino patients whose race and/or ethnicity were recorded as Asian and/or Filipino in the EHR were categorized into the “other Asian” group.…”

“…This study is the first to highlight disparities in COVID-19 outcomes among Asian American ethnic subgroups in the United States. We found a substantial burden of COVID-19 among South Asian and Chinese patients in NYC's public hospital system, with rates similar to those observed among Blacks and Hispanics.…”

Small Practices, Big (QI) Dreams: Customizing Quality Improvement (QI) Efforts for Under-Resourced Primary Care Practices to Improve Diabetes Disparities

“…The DREAM (Diabetes Research, Education, and Action for Minorities) Initiative is a 5-year randomized controlled trial to support weight loss and glycemic control efforts among South Asian patients receiving care in a network of PCPs in NYC. Details on project study design are described elsewhere [ 30 ]. The DREAM Initiative leverages multisectoral partnerships in its implementation, including the Primary Care Information Project (PCIP) at the NYC Department of Health and Mental Hygiene and EHR vendors representing the 2 systems utilized across study sites (MDLand and eClinicalWorks [eCW]).…”