A randomized study of the impact of home health aides on diabetic control and utilization patterns.

Hopper, Susan; Miller, Jamie K.; Birge, Clifford A.; Swift, Judy A.

doi:10.2105/ajph.74.6.600

Cited by 26 publications

(15 citation statements)

References 11 publications

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“…[33][34][35] Five showed no significant difference in ED visits. [36][37][38][39][40] Of the eight pre-post studies, five showed a significant decrease in ED visits relative to a baseline measurement, [41][42][43][44][45] and one had no significant decrease. 46 Two pre-post studies did not indicate statistical significance; of these, one intervention resulted in a decrease in ED visits 47 and one in an increase in ED visits.…”

Section: Emergency Department Visitsmentioning

confidence: 94%

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Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

et al. 2016

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BACKGROUND: As the US transitions to value-based healthcare, physicians and payers are incentivized to change healthcare delivery to improve quality of care while controlling costs. By assisting with the management of common chronic conditions, community health workers (CHWs) may improve healthcare quality, but physicians and payers who are making choices about care delivery also need to understand their effects on healthcare spending. METHODS: We searched PubMed, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PsycINFO, Embase, and Web of Science from the inception of each database to 22 June 2015. We included US-based studies that evaluated a CHW intervention for patients with at least one chronic health condition and reported cost or healthcare utilization outcomes. We evaluated studies using tools specific to study design. RESULTS: Our search yielded 2,941 studies after removing duplicates. Thirty-four met inclusion and methodological criteria. Sixteen studies (47%) were randomized controlled trials (RCTs). RCTs typically had less positive outcomes than other study designs. Of the 16 RCTs, 12 reported utilization outcomes, of which 5 showed a significant reduction in one or more of ED visits, hospitalizations and/or urgent care visits. Significant reductions reported in ED visits ranged from 23%-51% and in hospitalizations ranged from 21%-50%, and the one significant reduction in urgent care visits was recorded at 60% (p < 0.05 for all). DISCUSSION: Our results suggest that CHW interventions have variable effects, but some may reduce costs and preventable utilization. These findings suggest that it is possible to achieve reductions in care utilization and cost savings by integrating CHWs into chronic care management. However, variations in cost and utilization outcomes suggest that CHWs alone do not make an intervention successful. The paucity of rigorous studies and heterogeneity of study designs limited conclusions about factors associated with reduced utilization.

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Section: Emergency Department Visitsmentioning

confidence: 94%

“…Three of six RCTs showed a significant increase in visits relative to a control, 39,51,60 while three had no significant change. 38,40,61 One pre-post study found no significant change in clinic visits, 41 and a single cohort study saw a significant increase in ambulatory care. 62 …”

Section: Scheduled Outpatient Visitsmentioning

confidence: 99%

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

et al. 2016

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“…We found 14 interventions that implemented health systems changes-8 randomized controlled trials, 4 controlled trials, and 2 before/after studies, which are summarized in table 3 (Bray, Roupe, et al 2005;Bray, Thompson, et al 2005;California Medi-Cal Type 2 Diabetes Study Group 2004;Davidson 2003;Fanning et al 2004;Gary et al 2004;Hopper et al 1984;Jaber et al 1996;Miller et al 2003;Pettitt et al 2005;Philis-Tsimikas et al 2004;Rothman et al 2005;Shea et al 2006;Strum et al 2005;Thaler et al 1999 130S Note: Effect is defined as the difference in the parameter change from baseline in the intervention group compared to controls, unless otherwise noted. Percentage changes reflect absolute differences (i.e., 75% to 85% = +10% change) in the values.…”

Section: Health Care Organization Interventionsmentioning

confidence: 99%

Diabetes Health Disparities

2007

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Racial and ethnic minorities bear a disproportionate burden of the diabetes epidemic; they have higher prevalence rates, worse diabetes control, and higher rates of complications. This article reviews the effectiveness of health care interventions at improving health outcomes and/or reducing diabetes health disparities among racial/ethnic minorities with diabetes. Forty-two studies met inclusion criteria. On average, these health care interventions improved the quality of care for racial/ethnic minorities, improved health outcomes (such as diabetes control and reduced diabetes complications), and possibly reduced health disparities in quality of care. There is evidence supporting the use of interventions that target patients (primarily through culturally tailored programs), providers (especially through one-on-one feedback and education), and health systems (particularly with nurse case managers and nurse clinicians). More research is needed in the areas of racial/ethnic minorities other than African Americans and Latinos, health disparity reductions, long-term diabetes-related outcomes, and the sustainability of health care interventions over time.

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“…[32][33][34] The US has been documenting the participation of peer health workers since the 1950s, [35] although peer involvement in diabetes care did not appear in the literature until the mid-1980s. [36] One of the main roles of peers in healthcare is in the provision of peer support. Peer support within the healthcare context is defined as ''the provision of emotional, appraisal, and informational assistance by a created social network member who possesses experiential knowledge of a specific behavior or stressor and similar characteristics as the target population, to address a health-related issue of a potentially or actually stressed focal person.''…”

Section: Peer Support In Healthcarementioning

confidence: 99%

“…[53,67] Some peers attended clinic sessions with patients they served. [62] In other cases, peers also made referrals, [53,64,65] monitored clinical indicators, [36,61] and provided basic care [58] and case management services. [61,70] Outreach is an important part of the role of many peers.…”

Section: Access To Regular Medical Carementioning

confidence: 99%

The Role of Peer Support in Diabetes Care and Self-Management

Brownson

Heisler

2009

The Patient: Patient-Centered Outcomes Research

107

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In light of the growing prevalence and healthcare costs of diabetes mellitus, it is critically important for healthcare providers to improve the efficiency and effectiveness of their diabetes care. A key element of effective disease management for diabetes is support for patient self-management. Barriers to care exist for both patients and healthcare systems. As a result, many people with diabetes do not get the care and support needed to successfully manage their diabetes.Disease management approaches that incorporate peer support may be a promising way to help provide self-management support to patients with diabetes. Trained peers provide emotional support, instrumental (tangible or material) support, education, and skills training to those they serve, and outreach and care coordination for provider systems. They play a unique role that complements and supports clinical care.To describe how peers are currently supporting diabetes care, a number of databases were searched for studies describing the roles of peers using relevant key words. This paper reviews current literature that describes the roles and duties of peers in interventions to improve diabetes care, with a focus on their contributions to six essential elements of self-management support: (i) access to regular, high-quality clinical care; (ii) an individualized approach to assessment and treatment; (iii) patient-centered collaborative goal setting; (iv) education and skills training; (v) ongoing follow-up and support; and (vi) linkages to community resources.Peers worked under a variety of titles, which did not define their duties. The scope of their work ranged from assisting health professionals to playing a central role in care. Providing education and follow-up support were the two most common roles. In all but one study, these roles were carried out during face-to-face contact, most frequently in community sites.A growing body of literature supports the value of peer models for diabetes management. Additional research can answer remaining questions related to such issues as cost effectiveness, sustainability, integration of peers into health and social service delivery systems, and recruitment, training, and support of peers. Continuing to develop and evaluate innovative models for more effectively mobilizing and integrating peers into diabetes care has great potential for improving diabetes outcomes worldwide.

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A randomized study of the impact of home health aides on diabetic control and utilization patterns.

Cited by 26 publications

References 11 publications

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

Impact of Community Health Workers on Use of Healthcare Services in the United States: A Systematic Review

Diabetes Health Disparities

The Role of Peer Support in Diabetes Care and Self-Management

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