The Impact of Integrating Medical Assistants and Community Health Workers on Diabetes Care Management in Community Health Centers (BMC Health Services Research)

​Authors aimed to compare the impact of implementing team-based diabetes care management involving community health workers (CHWs) vs. medical assistants (MA) in community health centers (CHCs) on diabetes care processes, intermediate outcomes, and patients’ experiences of chronic care. Authors used clinical and administrative data and patient surveys pre-intervention and post-intervention. Surveys and key informant interviews of CHC staff assessed barriers and facilitators of implementation.

The study design was a three-arm cluster-randomized trial of CHC sites integrating MAs or CHWs for diabetes care management compared control CHC sites. Difference-in-difference multivariate regression with exact matching of patients estimated intervention effects.

 Main findings:

• Patients in the CHW intervention arm had improved annual glycated hemoglobin testing, while patients in the MA intervention arm had improved low-density lipoprotein cholesterol control and reported better chronic care experiences over time.
•  Except for chronic care experiences for patients in the MA intervention group, difference-in-difference estimates were not statistically significant because control group patients also improved over time.

Some diabetes care processes improved significantly more for control group patients than intervention group patients. Key informant interviews revealed that immediate patient care issues sometimes crowded out diabetes care management activities, especially for MAs.

• Hector P. Rodriguez
• Mark Friedberg
• Arturo Vargas Bustamante, PhD, MPP, MA
• Xiao Chen, PhD
• Ana E. Martinez, MPH
• Dylan H. Roby, PhD