Patient Navigators Connecting Patients to Community Resources to Improve Diabetes Outcomes

Natalia Y. Loskutova; Adam G. Tsai; Edwin B. Fisher; Debby M. LaCruz; Andrea L. Cherrington; T. Michael Harrington; Tamela J. Turner; Wilson D. Pace

doi:10.3122/jabfm.2016.01.150048

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Figure 1.
Patient navigation workflow.
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Table 1. Baseline Sample Characteristics of the Patient Sample and Clinical Measures (n = 179)^*

Age (years), mean ± SD	53.1 ± 12.2
Female sex	131 (73.2)
Race
White	27 (15.1)
African American	138 (77.1)
Other	2 (1.1)
Unknown/missing	12 (6.7)
Ethnicity
Non-Hispanic	137 (76.5)
Hispanic	5 (2.8)
Unknown/missing	37 (20.7)
Education
Some high school or less	20 (11.2)
High school graduate	36 (20.1)
Some college or technical school	21 (11.7)
College graduate	26 (14.5)
Postgraduate/professional	3 (1.7)
Unknown/missing	73 (40.8)
Insurance
Private	53 (29.6)
Public (Medicare/Medicaid)	74 (41.3)
None	47 (26.3)
Unknown/missing	5 (2.8)
Diagnosis
Diabetes mellitus type 2	117 (65.4)
Prediabetes	15 (8.4)
At risk	45 (25.1)
Unknown/missing	2 (1.1)
Smoking
Current	26 (14.5)
Former	33 (18.4)
Never	106 (59.2)
Unknown/missing	14 (7.8)

Data are n (%) unless otherwise indicated.
↵* The sociodemographic, insurance, and smoking data were obtained from the patient electronic health records and were included if collected as part of a regular clinical encounter.
SD, standard deviation.

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Table 2. Diabetes Risk Factor Prevalence

ADA Risk Test Risk Factors (Self-Reported)	Reported as “Yes” (n = 161) (%)
I am overweight or obese.	85.7
I do not exercise regularly.	67.1
I have a parent, brother, or sister with diabetes.	48.4
I am age 45 or older.	77.0
I have high blood pressure.	75.8
I am of nonwhite race.	76.4
Cholesterol: I have low HDL (good), high LDL (bad), or high triglycerides.	33.5
Women: I had gestational diabetes (while pregnant) or a baby that weighed ≥9 pounds at birth.	6.2

ADA, American Diabetes Association; HDL, high-density lipoprotein; LDL, low-density lipoprotein.

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Table 3. Clinical Characteristics and Change over Time

Clinical Measures	Before	After	P Value
Fasting glucose (mg/dl)	129.0 ± 51.1	124.4 ± 51.3	.85
HbA_1c (%) (diabetes only)	7.8 ± 1.9	7.2 ± 1.3	.001
Blood pressure (mmHg)
Systolic	134.3 ± 21.3	130.0 ± 16.5	.22
Diastolic	80.5 ± 11.0	80.3 ± 10.3	.38
Body mass index (kg/m²)	36.1 ± 8.8	36.2 ± 8.8	.20
Total cholesterol (mg/dl)	180.8 ± 38.0	178.2 ± 38.6	1.00
Low-density lipoprotein (mg/dl)	104.5 ± 34.3	100.4 ± 30.5	.50
High-density lipoprotein (mg/dl)	51.6 ± 15.9	48.9 ± 12.9	.79
Triglycerides (mg/dl)	132.7 ± 90.3	147.0 ± 101.1	.17
Self-efficacy level^*	3.1 ± 0.8	3.6 ± 0.7	<.001

Data are presented as mean ± standard deviation. Multivariate analysis of variance tests were used for the before/after analyses. Missing values were excluded on an analysis-by-analysis basis.
↵* Wilcoxon related samples signed rank test; scale, 0 (poor) to 5 (good).

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Table 4. Community Resources by Category and Activity

Resource	Community Category	Activities
1. Bluff Park United Methodist Church	Church	Zumba
2. Guiding Light Church		Zumba
3. Macedonia Church		Zumba
4. St. John AME Church		Zumba
5. 16th Street Baptist Church		Exercise classes
6. New Bethlehem Baptist		Zumba
7. First UMC, Trussville		Zumba
8. Love Fellowship Christian Center		Zumba
9. First UMC, Huffman		Yoga
10. The Summit Church		Zumba
11. Faith Chapel-Bridge Ministry		Zumba
12. MTC (More than Conquerors) Church		Zumba/fitness
13.Gardendale Civic Center	Community center	Exercise classes, spinning
14. Graysville Community Center	Community center	Exercise
15. PEER Community Garden	Community garden	Diet and nutrition
16. Western Community Gardens	Community garden	Diet and nutrition
17. St. Vincent's East Support Group	Diabetes support groups	Education/self-management
18. N. Birmingham Library Diabetes Support Group	Diabetes support groups	Education/self-management
19. Senior Transportation Services	Emergency services	Transportation
20. ADPH Social Worker	Emergency services	Social services
21. Alabama Farmers Market	Farmer's market	Nutrition and diet
22. East Lake Farmer's Market	Farmer's market	Nutrition and diet
23. Curves	Gym	Exercise and fitness
24. St. Vincent's 119		Exercise and fitness
25. Rivera Fitness		Exercise and fitness
26. Planet Fitness		Exercise and fitness
27. Next (The Old Sport Plex)		Exercise and fitness
28. YMCA	Health and wellness	Exercise, wellness, and health education
29. HealthSmart	Health and wellness	Health screenings, wellness, health education, and fitness
30. Library^*	Health education	Health education
31. Cooper Green	Healthcare	Diabetes education
32. Birmingham Health Care		Primary care physician
33. Diabetes Bridge Clinic		Education, health care
34. UAB Dental Clinic		Oral health care
35. Ruffner Mountain	Parks and recreation	Hiking
36. Harriman Park		Exercise classes
37. Hooper City Parks and Recreation		Zumba and aerobics classes
38. Ensley Parks and Recreation		Zumba
39. Alabama Clinical Therapeutic	Research	Diabetes trials
40. UAB Eat Right Weight Management	UAB research project	Nutrition and weight loss
41. ImWeL	UAB research project	Weight loss management
42. NIDDK	Website	Health education
43. ADA website		Health education (diabetes)
44. MyDiabetesConnect.com^{^†}		Community resources

↵* Library referrals are not broken down by location.
↵† Resource developed by the community as a part of Cities for Life Program (http://mydiabetesconnect.com/).
ADA, American Diabetes Association; ADPH, Alabama Diabetes Prevention and Control Program; AME, African Methodist Episcopal; MTC, More than Conquerors; NIDDK, National Institutes of Diabetes and Digestive and Kidney Diseases; PEER, Promoting Empowerment and Enrichment Resources; UAB, University of Alabama Birmingham; UMC, United Methodist Church; YMCA, Young Men's Christian Association.