Comparative Effectiveness Evaluation of a Diabetes Case Management Intervention in AI/AN Communities

University Of California-Irvine, Irvine CA

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Abstract

PROJECT SUMMARY The long-term goal of this project is to address the striking disparities in diabetes and its complications that American Indians and Alaska Natives (AI/ANs) face. To achieve this goal, effective strategies for diabetes management and cardiovascular disease (CVD) risk reduction are urgently needed to decrease morbidity and mortality among AI/ANs and to improve their overall health and quality of life. Case management is an important approach to enhance traditional health care delivery for people at elevated risk of adverse outcomes. It holds great promise for alleviating the heavy diabetes and CVD burden among AI/ANs and other minority populations. However, how to effectively implement this intervention in the real-world settings of large and diverse communities remains unclear. The proposed study will comparatively evaluate the effectiveness of the Healthy Heart demonstration project of Special Diabetes Program for Indians (SDPI-HH), a cardiovascular risk reduction project using an intensive case management (ICM) approach. The efficacy of the ICM approach was already well established, thus, SDPI-HH was designed as a translational project without a control group. The effectiveness of the intervention has been evaluated as a pre- and post-test design which, albeit necessary and informative, provides only a partial assessment of the program's ability to manage diabetes and its complications. In this proposal, the SDPI-HH data will be combined with 2 targeted sources, the Indian Health Service (IHS) Diabetes Care and Outcomes Audit data and the data form the Look AHEAD trial, a randomized trial comparing the impacts of an intensive lifestyle intervention (ILI) and diabetes support education (DSE) on cardiovascular outcomes among individuals with diabetes. The specific aims of this project are: (1) Using IHS Audit data, to broaden the understanding of SDPI-HH effectiveness by comparing the trends of diabetes quality of care between HH and non-HH facilities from 1998 to 2013; (2) Using data from the Look AHEAD trial and employing a propensity score matching approach, to compare the effectiveness of SDPI ICM intervention with the Look AHEAD ILI and DSE approaches among patients with diabetes. Our proposed analytic strategy has the potential to reduce or eliminate potential biases present in one arm pre- and post-test design that are frequently the only option in community-based translational intervention initiatives. Not only will the resulting findings provide critical guidance as we seek to reduce CVD risks among AI/ANs with diabetes, they will also demonstrate ways in which publicly available public health surveillance and/or historical control data may assist in evaluating similar community-based interventions.