Despite concerted federal and state attempts to reduce health disparities over the past decades substantialdisparities in reported rates of chronic disease for minorities still exist. In particular, African Americans andHispanics experience higher rates of Type 2 diabetes (T2DM), and cardiovascular disease (CVD) than doother segments of the U.S. population. The objectives of this proposed research project are to test twodifferent diabetes self-management (DSM) programs in a large multi-site health care organization in CentralTexas that serves large populations of minority and rural residents, comparing outcomes in order to evaluatetheir efficacy for reducing health disparities.
Our specific aims are to: i) document the nature and magnitudeof extant health disparities in diabetes treatment processes and outcomes; 2) evaluate different DSMintervention approaches on behavioral and clinical outcomes, with attention to differential effects by patientand environmental characteristics; 3) examine the cost-effectiveness of these different approaches to DSMeducation in minority and rural populations; and 4) explore the reach of our intervention efforts and thebroader organizational impacts of DSM education, including feedback loops to clinicians and organizationalreceptivity to self-management approaches. Our study will employ four different activities: i) an initialelectronic chart review of 1300 records of adults; 2) a 2 by 2 open 24 month randomized clinical trial ofbehaviorally and technologically based DSM interventions with 400 adults age 21 and older who have type 2diabetes (T2DM); 3) a cost-effectiveness analysis of the different treatment approaches; and 4) surveys ofprimary care providers and health care administrators. While our primary outcome will be reductions inhemoglobin Aic (HbAic), our conceptual model includes clinical, behavioral, economic and organizationaloutcomes. We will also assess the extent to which our interventions reduce health disparities by examiningdifferential treatment success. This study is innovative in its comparison of both behavioral and technologicalintervention approaches, its attention to the public health impact and cost-effectiveness of differentintervention approaches, and its concern with organizational responses to intervention sustainability. Anoteworthy significance will be the strengthening of the linkages between clinical and community treatmentapproaches and the identification of successful treatment strategies in different settings and populations.
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