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Updated: Jun 14, 2025

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From Trials to Practice: Implementing a Clinical Intervention in Community Settings.

Elizabeth M Vaughan1,2, Xiaoying Yu1, Victor J Cardenas1

  • 1University of Texas Medical Branch, Galveston, USA.

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The TIME program, using telehealth and community health workers (CHWs), effectively reduced HbA1c in uninsured Hispanic adults with type 2 diabetes, demonstrating cost savings and high participant satisfaction for practical implementation.

Keywords:
Hispanic or Latino(a)community clinicdiabetesdiabetes group visits or shared medical appointmentsimplementationpatient navigators or community health workerstelehealth

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Area of Science:

  • Implementation science
  • Community health
  • Diabetes management

Background:

  • Diabetes poses significant risks, particularly for vulnerable populations.
  • Previous research demonstrated the efficacy of the TIME (Telehealth-supported, Integrated Community Health Workers (CHWs), Medication access, group visit Education) program.
  • This study focused on translating the TIME program from clinical trials to real-world application.

Purpose of the Study:

  • To evaluate the practical implementation of the TIME program in a community clinic setting.
  • To gather data on the transition of a CHW-led diabetes care model from research to practice.
  • To assess implementation measures including acceptability, adoption, cost, feasibility, fidelity, satisfaction, and effectiveness.

Main Methods:

  • A 12-month randomized clinical trial (RCT) involving 58 uninsured Hispanic adults with type 2 diabetes.
  • Participants were randomized to the TIME intervention or usual care.
  • The TIME intervention included telehealth-supported group visits and mHealth contact with CHWs, guided by the Consolidated Framework for Implementation Research (CFIR).

Main Results:

  • High fidelity (88.2% CHW-participant contact success), feasibility (3.4% attrition), and cost savings ($16,435 net savings).
  • Significant HbA1c reductions observed in the intervention group at 6 months (-0.85% vs 0.35%, P=.004) and sustained at 12 months (-0.52% vs 0.25%, P=.062).
  • High appropriateness, satisfaction, and acceptability reported by providers, CHWs, and participants.

Conclusions:

  • The TIME program successfully met key implementation benchmarks, showing strong engagement and cost-effectiveness.
  • The findings support the transition of the TIME model from efficacy trials to scalable, community-based diabetes care.
  • Further research with larger studies is recommended to validate these implementation outcomes.