Influencing health policy for chronic disease management in underserved communities through evidence-based research

Adequate management of chronic diseases such as hypertension and diabetes is a difficult daily challenge for every patient. However, it is more burdensome for underserved minority populations since many of them suffer from insufficient resources and stiff barriers. In particular, recent immigrant groups such as Korean Americans (KA) are facing with linguistic, cultural and system associated barriers. Our years of community needs and asset assessments have led us to develop a community-based system of support to address significant health disparities in chronic disease management experienced by KA. Following descriptive phase of our program development, we have utilized a variety of intervention strategies including culturally tailored education, telephone counseling by bilingual nurses, and self-monitoring of BPs using tele-health. In addition, we have paid a close attention to making these programs sustainable by putting much effort in building a lasting community infrastructure. The approach has yielded several important resources and system to sustain key elements of our intervention within the community such as a pool of trained community health workers and establishment of an academic-community partnered chronic disease management program for underinsured KA. One of the key ingredients of our achievement was a tracking and documenting the process and outcome of our research projects. The documentation was instrumental in changing a couple of important health policies for chronic disease management in patients from the traditionally underserved community in Maryland. In this paper, we highlight the policy change processes that were driven by our evidence-based research.