title: Improving diabetes care and outcomes with community health workers.
abstract: Type II diabetes continues to be a major health problem in USA, particularly in minority populations. The Diabetes Equity Project (DEP), a clinic-based diabetes self-management and education program led by community health workers (CHWs), was designed to reduce observed disparities in diabetes care and outcomes in medically underserved, predominantly Hispanic communities.
  
  
  
  The purpose of this study was to evaluate the impact of the DEP on patients' clinical outcomes, diabetes knowledge, self-management skills, and quality of life.
  
  
  
  The DEP was implemented in five community clinics from 2009 to 2013 and 885 patients completed at least two visits with the CHW. Student's paired t-tests were used to compare baseline clinical indicators with indicators obtained from patients' last recorded visit with the CHW and to assess differences in diabetes knowledge, perceived competence in managing diabetes, and quality of life. A mixed-effects model for repeated measures was used to examine the effect of DEP visits on blood glucose (HbA1c), controlling for patient demographics, clinic and enrolment date.
  
  
  
  DEP patients experienced significant (P < 0.0001) improvements in HbA1c control, blood pressure, diabetes knowledge, perceived competence in managing diabetes, and quality of life. Mean HbA1c for all DEP patients decreased from 8.3% to 7.4%.
  
  
  
  Given the increasing prevalence of diabetes in USA and documented disparities in diabetes care and outcomes for minorities, particularly Hispanic patients, new models of care such as the DEP are needed to expand access to and improve the delivery of diabetes care and help patients achieve improved outcomes.
authors.affiliation: Community Care, Baylor Scott and White Health, Dallas, TX, USA.
authors.forename: Erin P
authors.initials: EP
authors.lastname: Kane
authors.affiliation: Center for Clinical Effectiveness, Baylor Scott and White Health, Dallas, TX, USA, Ashley.Collinsworth@baylorhealth.edu.
authors.forename: Ashley W
authors.initials: AW
authors.lastname: Collinsworth
authors.affiliation: STEEEP Analytics, Baylor Scott and White Health, Dallas, TX, USA.
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Schmidt
authors.affiliation: Center for Clinical Effectiveness, Baylor Scott and White Health, Dallas, TX, USA.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Brown
authors.affiliation: Community Care, Baylor Scott and White Health, Dallas, TX, USA.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Snead
authors.affiliation: STEEEP Analytics, Baylor Scott and White Health, Dallas, TX, USA.
authors.forename: Sunni A
authors.initials: SA
authors.lastname: Barnes
authors.affiliation: Center for Clinical Effectiveness, Baylor Scott and White Health, Dallas, TX, USA, Robbins Institute for Health Policy & Leadership in the Hankamer School of Business, Baylor University, Waco, TX, USA and.
authors.forename: Neil S
authors.initials: NS
authors.lastname: Fleming
authors.affiliation: Genesis Physicians Group, Dallas, TX, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Walton
mesh_terms: D000328:Adult; D003150:Community Health Workers; D003695:Delivery of Health Care / Q000592:standards*; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D007722:Health Knowledge, Attitudes, Practice; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012648:Self Care / Q000379:methods; D013781:Texas / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D035862:Vulnerable Populations
chemical_list: D006442:Glycated Hemoglobin
keywords: Community health workers; delivery of health care; diabetes mellitus; primary health care; quality improvement.