Alliance to Reduce Disparities in Diabetes

Dallas Team at the Minority Health and Health Disparities Grantees' Conference

The Effectiveness of the CHW-led Diabetes Equity Project

2014 Minority Health and Health Disparities Grantees' Conference
December 1-3, 2014
National Harbor, MD

Authors
E.P. Kane, C.A. Snead, K.L. Schmidt, S.A. Barnes, & A.W. Collinsworth

Abstract
Purpose: Baylor Health Care System (BHCS) created the Diabetes Equity Project (DEP), a five-year program with the goal of reducing disparities in diabetes care and outcomes in the medically underserved communities surrounding BHCS hospitals. The program featured specially trained, bilingual CHWs who served as members of primary care teams in 5 community clinics and delivered a culturally-relevant diabetes self-management and education curriculum targeting barriers to diabetes management commonly experienced by Hispanics. The objective of this study was to evaluate the impact of the DEP on clinical outcomes, diabetes knowledge and management skills, and quality of life.

Methods: This prospective cohort study included 885 patients with type 2 diabetes who enrolled in DEP from 2008-2013 and completed at least 2 visits with a CHW during a 1 year period. CHWs recorded clinical indicators including blood glucose (HbA1c), body mass index, and systolic and diastolic blood pressure during quarterly examinations. Patients completed the Diabetes Knowledge Assessment, Perceived Competence Scale, Diabetes Quality of Life, and the EQ-5D at baseline and follow-up. The effect of the DEP was assessed by comparing patient outcomes at baseline and final CHW visit using paired t-tests and a mixed effects model.

Results: DEP patients experienced a statistically significant reduction in HbA1c and systolic and diastolic blood pressure. Patients also demonstrated significant improvements in diabetes knowledge, perceived competence in managing diabetes, and quality of life.

Discussion/Conclusion: Adding CHWs to primary care teams to assist patients with diabetes management can help patients achieve improved diabetes control and quality of life.