The objective of the Northern Manhattan Diabetes Community Outreach Project (NOCHOP) is to examine the effectiveness of a community health worker (CHW) intervention at addressing glycemic control among Latinos with poorly controlled Type 2 diabetes. The rationale for the proposal is twofold. First, diabetes is a major public health crisis and is twice as likely to affect Latinos versus non-Hispanic whites. Second, diabetes interventions that are based on traditional models of health care delivery have not proven to be very effective among Latinos. For example, only 30% of patients in our predominantly Latino community have their diabetes under good control (Hemoglobin AIC (HgA1c) <7.0). Our group, however, has worked with a promising model of intervention that utilizes CHWs based at one of the major community partners of Columbia University's Center for the Health of Urban Minorities (CHUM), namely, Alianza Inc. Pilot data from this program has shown clinically significant pre-post test improvements in HgA1C. Using the Chronic Care Model as an overarching framework, the study design of NOCHOP is a randomized controlled trial of 360 Latinos, mostly of Caribbean descent, aged 35-70 years with HgA1C >=8.0. At a minimum, subjects in the intervention group will receive four home visits, ten group level visits and monthly phone calls by CHWs based at Alianza. The control groups will receive three separate mailings of bilingual diabetes health education materials. The primary outcome is glycemic control at 12-month follow-up, as measured by HgA1c. The secondary outcomes are changes in cholesterol and blood pressure (BP). We will also collect exploratory data on potential mechanisms through which our intervention resulted in hypothesized improvements including medication adherence, medication Intensification, diet and exercise. If successful, our project will make an important contribution 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 expressed strong interests in data from rigorously designed clinical trials addressing the role of CHWs in delivering culturally appropriate and effective diabetes care.
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