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Research article
Sonya S Shin
Brigham and Women's Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0003-3466-9055
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Navajo community members face high rates of diabetes mellitus and other chronic diseases. The Navajo Community Health Representative Outreach Program collaborated with healthcare providers and academic collaborators to implement structured and coordinated outreach to patients living with diabetes. The intervention, called Community Outreach and Patient Empowerment or COPE, provides home-based health coaching and community-clinic linkages to promote self-management and engagement in healthcare services among patients living with diabetes. The purpose of this study was to evaluate how outreach by Navajo Community Health Representatives (“COPE Program”) to affected utilization of health care services among patients living with diabetes.
Methods
De-identified data from 2010 to 2014 were abstracted from electronic health records at participating health facilities. In this observational cohort study, 173 cases were matched to 2,880 controls. Healthcare utilization was measured as the number of times per quarter services were accessed by the patient. Changes in utilization over four years were modeled using a difference-in-differences approach, comparing the trajectory of COPE patients’ utilization before versus after enrollment with that of the control group. The model was estimated using generalized linear mixed models for count outcomes, controlling for clustering at the patient level and the service unit level.
Results
COPE enrollees showed a 2.5% per patient per quarter (pppq) greater increase in total utilization (p = 0.001) of healthcare services than non-COPE enrollees; a 3.2% greater increase in primary care visits (p = 0.024); a 6.3% greater increase in utilization of counseling and behavioral health services (p = 0.013); and a 9.0% greater increase in pharmacy visits (p < 0.001). We found no statistically significant differences in utilization trends of inpatient, emergency room, specialty outpatient, dental, laboratory, radiology, or community encounter services among COPE participants versus control.
Conclusions
A structured intervention consisting of Community Health Representative outreach and coordination with clinic-based providers was associated with a modest increase in health care utilization, including primary care and counseling services, among Navajo patients living with diabetes. Community health workers may provide an important linkage to enable patients to access and engage in clinic-based health care.
Keywords
Health utilization, Health Disparities, Diabetes Mellitus, Community health workers, Community health representatives, Clinic-community linkages, American Indian, Navajo
This is a list of supplementary files associated with this preprint. Click to download.
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Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Health Services Research.
No community comments so far
Submission checks complete
On 14 Apr, 2020
Editorial decision: Accept
On 14 Apr, 2020
No comments provided
Editorial decision: Minor revision
On 10 Apr, 2020
Editor assigned
On 29 Mar, 2020
Editor invited
On 28 Mar, 2020
Submission checks complete
On 24 Mar, 2020
Version 1
Posted 27 Jan, 2020
No comments provided
Editorial decision: Minor revision
On 11 Mar, 2020
Reviewer #3 agreed
On 10 Mar, 2020
Review #2 received
Received 17 Feb, 2020
Review #1 received
Received 17 Feb, 2020
Reviewer #2 agreed
On 27 Jan, 2020
Reviewers invited
Invitations sent on 23 Jan, 2020
Reviewer #1 agreed
On 23 Jan, 2020
Editor invited
On 23 Jan, 2020
Editor assigned
On 23 Jan, 2020
Submission checks complete
On 22 Jan, 2020
First submitted
On 20 Jan, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at BMC Health Services Research.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Sonya S Shin
Brigham and Women's Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0003-3466-9055
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Health Services Research.
No community comments so far
Submission checks complete
On 14 Apr, 2020
Editorial decision: Accept
On 14 Apr, 2020
No comments provided
Editorial decision: Minor revision
On 10 Apr, 2020
Editor assigned
On 29 Mar, 2020
Editor invited
On 28 Mar, 2020
Submission checks complete
On 24 Mar, 2020
Version 1
Posted 27 Jan, 2020
No comments provided
Editorial decision: Minor revision
On 11 Mar, 2020
Reviewer #3 agreed
On 10 Mar, 2020
Review #2 received
Received 17 Feb, 2020
Review #1 received
Received 17 Feb, 2020
Reviewer #2 agreed
On 27 Jan, 2020
Reviewers invited
Invitations sent on 23 Jan, 2020
Reviewer #1 agreed
On 23 Jan, 2020
Editor invited
On 23 Jan, 2020
Editor assigned
On 23 Jan, 2020
Submission checks complete
On 22 Jan, 2020
First submitted
On 20 Jan, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Health Services Research.
Background
Navajo community members face high rates of diabetes mellitus and other chronic diseases. The Navajo Community Health Representative Outreach Program collaborated with healthcare providers and academic collaborators to implement structured and coordinated outreach to patients living with diabetes. The intervention, called Community Outreach and Patient Empowerment or COPE, provides home-based health coaching and community-clinic linkages to promote self-management and engagement in healthcare services among patients living with diabetes. The purpose of this study was to evaluate how outreach by Navajo Community Health Representatives (“COPE Program”) to affected utilization of health care services among patients living with diabetes.
Methods
De-identified data from 2010 to 2014 were abstracted from electronic health records at participating health facilities. In this observational cohort study, 173 cases were matched to 2,880 controls. Healthcare utilization was measured as the number of times per quarter services were accessed by the patient. Changes in utilization over four years were modeled using a difference-in-differences approach, comparing the trajectory of COPE patients’ utilization before versus after enrollment with that of the control group. The model was estimated using generalized linear mixed models for count outcomes, controlling for clustering at the patient level and the service unit level.
Results
COPE enrollees showed a 2.5% per patient per quarter (pppq) greater increase in total utilization (p = 0.001) of healthcare services than non-COPE enrollees; a 3.2% greater increase in primary care visits (p = 0.024); a 6.3% greater increase in utilization of counseling and behavioral health services (p = 0.013); and a 9.0% greater increase in pharmacy visits (p < 0.001). We found no statistically significant differences in utilization trends of inpatient, emergency room, specialty outpatient, dental, laboratory, radiology, or community encounter services among COPE participants versus control.
Conclusions
A structured intervention consisting of Community Health Representative outreach and coordination with clinic-based providers was associated with a modest increase in health care utilization, including primary care and counseling services, among Navajo patients living with diabetes. Community health workers may provide an important linkage to enable patients to access and engage in clinic-based health care.
This is a list of supplementary files associated with this preprint. Click to download.
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