Implementation of a multi-level community-clinical linkage intervention to improve glycemic control among south Asian patients with uncontrolled diabetes: study protocol of the DREAM initiative

Abstract Background A number of studies have identified patient-, provider-, and community-level barriers to effective diabetes management among South Asian Americans, who have a high prevalence of type 2 diabetes. However, no multi-level, integrated community health worker (CHW) models leveraging h...

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Autores principales:	Sahnah Lim, Laura C. Wyatt, Shinu Mammen, Jennifer M. Zanowiak, Sadia Mohaimin, Andrea B. Troxel, Stacy Tessler Lindau, Heather T. Gold, Donna Shelley, Chau Trinh-Shevrin, Nadia S. Islam
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	South Asian Community health workers Electronic health records Diabetes management Community-based participatory research Health disparities Diseases of the endocrine glands. Clinical endocrinology RC648-665
Acceso en línea:	https://doaj.org/article/b5681a7f02c54fe9a917d7a434db1f66
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spelling	oai:doaj.org-article:b5681a7f02c54fe9a917d7a434db1f662021-11-28T12:03:10ZImplementation of a multi-level community-clinical linkage intervention to improve glycemic control among south Asian patients with uncontrolled diabetes: study protocol of the DREAM initiative10.1186/s12902-021-00885-51472-6823https://doaj.org/article/b5681a7f02c54fe9a917d7a434db1f662021-11-01T00:00:00Zhttps://doi.org/10.1186/s12902-021-00885-5https://doaj.org/toc/1472-6823Abstract Background A number of studies have identified patient-, provider-, and community-level barriers to effective diabetes management among South Asian Americans, who have a high prevalence of type 2 diabetes. However, no multi-level, integrated community health worker (CHW) models leveraging health information technology (HIT) have been developed to mitigate disease among this population. This paper describes the protocol for a multi-level, community-clinical linkage intervention to improve glycemic control among South Asians with uncontrolled diabetes. Methods The study includes three components: 1) building the capacity of primary care practices (PCPs) to utilize electronic health record (EHR) registries to identify patients with uncontrolled diabetes; 2) delivery of a culturally- and linguistically-adapted CHW intervention to improve diabetes self-management; and 3) HIT-enabled linkage to culturally-relevant community resources. The CHW intervention component includes a randomized controlled trial consisting of group education sessions on diabetes management, physical activity, and diet/nutrition. South Asian individuals with type 2 diabetes are recruited from 20 PCPs throughout NYC and randomized at the individual level within each PCP site. A total of 886 individuals will be randomized into treatment or control groups; EHR data collection occurs at screening, 6-, 12-, and 18-month. We hypothesize that individuals receiving the multi-level diabetes management intervention will be 15% more likely than the control group to achieve ≥0.5% point reduction in hemoglobin A1c (HbA1c) at 6-months. Secondary outcomes include change in weight, body mass index, and LDL cholesterol; the increased use of community and social services; and increased health self-efficacy. Additionally, a cost-effectiveness analysis will focus on implementation and healthcare utilization costs to determine the incremental cost per person achieving an HbA1c change of ≥0.5%. Discussion Final outcomes will provide evidence regarding the effectiveness of a multi-level, integrated EHR-CHW intervention, implemented in small PCP settings to promote diabetes control among an underserved South Asian population. The study leverages multisectoral partnerships, including the local health department, a healthcare payer, and EHR vendors. Study findings will have important implications for the translation of integrated evidence-based strategies to other minority communities and in under-resourced primary care settings. Trial registration This study was registered with clinicaltrials.gov: NCT03333044 on November 6, 2017.Sahnah LimLaura C. WyattShinu MammenJennifer M. ZanowiakSadia MohaiminAndrea B. TroxelStacy Tessler LindauHeather T. GoldDonna ShelleyChau Trinh-ShevrinNadia S. IslamBMCarticleSouth AsianCommunity health workersElectronic health recordsDiabetes managementCommunity-based participatory researchHealth disparitiesDiseases of the endocrine glands. Clinical endocrinologyRC648-665ENBMC Endocrine Disorders, Vol 21, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	South Asian Community health workers Electronic health records Diabetes management Community-based participatory research Health disparities Diseases of the endocrine glands. Clinical endocrinology RC648-665
