Technology to improve the health of resource-poor Hispanics with diabetes

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1A. ABSTRACT I am an internist at Baylor College of Medicine in Houston, Texas. My career goal is to become an independent clinical investigator and expert in improving diabetes care for resource-poor individuals by increasing Community Health Worker (CHW) support. Receiving training and mentorship in Community-Based Participatory Research (CBPR) (Learning goal [LG] 1), Implementation Research (LG2), and study design and implementation of randomized controlled trials (RCTs) (LG3) are necessities for me to achieve independence as an investigator. To achieve these goals, I organized a detailed career development plan with diverse coursework and a scientific mentoring team that includes John Foreyt, PhD (primary mentor, Director of the DeBakey Heart Center's Behavioral Medicine Research Center which conducts NIDDK-supported RCTs in diabetes) and 3 co-mentors, Aanand Naik, MD (an expert in the field of Implementation Research), David Hyman, MD, MPH (an internist/researcher in CBPR who conducts RCTs in low-income settings), and Susan Samson, MD, PhD (an endocrinologist in patient-oriented outcomes diabetes research). In addition, Charles Minard (a biostatistician researcher at Baylor), Sanjeev Arora, MD (Founder/Director of an internationally recognized organization [Project ECHO] that uses modalities [i.e., CHWs, telemedicine] to increase access to care), and the University of Texas CHW training program will be collaborators throughout my training. The number of Hispanics diagnosed with diabetes is escalating in the US with disproportionately higher prevalence and complication rates than other ethnicities. CHWs are a well-established and culturally sensitive means to bridge gaps in care to individuals with diabetes. However CHWs are often left unsupported, placing patients at risk of substandard care or harm. Telemedicine is a term used to describe a range of technologies to support healthcare delivery via communication with the patient or a member of the healthcare delivery team. Though telemedicine has been implemented into diabetes programs for many years, there is a paucity of data showing the use of telemedicine for CHW training and support. In a pilot study, I initiated a CHW-led diabetes program for resource-poor Hispanics with in-person support for CHWs. The proposed research utilizes findings from the pilot study to evaluate the use of telemedicine support for CHWs who lead diabetes programs for resource-poor Hispanics. Specifically, I will conduct a RCT in 4 cohort waves with 176 adults diagnosed with type 2 diabetes. The study will compare clinical outcomes (Specific Aim 1) and treatment satisfaction (Specific Aim 2) of subjects who receive a CHW-led diabetes education program incorporating telemedicine support (T-CDEP) (intervention, n=88) to subjects who receive usual care (wait list control, n=88). In addition, I will analyze the acceptability of telemedicine use for CHWs (Exploratory Aim 1). The proposed research serves as the foundation for a multicenter, longitudinal study expanded to other ethnicities and settings (e.g., rural) for R01 submission prior to the completion of the 5-year K Award period.