Diabetes Tele-Health Program for Hispanic Veterans: Program Evaluation

Abstract

Background and Rationale: Rural Hispanic Veterans in the Southern Arizona region with type 2 diabetes mellitus (T2DM) are at risk for diabetes related complications. The Southern Arizona Veterans Administration Health Care System (SAVAHCS) care coordination home tele-health (CCHT) program serves as a useful tool in T2DM management in addition to services through primary care. CCHT has not been evaluated to determine effectiveness in this uniquely vulnerable demographic - rural Hispanic Veterans with T2DM in the Southern Arizona region. Purpose: The purpose of this DNP project was to evaluate the effectiveness of a nurse managed and nurse ran program known as the SAVAHCS CCHT T2DM program in achieving successful diabetes self-management and related biological measures among male and female Hispanic veterans who reside in rural Arizona counties and receive their health care through SAVAHCS. Project Aims: Aim I: Evaluate the effects of the SAVAHCS CCHT T2DM program among rural Hispanic veterans on the biological measure of glycosylated hemoglobin A1C (HbA1C) at three different time periods, initially at admission, three months after admission, and six months after admission. Aim II: Evaluate the effects of the SAVAHCS CCHT T2DM program among rural Hispanic veterans on the other quality measures of diabetes management including Body Mass Index (BMI), blood pressure (BP) and low density lipoprotein (LDL) cholesterol at three different time periods (see Aim I). Methods: A descriptive study design was used to evaluate the SAVAHCS CCHT program. The Centers for Disease Control and Prevention (CDC) Framework for Program Evaluation in Public Health was used to examine the effectiveness of the tele-health program. Data were collected from the Veterans Health Administration data warehouse. Biological measures were collected and analyzed at three different time points. Results: Descriptive data analysis of the veterans (n=12) demonstrated minimal intervention improvement of 0.1 units on A1C (8.3% of veterans), BP (16.7%) and BMI (16.7%). Due to missing data the results may not be due to the CCHT program but to structure and process issues related to collection of reliable data. A more robust program evaluation is recommended.