VIDA: Virtual Diabetes Group Visits Across Health Systems

VIDA：跨卫生系统的虚拟糖尿病小组访问

• 批准号: 10494186
• 负责人: Arshiya Ahmed Baig
• 金额: $ 62.27万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-24 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10494186
• 关键词: Chicago; Chronic; Diabetes Mellitus; Health system; Visit; virtual

PROJECT SUMMARY Of the 30 million adults with DM in the United States, 97% have at least one comorbid condition (e.g. hypertension, heart disease, kidney disease). DM and DM-related complications disproportionately affect people of color. The prevalence of DM is higher among Hispanics (12.5%) and African-Americans (11.7%) compared to non-Hispanic whites (7.5%); Hispanics and African-Americans have higher rates of diabetes-related complications, including amputations and CKD. Group visits (GVs) can provide patients with comprehensive care for their multimorbid chronic condition. Diabetes GVs—shared appointments where patients receive self- management education in a group setting and an individual medical visit—can improve glycemic control, decrease healthcare utilization, and provide social support and co-learning among peers. While virtual appointments have become a routine part of clinical care during the COVID-19 pandemic, group visits via virtual platforms remain uncommon and understudied. Before the model can be widely adopted, important questions about the effectiveness and implementation of the virtual diabetes GV model need to be addressed. We propose to build on an established program of in-person diabetes GVs and a virtual diabetes GV pilot by the University of Chicago and MidWest Clinician’s Network. We aim to implement the virtual GV model (VIDA: Virtual Diabetes Group Visits Across Health Systems) in two distinct health systems in the Chicago region: ACCESS and Advocate Aurora Health (AAH). ACCESS is one of the largest federally qualified health centers (FQHCs) in the U.S. with 35 sites across the Chicago metropolitan area, providing care for 175,000 medically underserved and low-income patients each year, including over 25,000 patients with diabetes. Advocate Aurora Health (AAH) is a large, diverse, integrated private not-for profit health system with more than 129 primary care clinics in Illinois serving over 117,000 patients with diabetes. The ability to train, implement and evaluate virtual group visits across two distinct health systems provides a unique opportunity to learn about adaptation and the barriers and facilitators for program implementation. This study will use a type I hybrid effectiveness-implementation design via a pragmatic cluster randomized trial to assess changes in clinical outcomes among adults with T2DM in virtual diabetes GVs versus usual care. We will first adapt and implement VIDA at one ACCESS FQHC center and one AAH primary care clinic using the Form and Function domains of the Complex Health Intervention Framework. We will assess integration of VIDA into clinical workflow and determine the type of and amount of training and technical support needed to assist staff in integrating virtual diabetes GV into the clinical setting. We will then conduct a pragmatic cluster randomized trial of virtual GVs across 9 intervention sites (180 adult patients with T2DM with A1C >9%) and 9 control sites (360 matched patients) and assess change in A1C from baseline to 12-months and change in other clinical outcomes including systolic blood pressure and body mass index. We will assess adoption, implementation, and maintenance of virtual GVs across systems using RE-AIM framework.

项目概要 在美国 3000 万患有 DM 的成年人中，97% 的人至少患有一种合并症（例如糖尿病）。 糖尿病和糖尿病相关并发症对人们的影响尤为严重 与有色人种相比，西班牙裔美国人 (12.5%) 和非裔美国人 (11.7%) 的糖尿病患病率更高。 非西班牙裔白人（7.5%）；西班牙裔和非裔美国人患糖尿病的比例较高 并发症，包括截肢和 CKD 团体就诊 (GV) 可以为患者提供全面的治疗。 糖尿病 GV——患者接受自我治疗的共享预约。 团体环境中的管理教育和个人就诊——可以改善血糖控制， 减少医疗保健利用率，并在虚拟时提供社会支持和同伴之间的共同学习。 在 COVID-19 大流行期间，预约已成为临床护理的常规部分，通过虚拟进行团体就诊 在该模型被广泛采用之前，平台仍然不常见且未被充分研究。 我们建议需要解决虚拟糖尿病 GV 模型的有效性和实施问题。 建立在大学已建立的面对面糖尿病 GV 和虚拟糖尿病 GV 试点计划的基础上 芝加哥和中西部临床医生网络的目标是实施虚拟 GV 模型（VIDA：虚拟糖尿病）。 芝加哥地区两个不同卫生系统的团体访问（跨卫生系统）：ACCESS 和 Advocate Aurora Health (AAH) 是美国最大的联邦合格健康中心 (FQHC) 之一。 美国在芝加哥大都市区设有 35 个站点，为 175,000 名医疗服务不足和缺乏医疗服务的人提供护理 Advocate Aurora Health (AAH) 每年为低收入患者提供服务，其中包括超过 25,000 名糖尿病患者。 一个大型、多元化、综合性的私人非营利性医疗系统，在伊利诺伊州拥有超过 129 个初级保健诊所 为超过 117,000 名糖尿病患者提供培训、实施和评估虚拟小组就诊的能力。 跨越两个不同的卫生系统提供了一个独特的机会来了解适应和障碍以及 本研究将使用 I 类混合有效性实施设计。 通过一项务实的整群随机试验来评估成人 T2DM 临床结果的变化 虚拟糖尿病 GV 与常规护理的比较 我们将首先在一个 ACCESS FQHC 中心采用并实施 VIDA。 以及一个使用复杂健康干预的形式和功能领域的 AAH 初级保健诊所 我们将评估 VIDA 与临床工作流程的整合，并确定其类型和数量。 协助工作人员将虚拟糖尿病 GV 融入临床环境所需的培训和技术支持。 然后将在 9 个干预地点（180 名成年患者）进行虚拟 GV 的务实集群随机试验 患有 A1C > 9% 的 T2DM 患者）和 9 个对照中心（360 名匹配患者），并评估 A1C 相对于基线的变化 至 12 个月以及其他临床结果的变化，包括收缩压和体重指数。 将使用 RE-AIM 框架评估跨系统虚拟 GV 的采用、实施和维护。