{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T15:54:00Z","timestamp":1785772440923,"version":"3.56.0"},"reference-count":54,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2026,8,1]]},"abstract":"<jats:sec>\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>Community health workers (CHWs) improve chronic disease management in underserved populations, but scalable integration strategies are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate whether a multidimensional intervention incorporating telementored CHWs and a structured participant-CHW-clinician feedback loop can improve diabetes outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>This 12-month randomized clinical trial was conducted at 3 institutionally and geographically diverse community clinics in Texas between September 1, 2023, and April 30, 2025, and included low-income, uninsured White Hispanic adults with type 2 diabetes identified through clinic databases. Data were analyzed between May 1 and July 31, 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Intervention<\/jats:title>\n                    <jats:p>Individuals were randomized 1:1 to the intervention or control. For the intervention, CHWs delivered (1) group diabetes education, (2) individualized telehealth-based coaching, and (3) a novel participant-CHW-clinician feedback loop to facilitate communication, address participant concerns, and improve care coordination. The control was usual care (quarterly clinician visits and access to multidisciplinary and social services).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>\n                      The primary outcome was baseline to 12-month change in hemoglobin A\n                      <jats:sub>1c<\/jats:sub>\n                      (HbA\n                      <jats:sub>1c<\/jats:sub>\n                      ) level. Secondary outcomes included changes in cholesterol levels, American Diabetes Association (ADA) guideline adherence, participant recruitment, intervention fidelity, and feedback loop issue resolution.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 257 participants included in the intention-to-treat analysis (mean [SD] age 54 [11] years; 166 [64.6%] female), 129 were in the intervention group and 128 were in the control group. The intervention reduced HbA\n                      <jats:sub>1c<\/jats:sub>\n                      (net difference, \u22121.0 [95% CI, \u22121.5 to \u22120.4] percentage points [pp];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.001), total cholesterol (net difference, \u221235.4 mg\/dL; 95% CI, \u221254.6 to \u221217.2 mg\/dL;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.02), and low-density lipoprotein cholesterol (net difference, \u221229.7 mg\/dL; 95% CI, \u221244.5 to \u221214.9 mg\/dL;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;amp;lt;\u2009.001) levels compared with control. ADA guideline adherence improved for foot examinations (absolute risk [AR], 19.2 [95% CI, 7.4-30.9] pp; relative risk [RR], 1.65 [95% CI, 1.19-2.27];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.03) and urine microalbumin screening (AR, 15.8 [95% CI, 5.3-26.3] pp; RR, 1.24 [95% CI, 1.07-1.43];\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.048). CHWs addressed 490 participant concerns (87.2%) via the feedback loop, including medication refills, glucose management, and access to care.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this randomized clinical trial, the CHW intervention significantly improved diabetes outcomes in low-income settings, potentially by reducing fragmentation through structured feedback. Findings also highlight limitations in usual care, underscoring the need for scalable strategies to strengthen chronic disease management in low-income populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov Identifier:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT04835493\">NCT04835493<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamainternmed.2026.1917","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T15:30:24Z","timestamp":1780932624000},"page":"1012","source":"Crossref","is-referenced-by-count":0,"title":["Structured Telehealth Community Health Worker\u2013Clinician Feedback and Diabetes Outcomes"],"prefix":"10.1001","volume":"186","author":[{"given":"Elizabeth M.","family":"Vaughan","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of Texas Medical Branch, Galveston"},{"name":"Department of Medicine, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoying","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics & Data Science, University of Texas Medical Branch, Galveston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amber B.","family":"Amspoker","sequence":"additional","affiliation":[{"name":"Department of Medicine, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aanand D.","family":"Naik","sequence":"additional","affiliation":[{"name":"Department of Management, Policy, and Community Health, UT Health Houston School of Public Health, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashok","family":"Balasubramanyam","sequence":"additional","affiliation":[{"name":"Department of Medicine, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig A.","family":"Johnston","sequence":"additional","affiliation":[{"name":"Department of Health and Human Performance, University of Houston, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christi M.","family":"Ballantyne","sequence":"additional","affiliation":[{"name":"Department of Medicine, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salim S.","family":"Virani","sequence":"additional","affiliation":[{"name":"Section of Cardiology, Department of Medicine, Aga Khan University, Karachi, Pakistan"},{"name":"Department of Population Health, Aga Khan University, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. 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