Patient centered intervention to improve care among diabetic older americans

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Because diabetes is a chronic condition with substantial associated morbidity among minority elders and is a condition in which self- management is particularly crucial in the prevention of complications, we set out to implement and evaluate culturally tailored patient-centered intervention to improve glycemic control by improving patient knowledge, self-management skills, and empowerment among community-residing minority older adults with diabetes. Specific aims of the project are: 1) to determine whether a multidimensional, culturally tailored intervention that focuses on increasing knowledge about diabetes care, empowerment, and self-management skills, will lead to better glycemic, lipid blood pressure, and weight control, fewer acute diabetes- related symptoms, and improvements in health-related quality of life; 2) to determine whether this intervention will lead to improvements in process of care; 3) to determine the cost-effectiveness of the intervention when compared to usual care. To evaluate the effectiveness of the intervention, the research team will conduct a controlled clinical trial that will randomize 600 older African American and Latino persons with diabetes who are cared for in 6 public clinics affiliated with the Martin Luther King-Drew University Medical Center. Randomization will occur at the patient level. The primary endpoint for the trial will be differences in glycemic control as reflected by mean difference in hemoglobin A1c over time for the active intervention versus usual care control group. The trial will also track a number of important secondary endpoints both before and after exposed to the intervention: self-management skills, knowledge about diabetes, diabetes-specific symptoms, quality of life, low density lipoprotein levels, blood pressure, weight, quality of care, and health care service use. The study will also collect data on variables that are likely to modify the effectiveness of the intervention, such as acculturation, insurance status and benefit structure, and social support. These data will provide the needed information to evaluate both the effectiveness and the cost effectiveness of the intervention among older African Americans and Latinos with diabetes. Because the effectiveness and specific design of the intervention is likely to be influenced by cultural factors, the cultural factors, the clinical trial will be powered for pre-planned sub-group analyses among African Americans and Latinos. The content of the proposed intervention will be determined by the result of a funded pilot study that is currently designing the intervention and assessing whether it is acceptable and feasible for African American and Latino older persons with diabetes. In summary, by designing and testing the intervention and assessing whether it is acceptable and feasible for African American and Latino older persons with diabetes. In summary, by designing and testing an intervention that focuses on the patient rather than the system of care, we hope to arm older diabetes with the needed skills, knowledge, and empowerment to have the best possible glycemic control and process of health care regardless of the resources available in their care setting.