The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #58409

Marian L. Batts-Turner, MSN, RN, CDE¹, Tiffany L Gary, PhD², Lee Bone, MPH, RN³, Felicia Hill-Briggs, PhD⁴, Martha Hill, PhD, RN⁵, David Levine, MD, ScD, MPH⁴, Christopher Saudek, MD⁴, and Frederick L. Brancati, MD, MHS⁶. (1) School of Medicine, The Johns Hopkins University, 2024 E. Monument Street, Suite 2-615, Baltimore, MD 21205, 410-563-6227, mlbatts@jhmi.edu, (2) Department of Epidemiology, The Johns Hopkins University, Bloomberg School of Public Health, 615 N Wolfe St. Rm E6035, Baltimore, MD 21205, (3) Department of Health Policy & Management, The Johns Hopkins University, Bloomberg School of Public Health, Hampton House 608, Baltimore, MD 21205, (4) Department of Rehabilitation, The Johns Hopkins Medical Institutions, 2024 E. Monument Street, Baltimore, MD 21205, (5) School of Nursing, The Johns Hopkins University, 525 N. Wolfe St., Baltimore, MD 21287, (6) Department of Medicine & Epidemiology, Johns Hopkins University, 2024 E. Monument Street, Suite 2-600, Baltimore, MD 21205

Implementation of clinical practice guidelines for diabetes care and control remains inadequate, particularly among underserved minority adults. We are testing algorithms and Intervention Action Plans (IAPs) delivered by a nurse (RN) and community health worker (CHW) team versus telephone interventions within Project Sugar 2, a randomized controlled trial. Participants include 542 urban African Americans (mean age 58 years, 73% female) attending any 1 of 5 clinics affiliated with an academic medical center. The RN/CHW group receives RN clinic and CHW home visits, telephone follow-up, feedback to physicians, and newsletters.

Algorithms and IAPs are based on guidelines, position statements, and expert recommendations. The algorithms address blood glucose, blood pressure, and lipids; depression; smoking; foot screening; and blood glucose monitoring. Algorithms triage level of control as optimal, suboptimal, poor, or very poor and direct the initiation of culturally appropriate Intervention Action Plans (IAPs). Higher risk participants (e.g. poor versus optimal) receive more aggressive and more frequent follow-up (e.g. face-to-face versus telephone, weekly versus monthly). IAPs address nutrition; physical activity; medication and appointment adherence; foot care; and socioeconomic issues (e.g. employment, insurance, caregiver concerns). Preliminary baseline data of the RN/CHW group (n=196) show that almost 50% are in suboptimal, poor, or very poor control in one or more of the following: blood glucose, blood pressure, lipids, foot care, and depression. Experiences of design and implementation of the algorithms and IAPs will be also discussed. This approach to enhance the utilization of national guidelines in practice also has implications for other chronic health conditions.

Learning Objectives:

• Identify techniques to implement guidelines in practice.
• Assess the utility of using clinical pathways to address chronic health conditions.
• Discuss culturally appropriate interventions for behavior change in African-American adults with diabetes.

Keywords: Interventions, African American

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.