Integrated Community-Clinical Linkage Model to Promote Weight Loss Among South Asians With Pre-Diabetes
| Status: | Recruiting |
|---|---|
| Conditions: | Obesity Weight Loss, Endocrine, Diabetes, Diabetes |
| Therapuetic Areas: | Endocrinology |
| Healthy: | No |
| Age Range: | 18 - Any |
| Updated: | 12/20/2018 |
| Start Date: | December 17, 2018 |
| End Date: | September 2021 |
| Contact: | Jennifer Zanowiak |
| Email: | Jennifer.Zanowiak@nyulangone.org |
| Phone: | 212 263 0485 |
The proposed study will inform efforts to prevent diabetes and promote weight loss in a
high-risk population and generate a reproducible, scalable, and sustainable model for use
with other insurer groups and clinical settings that work in immigrant populations with a
high burden of chronic disease.
high-risk population and generate a reproducible, scalable, and sustainable model for use
with other insurer groups and clinical settings that work in immigrant populations with a
high burden of chronic disease.
The study "Integrated Community-Clinical Linkage Model to Promote Weight Loss among South
Asians with Pre-Diabetes" aims to test the effectiveness and assess the implementation
process of an integrated intervention to support weight loss for South Asian patients at-risk
for type-2 diabetes mellitus (T2DM) in primary care settings. The integrated intervention
involves:
1. An electronic health record (EHR) intervention for primary care providers (PCPs)
utilizing embedded alerts to increase screening and identification of South Asian
patients at-risk for T2DM with BMI >23 kg/m2 and registries to track outcomes: and
2. Registry-driven community health worker (CHW)-led health coaching for patients. Using a
stepped-wedge design, we will implement the study in 25 New York City PCP sites
enrolling 2,840 South Asian patients at- risk for T2DM.
3. Provider Surveys (n=40) to capture data on satisfaction with workflow before and after
intervention, information sources for EHR-CHW initiatives before and after intervention,
acceptability of and satisfaction with the integrated EHR-CHW intervention, and barriers
and facilitators of point-of-care use of the tools.
4. Key Informant Interviews (n=35) with physician champions at each site and/or
administrator of each site, Health first representatives, and CHWs. At baseline, the
interviews will be incorporated into the workflow analysis to assess current
satisfaction and usage of EHR and health coaching. At follow-up, the interviews will
assess barriers and facilitators to the implementation and adoption process of the
integrated EHR-CHW intervention, fidelity to the interventions, and to solicit
recommendations for the replication and scalability of the intervention to other sites
and insurer organizations.
Asians with Pre-Diabetes" aims to test the effectiveness and assess the implementation
process of an integrated intervention to support weight loss for South Asian patients at-risk
for type-2 diabetes mellitus (T2DM) in primary care settings. The integrated intervention
involves:
1. An electronic health record (EHR) intervention for primary care providers (PCPs)
utilizing embedded alerts to increase screening and identification of South Asian
patients at-risk for T2DM with BMI >23 kg/m2 and registries to track outcomes: and
2. Registry-driven community health worker (CHW)-led health coaching for patients. Using a
stepped-wedge design, we will implement the study in 25 New York City PCP sites
enrolling 2,840 South Asian patients at- risk for T2DM.
3. Provider Surveys (n=40) to capture data on satisfaction with workflow before and after
intervention, information sources for EHR-CHW initiatives before and after intervention,
acceptability of and satisfaction with the integrated EHR-CHW intervention, and barriers
and facilitators of point-of-care use of the tools.
4. Key Informant Interviews (n=35) with physician champions at each site and/or
administrator of each site, Health first representatives, and CHWs. At baseline, the
interviews will be incorporated into the workflow analysis to assess current
satisfaction and usage of EHR and health coaching. At follow-up, the interviews will
assess barriers and facilitators to the implementation and adoption process of the
integrated EHR-CHW intervention, fidelity to the interventions, and to solicit
recommendations for the replication and scalability of the intervention to other sites
and insurer organizations.
Inclusion Criteria:
Provider Assessment Surveys
- clinicians employed by independent primary care practice that are members of
HealthFirst's network and have enrolled into the study.
Key Informant Interviews
- must be a provider, clinic manger, Healthfisrt staff, or community health worker.
Exclusion Criteria:
Provider Assessment Surveys
- Exclusion criteria include the following: participants who are unable to complete the
survey in the English language.
We found this trial at
1
site
462 1st Avenue
New York, New York 10010
New York, New York 10010
Principal Investigator: Nadia Islam, MD
Phone: 212-263-0485
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