Reports From the Field

Evaluation of a Diabetes Care Coordination Program for African-American Women Living in Public Housing

Journal of Clinical Outcomes Management. 2015 August;22(8)

Author(s):

Ithar Hassaballa, MA

Osagie Ebekozien, MBBS, MPH, CPHQ

Adeola Ogungbadero, MPH

Frederica Williams, MBA

Jerry Schultz, PhD

Jenna Hunter-Skidmore, MPH

Stephen Fawcett, PhD

Jomella Watson-Thompson, PhD

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From the University of Kansas Work Group for Community Health and Development, Lawrence, KS (Hassaballa, Schultz, Hunter-Skidmore, Fawcett, Watson-Thompson) and Whittier Street Health Center, Boston, MA (Ebekozien, Ogungbadero, Williams)

Abstract

Objective: To examine the implementation of the Diabetes Care Coordination Program (DCCP) and its effects on diabetes-related clinical health outcomes.
Methods: Program participants were African American women ( n = 148) with type 2 diabetes who lived in public housing in Boston’s Roxbury neighborhood. Through the DCCP, Whittier Street Health Center’s clinical team provided diabetes self-management education, support, and comprehensive diabetes care using the patient-centered medical home model and Diabetes Health Ambassadors as mediators for program delivery. Core intervention components of the DCCP included: 1) diabetes self-management education, 2) support for managing diabetes and distress, 3) enhancing access and linkage to care, 4) improving quality of care, 5) community organization, mobilization, and advocacy, and 6) health system and community transformation. A participatory monitoring and evaluation system was used to document and systematically reflect on program implementation.
Results: DCCP implementation was associated with modest improvements in diabetes-related clinical health outcomes for program participants. Results showed statistically significant improvements in HbA1c ( P = 0.016), weight (P = 0.021) and diastolic blood pressure ( P = 0.027).
Conclusion: Using neighborhood Diabetes Health Ambassadors for program delivery has implications for assuring access to quality diabetes care for populations experiencing health disparities.

The growing prevalence of type 2 diabetes, with its high morbidity and excess mortality, is imposing a heavy burden on the U.S. health care system [1–3]. It has been recognized that adoption of self-management skills by the person with diabetes is necessary in order to manage their diabetes. Diabetes self-management education and support (DSME/S) provides the foundation to help people with diabetes to navigate these decisions and activities and has been shown to improve health outcomes.

Compared to the general population, African Americans are disproportionately affected by diabetes. African Americans are also less likely to seek diabetes care and have routine diabetes-related visits with a health care professional [4,5]. African Americans have higher HbA1c levels, which contribute to the increased mortality and morbidity rates among this population [6]. Furthermore, African-American women have the poorest HbA1c control as compared to other groups [4]. Concentrated poverty and lower socioeconomic status are social determinants associated with higher prevalence of diabetes [7]. Economic barriers, living conditions, and the built environment play a significant role in contributing to this health disparity [8].

In 2010, the Bristol-Myers Squibb (BMS) Foundation launched the Together on Diabetes initiative to improve the health outcomes of adult populations disproportionately affected by type 2 diabetes. In November 2010, Together on Diabetes issued a request for proposals to encourage, identify, and promote new and evidence-based approaches to empower African-American women to control their diabetes [9–11], taking into account the opportunity these women have to influence the health of their families and communities. Whittier Street Health Center in Boston received a grant to implement a program that would connect African-American women living in public housing in the Roxbury neighborhood with comprehensive diabetes management, including health education by a certified diabetes educator, nutritional counseling by a dietitian, and a tailored program of physical activity.