Abstract
Background
Both community health workers and the Project ECHO model of specialist telementoring
are innovative approaches to support primary care providers in the care of complex
patients with diabetes. We studied the effect of an intervention that combined these
2 approaches on glycemic control.
Methods
Patients with diabetes were recruited from 10 federally qualified health centers in
New Mexico. We used electronic health record (EHR) data to compare HbA1c levels prior
to intervention enrollment with HbA1c levels after 3 months (early follow-up) and
12 months (late follow-up) following enrollment. We propensity matched intervention
patients to comparison patients from other sites within the same electronic health
records databases to estimate the average treatment effect.
Results
Among 557 intervention patients with HbA1c data, mean HbA1c decreased from 10.5% to
9.3% in the pre- versus postintervention periods (P < .001). As compared to the comparison group, the intervention was associated with
a change in HbA1c of −0.2% (95% confidence interval [CI] −0.4%-0.5%) and −0.3 (95%
CI −0.5–0.0) in the early and late follow-up cohorts, respectively. The intervention
was associated with a significant increase in percentage of patients with HbA1c <8%
in the late follow-up cohort (8.1%, 95% CI 2.2%−13.9%) but not the early follow-up
cohort (3.6%, 95% CI −1.5% to 8.7%)
Discussion
The intervention was associated with a substantial decrease in HbA1c in intervention
patients, although this improvement was not different from matched comparison patients
in early follow-up. Although combining community health workers with Project ECHO
may hold promise for improving glycemic control, particularly in the longer term,
further evaluations are needed.
Keywords
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Article Info
Publication History
Published online: December 29, 2021
Footnotes
Funding: This study was supported by The Leona M. and Harry B. Helmsley Charitable Trust.
Conflicts of Interest: None.
Authorship: All authors had access to the data and a role in writing this manuscript.
Identification
Copyright
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