Community-Created Programs: Can They Be the Basis of Innovative Transformations in Our Health Care Practice? Implications from 15 Years of Testing, Translating, and Implementing Community-Based, Culturally Tailored Diabetes Management Programs

Philis‐Tsimikas, Athena; Gilmer, Todd; Schultz, James; Walker, Chris; Fortmann, Addie L.; Gallo, Linda C.

doi:10.2337/diaclin.30.4.156

Cited by 11 publications

(17 citation statements)

References 37 publications

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“…The Project Dulce model is perhaps the longest standing example of a feasible cost-effective partnership between the community and the health system, as it has been implemented in community health centres in San Diego County for more than 15 years 36. Furthermore, shared medical care models, where diabetic patients attend medical visits in a group, have also been shown to effect clinically significant improvements and to not be subject to financial barriers from the current US provider reimbursement system 37.…”

Section: Discussionmentioning

confidence: 99%

Effect of social networks intervention in type 2 diabetes: a partial randomised study

Shaya

Chirikov

Howard

et al. 2013

J Epidemiol Community Health

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Section: Discussionmentioning

confidence: 99%

Effect of social networks intervention in type 2 diabetes: a partial randomised study

Shaya

Chirikov

Howard

et al. 2013

J Epidemiol Community Health

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“…Consistent with the Project Dulce model, 13 the PD group included a combination of care management by a multidisciplinary team led by trained clinicians and nurses, as well as a peer-led group education component. The flow of usual care at UMF #27 was modified to allow patients to be cared for by this multidisciplinary team.…”

Section: Methodsmentioning

confidence: 99%

“…Nurses also educate patients and promote adherence to treatment following evidence-based guidelines. Peer educators (individuals from the patients' communities with personal experience with diabetes) provide eight weekly educational sessions of 2 h each, using the Diabetes Among Friends curriculum 13 followed by monthly support groups.…”

Section: Introductionmentioning

confidence: 99%

Dulce Wireless Tijuana: A Randomized Control Trial Evaluating the Impact of Project Dulce and Short-Term Mobile Technology on Glycemic Control in a Family Medicine Clinic in Northern Mexico

Anzaldo-Campos

Contreras

Vargas-Ojeda

et al. 2016

Diabetes Technology & Therapeutics

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Background: The global epidemic of diabetes calls for innovative interventions. This study evaluated the effectiveness of the Project Dulce model, with and without wireless technology, on glycemic control and other clinical and self-reported outcomes in patients with poorly controlled type 2 diabetes in Mexico.Subjects and Methods: Adults with type 2 diabetes and a glycated hemoglobin A1c (HbA1c) level of ≥8% were recruited from Family Medical Unit #27 of the Instituto Mexicano del Seguro Social (IMSS) in Tijuana, México, and randomly assigned to one of three groups: Project Dulce–only (PD); Project Dulce technology-enhanced with mobile tools (PD-TE); or IMSS standard of care/control group (CG). Clinical and self-reported outcomes were assessed at baseline, Month 4, and Month 10. Time-by-group interactions and within-group changes were analyzed.Results: HbA1c reductions from baseline to Month 10 were significantly greater in PD-TE (−3.0% [−33 mmol/mol]) and PD (−2.6% [−28.7 mmol/mol]) compared with CG (−1.3% [−14.2 mmol/mol]) (P = 0.009 and 0.001, respectively). PD-TE and PD also exhibited significant improvement in diabetes knowledge when compared with CG (P < 0.05 for both). No statistically significant differences were detected between PD and PD-TE on these indicators (P = 0.54 and 0.86, respectively). Several within-group improvements were observed on other clinical and self-report indicators but did not vary significantly across groups.Conclusions: Project Dulce with and without wireless technology substantially improved glycemic control and diabetes knowledge in high-risk patients with type 2 diabetes in a Mexican family medical unit, suggesting that integrating peer-led education, nurse coordination, and 3G wireless technology is an effective approach for improving diabetes outcomes in high-risk populations.

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“…There is a growing body of research documenting the efficacy of combining CHWs and nurses to provide comprehensive care management that includes health care (e.g. diabetes treatment titration based on algorithms, vaccination administration), care coordination, patient education and referral/navigation among community resources to support lifestyle changes [8•, 9, 23–26]. Community health workers have also been integrated into health systems by linking community-based patient information (e.g.…”

Section: Methodsmentioning

confidence: 99%

“…The health centers that were randomized to receive the CHWs had significant increases in self-management goal setting among their patients in comparison to health centers that continued to receive only the QI intervention [37]. Current trends are for diabetes QI strategies to focus on care coordination to help patients develop skills to navigate the healthcare system, and manage their disease throughout their everyday lives in the community [8•, 9, 10••, 11, 12••, 14•, 15•, 16•, 23, 25–26, 29–30, 38]. Care coordination encompasses a range of individualized support for diabetes patients from clinic staff and/or CHWs, including education and consultation on self-management goals, assistance in healthcare system navigation, facilitating communication with providers, and connecting patients to community resources.…”

Section: Methodsmentioning

confidence: 99%

Integrated Community-Healthcare Diabetes Interventions to Reduce Disparities

et al. 2014

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Racial and ethnic minorities suffer disproportionately from diabetes-related morbidity and mortality. With the creation of Accountable Care Organizations (ACOs) under the Affordable Care Act, healthcare organizations may have an increased motivation to implement interventions that collaborate with community resources and organizations. As a result, there will be an increasing need for evidence-based strategies that integrate healthcare and community components to reduce diabetes disparities. This paper summarizes the types of community/health system partnerships that have been implemented over the past several years to improve minority health and reduce disparities among racial/ethnic minorities and describes the components that are most commonly integrated. In addition, we provide our recommendations for creating stronger healthcare and community partnerships through enhanced community support.

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Community-Created Programs: Can They Be the Basis of Innovative Transformations in Our Health Care Practice? Implications from 15 Years of Testing, Translating, and Implementing Community-Based, Culturally Tailored Diabetes Management Programs

Cited by 11 publications

References 37 publications

Effect of social networks intervention in type 2 diabetes: a partial randomised study

Effect of social networks intervention in type 2 diabetes: a partial randomised study

Dulce Wireless Tijuana: A Randomized Control Trial Evaluating the Impact of Project Dulce and Short-Term Mobile Technology on Glycemic Control in a Family Medicine Clinic in Northern Mexico

Integrated Community-Healthcare Diabetes Interventions to Reduce Disparities

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