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APHA Scientific Session and Event Listing

Dan Culica, MD, PhD¹, Elizabeth Prezio, MD, FACE², and Karen Harker, MLS, MPH². (1) Health Research and Educational Trust, American Hospital Association, One North Franklin, Suite 30132, Chicago, TX 60606, 312-422-2641, dculica@aha.org, (2) School Public Health, University of Texas, 5323 Harry Hines Blvd., V8.112, Dallas, TX 75390-9128

Low-cost diabetes education programs that target Mexican-Americans with diabetes are essential to reduce poor outcomes among this population. Education programs recognized by the American Diabetes Association are resource intensive requiring a complex mix of professionals to manage/educate diabetic patients. The centerpiece of a Community Diabetes Education (CoDE) Program, a culturally competent intervention was developed as an affordable alternative educational model. The CoDE Program features a low cost Community Health Worker as the sole educator/case manager. Evaluation of the effectiveness of this intervention is the purpose of this pilot study. CoDE is a one-to-one collaborative educational model delivered in seven patient contact hours by a specially trained Community Health Worker (CHW) over twelve months in a community clinic serving the uninsured. An experimental controlled design was implemented to randomize 90 diabetic patients to the CoDE intervention and 90 patients to routine care. Using the American Diabetes Association standards for diabetes care, the CHW surveyed patients' attitudes about diabetes, provided culturally appropriate education for disease self-management, and case-managed clinical progress under the direct supervision of clinic physicians. A data base was created combining patients' medical charts with survey information to measure metabolic and clinical outcomes, beliefs and knowledge about diabetes, as well as achievement of ADA standards of diabetes care. The Hemoglobin A1c was significantly lower (á<0.05) among the experimental group in contrast to the control group after six months of intervention. Although there was a sizeable change observed in the levels of HbA1c in both groups of patients, a significant decrease was found only in the intervention group that was managed by the CHW. One of the expected results of the CODE program was a decrease of 20% in the concentration of HbA1c. Tested with a multivariate analysis this decrease was significantly lower among patients in the participating in the experimental group. The absolute change in the HbA1c levels was significantly associated with a decrease in Body Mass Index and the amount of physical activity. Uninsured predominantly Mexican-American patients with diabetes educated and case-managed solely by a bilingual CHW in the CoDE Program showed remarkable improvement in glycemic control. Periodic evaluations at 3 and 6 months showed steady improvement also in patients' attitudes towards diabetes, lifestyle change and compliance with clinical recommendations. Significant impact is expected at the end of the 12 months of intervention under this investigation. The CoDE Program is a low cost diabetes education model with wide applicability.

Learning Objectives: At the conclusion of the session, the participant in this session will be able to

(
• Recognize an efficient and comprehensive education intervention for diabetes care at community level; (
• Identify the principal outcome indicators of diabetes care and the standards for diabetes management; (
• Develop a new model of diabetes management to integrate disease self management with case management.

Keywords: Diabetes, Disease Management

Presenting author's disclosure statement:

Any relevant financial relationships? No