Johns Hopkins School of Nursing, Baltimore, MD.
Rocking Horse Community Health Center, Springfield, OH.
J Am Assoc Nurse Pract. 2022 Oct 1;34(10):1156-1166. doi: 10.1097/JXX.0000000000000773.
Diabetes care among rural underserved older adults is negatively affected by social determinants of health (SDOH). Although there is an increased awareness of this problem, evidence-based clinical and community interventions are not widely integrated. This project implemented telemedicine and community health worker (CHW) interventions to improve diabetes management and outcomes.
One in five older adults with diabetes mellitus (DM) at a Federally Qualified Health Center in southwest Ohio has uncontrolled disease, largely due to their limited resources and ability to participate in routine clinical management.
This quality improvement project used a pre-post intervention design. Participants were adults aged ≥65 years with uncontrolled DM type 1 or 2. The outcomes of interest included A1C values, diabetes self-care activities, diabetes knowledge, and patient and health care provider (HCP) satisfaction levels.
The project involved biweekly CHW home visits and diabetes self-management education for 12 weeks. The CHWs, with supervision from a nurse practitioner, conducted SDOH assessments and basic education, and facilitated same-day telemedicine appointments with the HCP to reinforce disease management.
The A1C levels and diabetes knowledge of older adults significantly improved after three months. However, there were no statistically significant changes in diabetes self-care activities. The patients and HCPs were highly satisfied with the project interventions.
This project delivered patient-centered and equitable diabetes care services that were previously unavailable to underserved older patients, while demonstrably improving outcomes. Future research should evaluate the cost-effectiveness, long-term impact, and sustainability of the project in other primary care settings.
农村服务不足的老年人群体的糖尿病护理受到健康社会决定因素（SDOH）的负面影响。尽管人们越来越意识到这个问题，但基于证据的临床和社区干预措施并未得到广泛整合。该项目实施了远程医疗和社区卫生工作者（CHW）干预措施，以改善糖尿病管理和结果。
俄亥俄州西南部一家合格的联邦健康中心，每五个患有 1 型或 2 型糖尿病的老年患者中就有一个患者病情无法得到控制，这主要是由于他们资源有限，且无法参与常规临床管理。
本质量改进项目采用了干预前后设计。参与者为年龄≥65 岁且患有 1 型或 2 型未控制糖尿病的成年人。感兴趣的结果包括 A1C 值、糖尿病自我护理活动、糖尿病知识以及患者和医疗保健提供者（HCP）的满意度。
该项目包括每两周进行一次 CHW 家访和为期 12 周的糖尿病自我管理教育。CHW 在执业护士的监督下进行 SDOH 评估和基础教育，并为 HCP 安排当天的远程医疗预约，以加强疾病管理。
老年人的 A1C 水平和糖尿病知识在三个月后显著提高。然而，糖尿病自我护理活动没有统计学意义上的变化。患者和 HCP 对项目干预措施非常满意。
该项目提供了以患者为中心且公平的糖尿病护理服务，这些服务以前无法提供给服务不足的老年患者，同时明显改善了结果。未来的研究应评估该项目在其他初级保健环境中的成本效益、长期影响和可持续性。
