Cambodian patients at the MGH Revere HealthCare Center were identified as the population facing the greatest challenges to effective diabetes control. The Disparities Solutions Center (DSC) in collaboration with the MGH Revere HealthCare Center, began a culturally competent diabetes management program for Cambodian patients in 2009, modeled after the Chelsea HealthCare Center’s successful diabetes management program. The program included two main components: 1) individual bilingual (English and Khmer) coaching using a culturally competent model of care to address patients’ needs/concerns regarding diabetes self-management; and 2) Diabetes Self Management Education, including bilingual group education sessions with discussions facilitated by the diabetes coach. In response to the direct needs of the Cambodian population, the diabetes coach also served as a patient navigator, helping patients interact with the health care system (e.g. calling pharmacy, sending appointment reminders, etc.). Over the course of the project, 55 patients participated in the program with a total of 334 sessions conducted. Program participants had a 0.88 drop in HbA1c. Project results demonstrate that culturally-tailored disease management programs are critical for improving patient care and self-management, especially for chronic diseases like diabetes. Coaching can be a successful model for motivating patients to improve self-care activities, and navigation services are particularly important for patients facing barriers associated with language ability.
Project Directors: Alexander R. Green, M.D., M.P.H. and Roger Pasinski, M.D.
Time Frame: May 2008-November 2011
MGH CHELSEA DIABETES MANAGEMENT PROGRAM FOR LATINO PATIENTS
The Chelsea Diabetes Disparities Program is a quality improvement and disparities reduction intervention targeting poorly controlled diabetic patients at MGH’s Chelsea Health Care Center. The Disparities Solutions Center is actively involved in the design of this program based on a culturally competent disease management model involving both individual coaching and group visits. The Center will conduct the evaluation study to assess improvements in glucose control, reductions in disparities between Latino and non-Latino white patients, and patients’ potential barriers to achieving control of their diabetes.
Project Director: Alexander R. Green, M.D., M.P.H.
Time Frame: April 2005-April 2007
COLORECTAL CANCER SCREENING DISPARITIES PROGRAM
The DSC has begun to work with the MGH Gastroenterology Unit, the Community Benefits Office, and MGH Chelsea HealthCare Center to develop a quality improvement/disparities reduction project to address the marked disparity found in colonoscopy screening rates, particularly striking among Latinos. Similar to the Diabetes Program, this program will focus on identifying barriers to CRC screening, and overcoming these barriers with the help of a bilingual, culturally competent patient navigator. The program will also focus on patient education, provider education, and overcoming logistical and financial barriers to colonoscopy screening.
Project Directors: Alexander R. Green, M.D., M.P.H
Time Frame: April 2006 – continuing
MENTAL HEALTH DISPARITIES PROGRAM
The Disparities Solutions Center is working with MGH Psychiatry to investigate where disparities in mental health service utilization exist throughout MGH, both through research and collaboration with participating clinics. The DSC will propose measures to increase mental health services to minority populations and seek to encourage clinicians and support staff to participate in improving care for minorities with depression.
Project Directors: Alexander R. Green, M.D., M.P.H. & Joseph R. Betancourt, M.D., M.P.H.
Time Frame: January 2007 – December 2008
In partnership with the MGH Community Benefit Program the Center plans to pilot innovative interventions in three disease areas—diabetes, colorectal cancer, and depression in predominantly Latino and African American communities served by the MGH Chelsea Health Center and MGH Revere Health Center. Model programs will be implemented and sustained locally, and will serve as models for addressing disparities that can be replicated in other clinical settings and disseminated widely across the country.
Project Directors: Joseph R. Betancourt, M.D., M.P.H. & Alexander R. Green, M.D., M.P.H.
Time Frame: December 2006- December 2008