Integrating Community Health Workers to Improve Diabetes Prevention

Not Applicable

Completed

Brief Summary: Cluster randomized trial to test the impact of peer health coaches on prediabetic patients. This study will test a scalable model of peer health coaching to address the millions of patients at risk for Diabetes Mellitus, using low cost, culturally congruent personnel to promote prevention of Diabetes Mellitus in patient-centered medical home (PCMH) practice.

Detailed Description: This population based trial aims to understand the impact of peer health interventions on panels of patients in a real clinic environment

Investigators will conduct a cluster-randomized trial to test the impact of peer health coaches on prediabetic patients cared for by patient-centered medical home model (PCMH) teams to:

1. Reduce the incidence of type 2 DM in pre-diabetic, PCMH patients;

2. Promote weight loss among pre-diabetic patients;

3. Increase patient activation levels, a measureable construct of engagement, efficacy, skills, and confidence in managing one's health, among pre-DM patients, resulting in:

1. Improved secondary clinical outcomes: better glycemic and blood pressure control, and lower Framingham risk scores;

2. Increased utilization of preventive services (e.g. MOVE!, TeleMOVE!, Healthy Lifestyles, etc);

3. Improved health behaviors (e.g. making dietary and exercise changes); and

4. Develop, implement and assess strategies to recruit, train, and integrate peer CHW health coaches within the PCMH model.

This study will test a scalable model of peer health coaching to address the millions of patients at risk for Diabetes Mellitus (DM),using low cost, culturally congruent personnel to promote prevention of DM in PCMH practice.

Recruitment & Eligibility

Inclusion Criteria

Having at least one HbA1c result in the prediabetic range (5.7-6.5%) in the 5 years prior to the start date of Phase 2.

Exclusion Criteria

A diagnosis of DM, based on ICD-9 codes applied during ambulatory encounters in the 2 years prior to Phase 2
Treatment with DM medication other than metformin (e.g. insulin or oral agents)
age greater than 75 years
exclusion by patient's PCP due to contraindication for lifestyle intervention or CHW outreach.
Does not speak English or Spanish (necessary to communicate with community health worker)

Arm && Interventions

Group	Intervention	Description
Control Group (Data Only)	Data Only	The teams randomly allocated to the Control Group will not have access to CHWs.
Intervention Group: (CHW Health Coaching Integrated into Team)	CHW Training	Teams randomly allocated to the Intervention Group will also receive regular panel data on their pre-DM patients and will have a CHW join the team, attend team meetings, and provide an outreach intervention to all prediabetic patients in the panel, as described below. CHWs and the researchers will provide regular updates to the team on these activities.

Primary Outcome Measures

Name	Time	Method
Patient Activation Measure (PAM) scores	36 Months	The PAM survey reliably predicts future ER visits, hospital admissions and readmissions, medication adherence and more.
Incidence rates of type 2 DM	36 Months	Cumulative DM incidence rates and time to DM incidence
Weight loss and obesity rates	36 Months	Will conduct chi-square test to compare DM incidence rates at 36-months follow-up of the intervention and control arms.

Secondary Outcome Measures

Name	Time	Method

Locations (1): New York University Medical Center
🇺🇸
New York, New York, United States

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