Date of Award

Summer 8-7-2023

Embargo Period

8-10-2023

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD) in Health & Rehabilitation Science

College

College of Health Professions

First Advisor

Annie Simpson

Second Advisor

Kit Simpson

Third Advisor

Tucker Marrison

Fourth Advisor

Ralph Ward

Abstract

Community health worker interventions have shown potential to improve health outcomes and reduce inequities particularly for patients with chronic diseases such as type 2 diabetes (T2D). However, there is a lack of support for CHW integration in the delivery of health care. The recent COVID pandemic may have affected outcomes for T2D patients and exacerbated existing inequities in care. This dissertation aimed to address three broad questions through three separate manuscripts. The first one was a systematic literature review to examine the impact of community health workers on health outcomes for rural US populations. The second and third papers used electronic health record data from the Medical University of South Carolina primary care clinics to assess the impact of the COVID interruption on monthly diabetes visits and HbgA1c measures on T2D patients, including analyses by high-risk subgroups based on age, race, ethnicity, rurality, and insurance status. The systematic review provided evidence that CHW can improve access to care in rural settings and may represent a cost-effective investment for the healthcare system. After the onset of the COVID-19 pandemic in South Carolina in March 2020, the overall rate outpatient visits for type 2 diabetes (T2D) patients did not significantly drop thanks to the implementation of telehealth services. Nonetheless, glycemic control was negatively impacted by the COVID-19 interruption, especially for older patients and those covered by Medicaid or without insurance. Taken together these results can inform future research and interventions leveraging CHW and telehealth modalities to better address equitable T2D management.

Rights

Copyright is held by the author. All rights reserved.

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