Diabetes Self-Management Models to Reduce Health Disparities
| Status: | Completed |
|---|---|
| Conditions: | Diabetes |
| Therapuetic Areas: | Endocrinology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 10/19/2013 |
| Start Date: | January 2009 |
| End Date: | May 2012 |
| Contact: | Dawn Begaye |
| Email: | dbegaye@swmail.sw.org |
| Phone: | 254-771-7749 |
Employing Diabetes Self-Management Models to Reduce Health Disparities in Texas
To evaluate the effectiveness of two different diabetes self-management approaches (Personal
Digital Assistant-based intervention & Chronic Disease Self-Management Program) to reduce
health disparities in minority, rural residents, and other underserved populations with type
2 diabetes in Central Texas. We hypothesise that: 1) Racial/ethnic minority patients with
T2DM will be found to experience disparities in diabetes self-management treatment protocols
and clinical outcomes, which persist even when controlling for age, gender, obesity, and
insurance status; 2) Patients with T2DM who reside in more rural areas will be found to
experience disparities in diabetes self-management treatment protocols and clinical outcomes
as compared to more urban counterparts, controlling for age, gender, race/ethnicity,
obesity, and insurance status; 3) The introduction of CSDMP and HIT protocols will improve
diabetes-related self management behaviors, reduce HBA1c values, and increase quality of
life in persons with T2DM as compared to controls. A combined intervention approach will
result in the greatest reductions; 4) Health improvements following the introduction of
CDSMP, HIT or CDSMP/HIT protocols in persons with T2DM compared to controls will be more
marked in racial/ethnic minority patients and those patients residing in rural areas; 5) The
introduction of self-management interventions will be cost-effective in reducing HbA1c
values over time, and associated health care utilization including overall reduction in ER
and acute care hospital admissions; 6) Although there is little prior research in this area
to guide specific hypotheses, we hypothesize that, overall, there will be no significant
cost-effective differential in CDSMP as compared to HIT approaches, although the
cost-effective ratio may be stronger in particular subpopulations. The combined approach
will have higher costs, but is also anticipated to have a higher cost-benefit ratio for
minority populations; 7) The majority of clinicians will be willing to let their patients
enroll in the study and will reinforce intervention protocols; and 8) These interventions
can be embedded into existing health care structures. At the end of the study, Scott and
White will institutionalize cost-effective treatment protocols.
Despite concerted federal and state attempts to reduce health disparities over the past
decades substantial disparities in reported rates of chronic disease for minorities still
exist. In particular, African Americans and Hispanics experience higher rates of Type 2
diabetes (T2DM), and cardiovascular disease (CVD) than do other segments of the U.S.
population. The objectives of this proposed research project are to test two different
diabetes self-management (DSM) programs in a large multi-site health care organization in
Central Texas that serves large populations of minority and rural residents, comparing
outcomes in order to evaluate their efficacy for reducing health disparities. Our specific
aims are to: 1) document the nature and magnitude of extant health disparities in diabetes
treatment processes and outcomes; 2) evaluate different DSM intervention approaches on
behavioral and clinical outcomes, with attention to differential effects by patient and
environmental characteristics; 3) examine the cost-effectiveness of these different
approaches to DSM education in minority and rural populations; and 4) explore the reach of
our intervention efforts and the broader organizational impacts of DSM education, including
feedback loops to clinicians and organizational receptivity to self-management approaches.
Our study will employ four different activities: 1) an initial electronic chart review of
1300 records of adults; 2) a 2 by 2 open 24 month randomized clinical trial of behaviorally
and technologically based DSM interventions with 400 adults age 21 and older who have type 2
diabetes (T2DM); 3) a cost-effectiveness analysis of the different treatment approaches; and
4) surveys of primary care providers and health care administrators. While our primary
outcome will be reductions in hemoglobin A1c (HbA1c), our conceptual model includes
clinical, behavioral, economic and organizational outcomes. We will also assess the extent
to which our interventions reduce health disparities by examining differential treatment
success. This study is innovative in its comparison of both behavioral and technological
intervention approaches, its attention to the public health impact and cost-effectiveness of
different intervention approaches, and its concern with organizational responses to
intervention sustainability. A noteworthy significance will be the strengthening of the
linkages between clinical and community treatment approaches and the identification of
successful treatment strategies in different settings and populations.
Inclusion Criteria:
- Patients with T2DM, including those who require insulin therapy, aged >18 years
(eliminates the need to obtain assent for minors who are also dependent on their
parents).
- Last measured HbA1c value of > 7.5% (this study hopes to show an improvement in the
control of patient's diabetes, and not focused on patients who already show evidence
of good disease control).
- Willingness and ability to attend one initial research visit and semi-annual routine
follow-up visits over a 24-month period. The follow-up visits include height,
weight, and blood pressure measurement and a survey. Surveys may be conducted by
phone interview or mail when a follow-up visit can not be scheduled.
- Ability to read, write, and speak English at least at a grade 8 level so as to be
able to engage in self-monitoring and use the commercial diabetes management software
program (Diabetes Pilot), which is available only in English. For those with
lower-literacy, assistance in filling out forms and understanding required
intervention protocols will be provided, and use of a "buddy" will be recommended.
Exclusion Criteria:
- Not willing to sign an informed consent or be randomized to any of the four
treatment/control groups, (we want to minimize any upfront treatment biases, while
adhering to human subject protocols).
- Currently, documented severe alcoholism or drug abuse that is < 6 months ago
(concerns that this problem is likely to significantly affect their ability and
likelihood to comply with the study requirements over the course of the 24 months).
- Female patients who are pregnant or planning to become pregnant within 12 months (in
pregnancy, type 2 diabetes is managed in a completely different manner than in
non-pregnant patients).
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