The objective of the Northern Manhattan Diabetes Community Outreach Project (NOCHOP) is to examine theeffectiveness of a community health worker (CHW) intervention at addressing glycemic control among Latinoswith poorly controlled Type 2 diabetes. The rationale for the proposal is twofold. First, diabetes is a majorpublic health crisis and is twice as likely to affect Latinos versus non-Hispanic whites. Second, diabetesinterventions that are based on traditional models of health care delivery have not proven to be very effectiveamong Latinos. For example, only 30% of patients in our predominantly Latino community have their diabetesunder good control (Hemoglobin AIC (HgA1c) <7.0). Our group, however, has worked with a promising modelof intervention that utilizes CHWs based at one of the major community partners of Columbia University'sCenter for the Health of Urban Minorities (CHUM), namely, Alianza Inc. Pilot data from this program hasshown clinically significant pre-post test improvements in HgA1C. Using the Chronic Care Model as anoverarching framework, the study design of NOCHOP is a randomized controlled trial of 360 Latinos, mostly ofCaribbean descent, aged 35-70 years with HgA1C >=8.0. At a minimum, subjects in the intervention group willreceive four home visits, ten group level visits and monthly phone calls by CHWs based at Alianza. Thecontrol groups will receive three separate mailings of bilingual diabetes health education materials. Theprimary outcome is glycemic control at 12-month follow-up, as measured by HgA1c. The secondary outcomesare changes in cholesterol and blood pressure (BP). We will also collect exploratory data on potentialmechanisms through which our intervention resulted in hypothesized improvements including medicationadherence, medication Intensification, diet and exercise. If successful, our project will make an importantcontribution to ongoing national and local debates about the sustainability of CHW programs. In particular,data from this study would be extremely useful for local Medicaid managed care plans who have expressedstrong interests in data from rigorously designed clinical trials addressing the role of CHWs in deliveringculturally appropriate and effective diabetes care.
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