spellingShingle	South Asian Community health workers Electronic health records Diabetes management Community-based participatory research Health disparities Diseases of the endocrine glands. Clinical endocrinology RC648-665 Sahnah Lim Laura C. Wyatt Shinu Mammen Jennifer M. Zanowiak Sadia Mohaimin Andrea B. Troxel Stacy Tessler Lindau Heather T. Gold Donna Shelley Chau Trinh-Shevrin Nadia S. Islam Implementation of a multi-level community-clinical linkage intervention to improve glycemic control among south Asian patients with uncontrolled diabetes: study protocol of the DREAM initiative
description	Abstract Background A number of studies have identified patient-, provider-, and community-level barriers to effective diabetes management among South Asian Americans, who have a high prevalence of type 2 diabetes. However, no multi-level, integrated community health worker (CHW) models leveraging health information technology (HIT) have been developed to mitigate disease among this population. This paper describes the protocol for a multi-level, community-clinical linkage intervention to improve glycemic control among South Asians with uncontrolled diabetes. Methods The study includes three components: 1) building the capacity of primary care practices (PCPs) to utilize electronic health record (EHR) registries to identify patients with uncontrolled diabetes; 2) delivery of a culturally- and linguistically-adapted CHW intervention to improve diabetes self-management; and 3) HIT-enabled linkage to culturally-relevant community resources. The CHW intervention component includes a randomized controlled trial consisting of group education sessions on diabetes management, physical activity, and diet/nutrition. South Asian individuals with type 2 diabetes are recruited from 20 PCPs throughout NYC and randomized at the individual level within each PCP site. A total of 886 individuals will be randomized into treatment or control groups; EHR data collection occurs at screening, 6-, 12-, and 18-month. We hypothesize that individuals receiving the multi-level diabetes management intervention will be 15% more likely than the control group to achieve ≥0.5% point reduction in hemoglobin A1c (HbA1c) at 6-months. Secondary outcomes include change in weight, body mass index, and LDL cholesterol; the increased use of community and social services; and increased health self-efficacy. Additionally, a cost-effectiveness analysis will focus on implementation and healthcare utilization costs to determine the incremental cost per person achieving an HbA1c change of ≥0.5%. Discussion Final outcomes will provide evidence regarding the effectiveness of a multi-level, integrated EHR-CHW intervention, implemented in small PCP settings to promote diabetes control among an underserved South Asian population. The study leverages multisectoral partnerships, including the local health department, a healthcare payer, and EHR vendors. Study findings will have important implications for the translation of integrated evidence-based strategies to other minority communities and in under-resourced primary care settings. Trial registration This study was registered with clinicaltrials.gov: NCT03333044 on November 6, 2017.
format	article
author	Sahnah Lim Laura C. Wyatt Shinu Mammen Jennifer M. Zanowiak Sadia Mohaimin Andrea B. Troxel Stacy Tessler Lindau Heather T. Gold Donna Shelley Chau Trinh-Shevrin Nadia S. Islam
author_facet	Sahnah Lim Laura C. Wyatt Shinu Mammen Jennifer M. Zanowiak Sadia Mohaimin Andrea B. Troxel Stacy Tessler Lindau Heather T. Gold Donna Shelley Chau Trinh-Shevrin Nadia S. Islam
author_sort	Sahnah Lim
title	Implementation of a multi-level community-clinical linkage intervention to improve glycemic control among south Asian patients with uncontrolled diabetes: study protocol of the DREAM initiative
title_short	Implementation of a multi-level community-clinical linkage intervention to improve glycemic control among south Asian patients with uncontrolled diabetes: study protocol of the DREAM initiative
title_full	Implementation of a multi-level community-clinical linkage intervention to improve glycemic control among south Asian patients with uncontrolled diabetes: study protocol of the DREAM initiative
title_fullStr	Implementation of a multi-level community-clinical linkage intervention to improve glycemic control among south Asian patients with uncontrolled diabetes: study protocol of the DREAM initiative
title_full_unstemmed	Implementation of a multi-level community-clinical linkage intervention to improve glycemic control among south Asian patients with uncontrolled diabetes: study protocol of the DREAM initiative
title_sort	implementation of a multi-level community-clinical linkage intervention to improve glycemic control among south asian patients with uncontrolled diabetes: study protocol of the dream initiative
publisher	BMC
publishDate	2021
url	https://doaj.org/article/b5681a7f02c54fe9a917d7a434db1f66
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Implementation of a multi-level community-clinical linkage intervention to improve glycemic control among south Asian patients with uncontrolled diabetes: study protocol of the DREAM initiative

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