Observational studyBMC health services research2020
Community-based outreach associated with increased health utilization among Navajo individuals living with diabetes: a matched cohort study.
Observational study in BMC health services research, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03326206 (Evaluating the Navajo Community Outreach and Patient Empowerment), which is not on this map. Cited by 9 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Evaluating the Navajo Community Outreach and Patient Empowerment (COPE) Program
Who cites it
9 citing papers in PubMed, 2 syntheses or guidelines pooled it, 19 citations in OpenAlex.
- The cultural safety of research reports on primary healthcare use by Indigenous Peoples: a systematic review.BMC health services research · 2024Pooled it
- A realist synthesis of staff-based primary health care interventions addressing universal health coverage.Journal of global health · 2022Pooled it
- Outcomes for American Indian and Alaska Native Populations With Cancer in Traditional Medicare.JAMA network open · 2026Observational
- The role of community health workers in enhancing home and community-based services in American Indian communities.PEC innovation · 2025Article
- Patients' perspective and practices of heart failure recurrence prevention in Yancheng City.Scientific reports · 2024Article
- Indigenous data governance approaches applied in research using routinely collected health data: a scoping review.NPJ digital medicine · 2024Article
- Application Status Among Women Enrolled in a Healthy Start Program in Arkansas for the Special Nutrition Program for Women and Children.Journal of community health · 2023Article
- Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes.International journal of environmental research and public health · 2021Article
- A Case for Using Electronic Health Record Data in the Evaluation of Produce Prescription Programs.Journal of primary care & community healthArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 5 institutions in 1 country.
Funding
Abstract
backgroundNavajo community members face high rates of diabetes mellitus and other chronic diseases. The Navajo Community Health Representative Outreach Program collaborated with healthcare providers and academic partners to implement structured and coordinated outreach to patients living with diabetes. The intervention, called Community Outreach and Patient Empowerment or COPE, provides home-based health coaching and community-clinic linkages to promote self-management and engagement in healthcare services among patients living with diabetes. The purpose of this study was to evaluate how outreach by Navajo Community Health Representatives ("COPE Program") affected utilization of health care services among patients living with diabetes.
methodsDe-identified data from 2010 to 2014 were abstracted from electronic health records at participating health facilities. In this observational cohort study, 173 cases were matched to 2880 controls. Healthcare utilization was measured as the number of times per quarter services were accessed by the patient. Changes in utilization over 4 years were modeled using a difference-in-differences approach, comparing the trajectory of COPE patients' utilization before versus after enrollment with that of the control group. The model was estimated using generalized linear mixed models for count outcomes, controlling for clustering at the patient level and the service unit level.
resultsCOPE enrollees showed a 2.5% per patient per quarter (pppq) greater increase in total utilization (p = 0.001) of healthcare services than non-COPE enrollees; a 3.2% greater increase in primary care visits (p = 0.024); a 6.3% greater increase in utilization of counseling and behavioral health services (p = 0.013); and a 9.0% greater increase in pharmacy visits (p < 0.001). We found no statistically significant differences in utilization trends of inpatient, emergency room, specialty outpatient, dental, laboratory, radiology, or community encounter services among COPE participants versus control.
conclusionsA structured intervention consisting of Community Health Representative outreach and coordination with clinic-based providers was associated with a modest increase in health care utilization, including primary care and counseling services, among Navajo patients living with diabetes. Community health workers may provide an important linkage to enable patients to access and engage in clinic-based health care.
trial registrationNCT03326206, registered 10/31/2017, retrospectively registered.
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Registered trials
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