Abstract P030: Recruitment and Effectiveness by Cohort in a Case Management Intervention Among American Indians and Alaska Natives with Diabetes

Abstract

Introduction: To determine the optimal strategies for effective large-scale implementation of evidence-based interventions, it is critical to investigate continued effectiveness as an intervention rolls out to large, diverse populations. The purpose of this study is to evaluate whether patient characteristics and intervention effectiveness differ by year of enrollment in a multi-year evidence-based translational intervention. Hypothesis: We hypothesize the patients recruited early may have a higher level of readiness to change their behaviors and achieve more improvements in their intervention outcomes than patients enrolled in later years. Methods: The Special Diabetes Program for Indians Healthy Heart (SDPI-HH) Demonstration Project is an intensive case management intervention designed to reduce cardiovascular disease (CVD) risk among American Indian and Alaska Native patients with diabetes. SDPI-HH participants recruited from 2006 through 2008 were included (n=2,910). Baseline characteristics were compared by year of enrollment. We also evaluated the differences in improvements in CVD risk factors among participants recruited in different years. Results: The baseline characteristics of the three cohorts revealed significant differences in demographics, diabetes duration, health behaviors, level of motivation, and clinical measures. Improvements in 13 clinical and behavioral outcomes differed by enrollment year with the 2006 cohort having the greatest number of statistically significant improvements (Table 1). The 2006 cohort also had the highest rates of participant participation and retention. Conclusions: The SDPI-HH participants recruited later had fewer improvements in CVD risk factors, potentially due to the decline in participant motivation over the three years. Further investigation into ways to modify the intensive case management model to address differences in levels of motivation and participation is warranted to improve the prevention of chronic disease in Indian health.