Results of the Northern Manhattan diabetes community outreach project: A randomized trial studying a community health horker intervention to improve diabetes care in hispanic adults

Walter Palmas, Sally E. Findley, Miriam Mejia, Milagros Batista, Jeanne Teresi, Jian Kong, Stephanie Silver, Elaine M. Fleck, Jose A. Luchsinger, Olveen Carrasquillo

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

OBJECTIVE: The Northern Manhattan Diabetes Community Outreach Project evaluated whether a community health worker (CHW) intervention improved clinically relevant markers of diabetes care in adult Hispanics. RESEARCH DESIGN AND METHODS: Participants were adult Hispanics, ages 35-70 years, with recent hemoglobin A1c (A1C) ≥8% (≥64 mmol/mol), from a university-affiliated network of primary care practices in northern Manhattan (New York City, NY). They were randomized to a 12-month CHW intervention (n = 181), or enhanced usual care (educational materials mailed at 4-month intervals, preceded by phone calls, n = 179). The primary outcome was A1C at 12 months; the secondary outcomes were systolic blood pressure (SBP), diastolic blood pressure, and LDL-cholesterol levels. RESULTS: There was a nonsignificant trend toward improvement in A1C levels in the intervention group (from unadjusted mean A1C of 8.77 to 8.40%), as compared with usual care (from 8.58 to 8.53%) (P = 0.131). There was also a nonsignificant trend toward an increase in SBP and LDL cholesterol in the intervention arm. Intervention fidelity, measured as the number of contacts in the intervention arm (visits, phone contacts, group support, and nutritional education), showed a borderline association with greater A1C reduction (P = 0.054). When assessed separately, phone contacts were associated with greater A1C reduction (P = 0.04). CONCLUSIONS: The trend toward A1C reduction with the CHW intervention failed to achieve statistical significance. Greater intervention fidelity may achieve better glycemic control, and more accessible treatment models, such as phone-based interventions, may be more efficacious in socioeconomically disadvantaged populations.

Original languageEnglish
Pages (from-to)963-969
Number of pages7
JournalDiabetes Care
Volume37
Issue number4
DOIs
StatePublished - Jan 1 2014

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Community-Institutional Relations
Hispanic Americans
Blood Pressure
Health
LDL Cholesterol
Nutritional Support
Vulnerable Populations
Primary Health Care
Hemoglobins
Research Design
Education
Population

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

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Results of the Northern Manhattan diabetes community outreach project : A randomized trial studying a community health horker intervention to improve diabetes care in hispanic adults. / Palmas, Walter; Findley, Sally E.; Mejia, Miriam; Batista, Milagros; Teresi, Jeanne; Kong, Jian; Silver, Stephanie; Fleck, Elaine M.; Luchsinger, Jose A.; Carrasquillo, Olveen.

In: Diabetes Care, Vol. 37, No. 4, 01.01.2014, p. 963-969.

Research output: Contribution to journalArticle

Palmas, Walter ; Findley, Sally E. ; Mejia, Miriam ; Batista, Milagros ; Teresi, Jeanne ; Kong, Jian ; Silver, Stephanie ; Fleck, Elaine M. ; Luchsinger, Jose A. ; Carrasquillo, Olveen. / Results of the Northern Manhattan diabetes community outreach project : A randomized trial studying a community health horker intervention to improve diabetes care in hispanic adults. In: Diabetes Care. 2014 ; Vol. 37, No. 4. pp. 963-969.
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abstract = "OBJECTIVE: The Northern Manhattan Diabetes Community Outreach Project evaluated whether a community health worker (CHW) intervention improved clinically relevant markers of diabetes care in adult Hispanics. RESEARCH DESIGN AND METHODS: Participants were adult Hispanics, ages 35-70 years, with recent hemoglobin A1c (A1C) ≥8{\%} (≥64 mmol/mol), from a university-affiliated network of primary care practices in northern Manhattan (New York City, NY). They were randomized to a 12-month CHW intervention (n = 181), or enhanced usual care (educational materials mailed at 4-month intervals, preceded by phone calls, n = 179). The primary outcome was A1C at 12 months; the secondary outcomes were systolic blood pressure (SBP), diastolic blood pressure, and LDL-cholesterol levels. RESULTS: There was a nonsignificant trend toward improvement in A1C levels in the intervention group (from unadjusted mean A1C of 8.77 to 8.40{\%}), as compared with usual care (from 8.58 to 8.53{\%}) (P = 0.131). There was also a nonsignificant trend toward an increase in SBP and LDL cholesterol in the intervention arm. Intervention fidelity, measured as the number of contacts in the intervention arm (visits, phone contacts, group support, and nutritional education), showed a borderline association with greater A1C reduction (P = 0.054). When assessed separately, phone contacts were associated with greater A1C reduction (P = 0.04). CONCLUSIONS: The trend toward A1C reduction with the CHW intervention failed to achieve statistical significance. Greater intervention fidelity may achieve better glycemic control, and more accessible treatment models, such as phone-based interventions, may be more efficacious in socioeconomically disadvantaged populations.",
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AU - Kong, Jian

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