Evaluation of a Diabetes Care Coordination Program for African-American Women Living in Public Housing

Vol. 22, No. 8 August 2015 JCOM 365 AbstrAct • Objective: To examine the implementation of the Diabetes Care Coordination Program (DCCP) and its effects on diabetes-related clinical health outcomes. • Methods: Program participants were African American women (n = 148) with type 2 diabetes who lived in public housing in Boston’s Roxbury neighborhood. Through the DCCP, Whittier Street Health Center’s clinical team provided diabetes self-management education, support, and comprehensive diabetes care using the patient-centered medical home model and Diabetes Health Ambassadors as mediators for program delivery. Core intervention components of the DCCP included: 1) diabetes self-management education, 2) support for managing diabetes and distress, 3) enhancing access and linkage to care, 4) improving quality of care, 5) community organization, mobilization, and advocacy, and 6) health system and community transformation. A participatory monitoring and evaluation system was used to document and systematically reflect on program implementation. • Results: DCCP implementation was associated with modest improvements in diabetes-related clinical health outcomes for program participants. Results showed statistically significant improvements in HbA1c (P = 0.016), weight (P = 0.021) and diastolic blood pressure (P = 0.027). • Conclusion: Using neighborhood Diabetes Health Ambassadors for program delivery has implications for assuring access to quality diabetes care for populations experiencing health disparities.