Quality Improvement in Diabetes Care Using Community Health Workers

Community health centers take care of patients who are at high risk for adverse medical outcomes because of poverty, linguistic isolation, poor education, and poor health habits. Because of their population focus, health centers are positioned to implement systems-level changes affecting many patients. We report here on a successful quality improvement initiative focusing on patients with diabetes in Holyoke, Mass.Holyoke Health Center (HHC) has two sites and serves ∼ 20,000 patients, most of whom are Spanish speaking. At present, > 1,700 of the center's adult patients have diabetes, and this figure has been increasing rapidly. In 1999, HHC adopted an electronic registry to track these patients and their clinical data as part of a larger effort to implement an integrated approach to chronic disease management.1 In 2003, community health workers (CHWs) were added to the diabetes care team to enhance the capability to engage and support patients who were not succeeding in managing their diabetes.The center's CHWs are patients with diabetes who have become good self-managers of their disease. The CHWs have had no previous training as medical personnel. They participate in a 3-day training using the Diabetes Education and Empowerment Curriculum developed by the Midwest Latino Research, Training, and Policy Center,2 a 4-day training in Stanford's Chronic Disease Self-Management Training Program,3 several sessions of training through …