Integrating Community Health Workers into Primary Care Teams to improve Diabetes Prevention in Underserved Communities

摘要 2型糖尿病（DM）是一种可预防的慢性疾病，影响9.3%的美国成人和儿童。是 据估计，8600万美国成年人是糖尿病前期（37%），因此有糖尿病和心血管疾病的风险。 疾病糖尿病是导致死亡的主要原因，是心脏病和中风的主要原因之一， 威胁生活质量。与普通人群相比，DM的医疗费用增加了一倍多。 安全网机构，如贝尔维尤医院中心（BH）和弗吉尼亚州纽约港医疗保健系统（VA）护理 糖尿病和糖尿病风险负担不成比例的人群。在870万美国退伍军人中， 患有糖尿病，在贝尔维尤的30，000名初级保健成人患者中，这一比例超过15%。 尽管有降低发病率和节省成本的潜力，初级保健系统必须克服几个 障碍，系统地提供这些行之有效的，预防性的策略，在糖尿病的最高风险的患者。 聘请社区卫生工作者（CHW）教练进行行为咨询， 计划，教育是一个有前途的方法，可以扩大卫生系统的能力，以更好地 预防和管理慢性疾病。尽管同伴主导的干预有可能提高DM 在以病人为中心的医疗之家（PCMH）模式中，需要高质量的预防工作， 评估CHW支持的特定模型的随机试验;帮助实施此类模型， 包括确定招聘、培训、监督和留住非专业人员的有效战略 人员;并成功地将这些人员纳入PCMH。 这项研究的目的是开发和测试一种CHW健康指导模式，旨在防止 2型糖尿病在大量未得到充分服务的高危患者中的发病。社区卫生工作者将从 目标人群和核心能力的培训，作为同侪健康教练。我们的中心前提是， CHW是唯一适合通过鼓励生活方式的改变，通过分享， 经验和社会支持，以扩大初级保健（PC）的覆盖面超越诊所访问。本研究将 测试一个可扩展的同伴健康指导模型，以解决数百万有糖尿病风险的患者，使用低成本， 文化一致的人员，以促进预防糖尿病在PCMH的做法。

Abstract Type 2 Diabetes Mellitus (DM) is a preventable chronic disease that affects 9.3% of US adults and children. It is estimated that 86 million American adults are prediabetic (37%), and thus at risk of DM and cardiovascular disease. DM is a leading cause of death, one of the major causes of heart disease and stroke, and severely threatens quality of life. DM more than doubles the health care costs compared to the general population. Safety-net institutions like Bellevue Hospital Center (BH) and the VA NY Harbor Healthcare System (VA) care for populations with a disproportionate burden of DM and DM risk. Nearly 25% of the 8.7 million US veterans have DM and the rate among Bellevue’s 30,000 primary care adult patients is more than 15%. Despite the potential for reduced morbidity and cost-savings, primary care systems must overcome several barriers to systematically deliver these proven, preventive strategies to patients at highest risk of DM. Employing community health worker (CHW) coaches to conduct behavioral counseling, follow-up referral to programs, and education is a promising approach that could extend the capacity of health systems to better prevent and manage chronic conditions. Despite the potential for peer-led intervention to enhance DM prevention efforts within the patient-centered medical home (PCMH) model, there is need for high quality, randomized trials to asses specific models for CHW support; to aid with implementation of such model, including identification of effective strategies for recruitment, training, monitoring and retention of lay personnel; and to successfully integrate these personnel within the PCMH. The goal of this proposal study is to develop and test a model of CHW health coaching, designed to prevent the onset of Type 2 DM in a large population of underserved patients at risk. CHWs will be recruited from the target populations and trained in core competencies to serve as peer health coaches. Our central premise is that CHWs are uniquely suited to engage fellow patients by encouraging lifestyle change through shared experiences and social support to extend the reach of primary care (PC) beyond the clinic visit. This study will test a scalable model of peer health coaching to address the millions of patients at risk for DM, using low cost, culturally congruent personnel to promote prevention of DM in PCMH practice.