Although efforts to improve the quality of diabetes care have increased over the past decade, quality remains suboptimal, especially for minority patients. We propose to test the effectiveness of an intervention designed to increase patient participation in treatment decisions on diabetes quality, particularly HbA1c values, among Mexican American, Vietnamese American, and non-Hispanic white patients in community-based outpatient clinics. This intervention, now called """"""""Coached Care,"""""""" has been well tested in multiple randomized controlled trials among less diverse patient groups, including those with diabetes, hypertension, breast cancer, and rheumatoid arthritis. Different from self-management or more traditional patient education, this intervention focuses on: 1) providing patients with individualized treatment information based on an algorithm for diabetes management coupled with a patients'medical records;2) skills for using the information to negotiate a treatment regimen more consistent with the patients'preferences and lifestyle;and 3) preparation of patients immediately preceding the office visit for a more active role in care. In order to adapt this intervention to the unique needs of Mexican and Vietnamese American patients, we propose to have volunteer """"""""coaches,"""""""" drawn from the patient's community who themselves have diabetes. These coaches will prepare patients prior to office visits to participate in treatment decisions and identity barriers to effective participation. The coaches will reinforce negotiation skills between office visits. They will also help patients and physicians to identify and resolve culture-specific conflicts with effective treatment implementation and disease management. In a large randomized controlled trial, we will test the impact of the intervention on clinical outcomes and on the quality of interpersonal for each of the three patient groups. We will measure the costs of the intervention relative to any observed changes in the quality of diabetes care to assess the feasibility of widespread implementation of the intervention. If the intervention is effective and feasible, it could serve as model for improving chronic disease care in minority communities in settings with limited resources.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Demonstration and Dissemination Projects (R18)
Project #
5R18DK069846-04
Application #
7795093
Study Section
Special Emphasis Panel (ZDK1-GRB-1 (J1))
Program Officer
Staten, Myrlene A
Project Start
2007-04-01
Project End
2012-03-31
Budget Start
2010-04-01
Budget End
2011-03-31
Support Year
4
Fiscal Year
2010
Total Cost
$525,976
Indirect Cost
Name
University of California Irvine
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
046705849
City
Irvine
State
CA
Country
United States
Zip Code
92697
Choi, Sarah E; Ngo-Metzger, Quyen; Billimek, John et al. (2016) Contributors to Patients' Ratings of Quality of Care Among Ethnically Diverse Patients with Type 2 Diabetes. J Immigr Minor Health 18:382-9
Sorkin, Dara H; Billimek, John; August, Kristin J et al. (2015) Mental health symptoms and patient-reported diabetes symptom burden: implications for medication regimen changes. Fam Pract 32:317-22
Billimek, John; Malik, Shaista; Sorkin, Dara H et al. (2015) Understanding disparities in lipid management among patients with type 2 diabetes: gender differences in medication nonadherence after treatment intensification. Womens Health Issues 25:6-12
Billimek, John; August, Kristin J (2014) Costs and beliefs: understanding individual- and neighborhood-level correlates of medication nonadherence among Mexican Americans with type 2 diabetes. Health Psychol 33:1602-5
Nguyen, Hannah; Sorkin, Dara H; Billimek, John et al. (2014) Complementary and alternative medicine (CAM) use among non-Hispanic white, Mexican American, and Vietnamese American patients with type 2 diabetes. J Health Care Poor Underserved 25:1941-55
Malik, Shaista; Billimek, John; Greenfield, Sheldon et al. (2013) Patient complexity and risk factor control among multimorbid patients with type 2 diabetes: results from the R2D2C2 study. Med Care 51:180-5
Kaplan, Sherrie H; Billimek, John; Sorkin, Dara H et al. (2013) Reducing racial/ethnic disparities in diabetes: the Coached Care (R2D2C2) project. J Gen Intern Med 28:1340-9
Billimek, John; Sorkin, Dara H (2012) Self-reported neighborhood safety and nonadherence to treatment regimens among patients with type 2 diabetes. J Gen Intern Med 27:292-6
Ngo-Metzger, Quyen; Sorkin, Dara H; Billimek, John et al. (2012) The effects of financial pressures on adherence and glucose control among racial/ethnically diverse patients with diabetes. J Gen Intern Med 27:432-7
Greenfield, Sheldon; Kaplan, Sherrie H (2012) Building useful evidence: changing the clinical research paradigm to account for comparative effectiveness research. J Comp Eff Res 1:263-70

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