My Diabetes My Community

我的糖尿病我的社区

基本信息

批准号：
10170938
负责人：
ELBERT S. HUANG
金额：
$ 542.75万
依托单位：
UNIVERSITY OF CHICAGO
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-09-15 至 2024-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10170938
关键词：
Address Adverse drug event African American Agreement American Behavior COVID-19 Cardiovascular system Caring Cessation of life Chicago Chronic Disease Clinical Communication Communities Complex Conflict (Psychology)Diabetes Mellitus Disease Disease Management Documentation Elderly Electronic Health Record Emergency department visit Evaluation Evidence based intervention Food Geriatrics Glycosylated hemoglobin A Goals Guidelines Health Health Status Hospitalization Housing Hypoglycemia Incontinence Information Systems Intervention Knowledge Life Mental Depression Methods Microvascular Dysfunction Minority Modeling Nursing Care Management Outcome Patient Self-Report Patients Physical activity Population Pragmatic clinical trial Predisposition Process Psyche structure Publishing Quality of life Randomized Controlled Trials Recommendation Resources Risk Risk Assessment Risk Factors Self Care Self Efficacy Self Management Societies Surveys Symptoms Syndrome System Telephone Universities Vulnerable Populations arm barrier to care base caregiving clinical encounter comorbidity cost design diabetes management diabetes mellitus nursing evidence base experience falls food insecurity functional disability functional status glycemic control health assessment health care service utilization high risk population improved older patient patient engagement patient portal personalized approach preference satisfaction screening shared decision making social socioeconomics theories therapy design three-arm study treatment as usual usual care arm

项目摘要

PROJECT SUMMARY Older African Americans with diabetes are a highly vulnerable population. In addition to high susceptibility to external insults such as COVID-19, this population suffers the highest rates of cardiovascular and microvascular complications as well as adverse drug events such as hypoglycemia. To address the unique needs of this population, multiple organizations have called for a personalized approach to setting risk factor goals and self- care plans that account for comorbidities, functional status, and socioeconomic risks. Despite widespread agreement, the clinical impact of this highly personalized approach to geriatric diabetes care has rarely been studied in controlled trials. Interventions designed to personalize diabetes care must overcome multiple challenges to implementation including the brief clinical encounter, lack of engagement between encounters, and lack of systems to leverage community-based self-care resources. We propose to address these knowledge and care gaps by studying the integration of two evidence-based interventions, Managing Diabetes to Gain Opportunities for a More Active Life (My Diabetes GOAL) and CommunityRx. The My Diabetes GOAL intervention is designed to engage older patients in personalized goal setting and chronic disease management. The intervention consists of an initial assessment of health status, hypoglycemia risk, barriers to care, and treatment preferences delivered via the electronic health record (EPIC®) patient portal (MyChart®). A diabetes nurse reviews the survey results with the patient to arrive at personalized diabetes goals and provides monthly telephonic care management. Nurse care management may be significantly enhanced with CommunityRx (CRx), a community resource referral information system, developed in partnership with stakeholders across sectors and local residents. During encounters, a HealtheRx is generated, including resources for basic needs such as food and housing, physical and mental wellness, disease self-management and caregiving. Across the University of Chicago Practice Network, we will conduct a 12-month three-arm parallel pragmatic randomized controlled trial of 600 subjects comparing (1) Usual Care vs. (2) My Diabetes GOAL vs. (3) My Diabetes GOAL + CommunityRx. During the trial, we will (1) evaluate the impact of My Diabetes GOAL Arms versus Usual Care on processes of personalized diabetes care (e.g., decisional conflict regarding goals of diabetes care), (2) evaluate the relative impact of the three study arms on self-efficacy, self-care and utilization of community-based resources and (3) evaluate the relative effect of the three study arms on clinical outcomes (e.g., glycemic control, hypoglycemia, geriatric conditions, functional status) and health care utilization (ED visits and unplanned hospitalizations). We will then conduct a mixed-methods evaluation of the trial experience among key stakeholder groups. Personalizing diabetes care in older African American patients with scalable strategies that acknowledge personal preference, barriers to self-care and community connections have the potential to improve quality of life while avoiding adverse drug events.

项目概要患有糖尿病的老年非洲裔美国人除了高度易感之外，也是一个高度脆弱的人群。由于外部侵害（如 COVID-19），该人群心血管和微血管疾病发生率最高并发症以及低血糖等药物不良事件，以满足这一独特需求。人口，多个组织呼吁采用个性化方法来设定风险因素目标和自我评估尽管存在广泛的风险，但护理计划仍考虑到合并症、功能状态和社会经济风险。一致认为，这种高度个性化的老年糖尿病护理方法的临床影响很少得到重视对照试验中研究的旨在个性化糖尿病护理的干预措施必须克服多重因素。实施方面的挑战，包括短暂的临床接触、接触之间缺乏参与、以及缺乏利用基于社区的自我护理资源的系统。我们建议解决这些知识问题。通过研究两种循证干预措施的整合来弥补护理差距，管理糖尿病以取得成果更积极生活的机会（我的糖尿病目标）和 CommunityRx。干预旨在让老年患者参与个性化目标设定和慢性病管理。干预措施包括对健康状况、低血糖风险、护理障碍的初步评估，以及通过电子健康记录 (EPIC®) 患者门户 (MyChart®) 提供治疗偏好 A 型糖尿病。护士与患者一起审查调查结果，以达成个性化的糖尿病目标，并每月提供 CommunityRx 可以显着增强电话护理管理。 (CRx)，一个社区资源推荐信息系统，与各利益相关者合作开发在接触过程中，会生成 HealtheRx，其中包括满足基本需求的资源。例如食物和住房、身心健康、疾病自我管理和护理。芝加哥大学实践网络，我们将进行为期12个月的三臂平行实用随机对 600 名受试者进行的对照试验，比较 (1) 常规护理与 (2) 我的糖尿病目标与 (3) 我的糖尿病目标 + CommunityRx 在试验期间，我们将 (1) 评估 My Diabetes GOAL Arms 与常规护理的影响关于个性化糖尿病护理的过程（例如，关于糖尿病护理目标的决策冲突），(2) 评估三个研究组对自我效能、自我护理和社区资源利用的相对影响 (3) 评估三个研究组对临床结果的相对影响（例如，血糖控制、低血糖、老年病、功能状态）和医疗保健利用（急诊就诊和计划外然后，我们将对关键人员的试验经历进行混合方法评估。利益相关者团体通过可扩展的策略对老年非裔美国患者进行个性化糖尿病护理。承认个人偏好、自我护理和社区联系的障碍都有可能得到改善生活质量，同时避免药物不良事件。