T1DTechCHW: Enhancing the Community Health Worker (CHW) Model to Promote Diabetes Technology Use in Young Adults from Underrepresented Minority Groups (YA-URMs) with Type 1 Diabetes (T1D)

T1DTechCHW：加强社区卫生工作者 (CHW) 模式，促进患有 1 型糖尿病 (T1D) 的弱势少数群体 (YA-URM) 年轻人使用糖尿病技术

• 批准号: 10596642
• 负责人: Shivani Agarwal
• 金额: $ 33.79万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10596642
• 关键词: Accounting; Address; Adoption; Advocate; Affect; Black race; Caring; Clinical; Clinical Trials; Communities; Community Health Aides; Community Healthcare; Competence; Continuous Glucose Monitor; Costs and Benefits; Data; Diabetes Mellitus; Diabetic Ketoacidosis; Disease; Disparity; Distal; Educational Technology; Endocrinologist; Endocrinology; Evaluation; Foundations; Future; Glycosylated hemoglobin A; Goals; Health; Health Benefit; Health Personnel; Health system; Healthcare; Hearing; Hispanic; Hospitalization; Hospitals; Inequity; Insulin Infusion Systems; Insulin-Dependent Diabetes Mellitus; Insurance; Insurance Coverage; Intervention; Knowledge; Link; Measures; Mediator; Methods; Minority Groups; Mission; Modeling; National Institute of Diabetes and Digestive and Kidney Diseases; Outcome; Patients; Population; Positioning Attribute; Primary Care; Proctor framework; Provider; Race; Randomized; Randomized, Controlled Trials; Reporting; Research; Resources; Risk; Self Determination; Social support; Socioeconomic Status; System; Technology; Testing; Time; Trust; Underrepresented Minority; Underserved Population; United States; Work; aged; base; care delivery; care outcomes; clinical practice; cost; cost effective; cost effective intervention; effective intervention; emerging adult; ethnic disparity; evidence base; experience; flexibility; health inequalities; high risk; implementation outcomes; implementation science; improved; member; mortality; mortality risk; next generation; outreach; patient oriented; patient-level barriers; peer support; pragmatic trial; primary care practice; primary care provider; programs; provider-level barriers; racial disparity; recruit; response; safety net; shared decision making; social; standard of care; system-level barriers; team-based care; theories; treatment as usual; underserved community; uptake; young adult

PROJECT ABSTRACT This R01 responds to PAS-20-160 (Small R01s for Clinical Trials Targeting Diseases within the Mission of NIDDK, supporting “short-term exploratory clinical trials” to gather pilot data to “support a future larger fully- powered trial affecting important health outcomes”). The objective of this application is to test the early effects and implementation of an enhanced community health worker (CHW) model (T1DTechCHW) that encourages and supports diabetes technology use in young adults from underrepresented minority groups (YA-URMs) with type 1 diabetes (T1D). YA-URMs are the largest growing population with T1D in the United States, and demonstrate wide racial-ethnic inequity in glycemic, hospitalization, and mortality outcomes. Emerging evidence by our group and others has demonstrated racial-ethnic inequity in use of diabetes technologies, such as insulin pump therapy and continuous glucose monitors (CGM), which may be contributing to poor outcomes and represents a potential intervention target. Our work also highlights unique patient, provider, and system-level barriers to technology use that go beyond insurance coverage. CHWs are an evidence-based, cost-effective, scalable work force that can address multi-level barriers to diabetes technology use in YA-URMs with T1D, but have not previously been tested in this capacity. CHWs are unique in their ability to share lived experiences and advocate for patients from underserved communities, acting as links between community and health system instead of being a part of the system in which YA-URMs have low trust. Building off our prior research, grounded in self-determination theory, and our extensive clinical experience with YA-URMs with T1D in the Supporting Emerging Adults with Diabetes (SEAD) program, our central hypothesis is that CHWs will increase technology use by becoming part of the T1D team-based care approach, using their unique position to engender trust, and increase YA-URM autonomy, competence, and social support, while also filling provider workforce gaps. YA-aged CHWs will address commonly cited barriers to technology use by providing YA-URMs with T1D technology education, goal-setting, peer support, and social needs management, while shifting insurance approval work from providers and better aligning patient-provider priorities. We will conduct a 6-month randomized controlled trial in which YA-URMs will be randomized to T1DTechCHW or usual care. We will recruit from endocrinology and primary care practices in a large safety-net health system in the Bronx, NY. Our specific aims are to: 1) evaluate T1DTechCHW effects on technology initiation and continued use over 6 months and 2) evaluate T1DTechCHW implementation using Proctor’s Taxonomy of Implementation Outcomes: feasibility, adoption, fidelity, and cost. To strengthen rigor: we leverage a preexisting integrated CHW program; engage stakeholders to increase acceptability and uptake; and boost generalizability by recruiting from primary care and endocrinology practices. This small R01 trial is the next step to test a sustainable model aimed at root causes of disparities and will advance the field of T1D disparities research.

项目摘要 该 R01 响应 PAS-20-160（针对疾病临床试验的小 R01） NIDDK，支持“短期探索性临床试验”来收集试点数据，以“支持未来更大规模的全面- 影响重要健康结果的动力试验”）该应用程序的目的是测试早期效果。 实施强化社区卫生工作者 (CHW) 模式 (T1DTechCHW)，鼓励 并支持来自代表性不足的少数群体 (YA-URM) 的年轻人使用糖尿病技术 1 型糖尿病 (T1D) 是美国增长最快的 T1D 人群，并且 表现出在血糖、住院和死亡率方面存在广泛的种族不平等。 我们小组和其他人的证据表明，在使用糖尿病技术方面存在种族不平等， 例如胰岛素泵疗法和连续血糖监测仪（CGM），这可能会导致贫困 我们的工作还强调了独特的患者、提供者和患者。 超出保险范围的技术使用的系统级障碍是基于证据的、 具有成本效益、可扩展的劳动力，可以解决 YA-URM 中糖尿病技术使用的多层次障碍 患有 T1D，但以前没有经过过这种能力的测试，CHW 的分享生活能力是独一无二的。 为来自服务欠缺社区的患者提供经验和倡导，充当社区和社区之间的纽带 卫生系统，而不是成为 YA-URM 信任度较低的系统的一部分。 基于自我决定理论的研究以及我们在 T1D 的 YA-URM 方面的丰富临床经验 在支持新兴成人糖尿病 (SEAD) 计划中，我们的中心假设是社区卫生工作者将 通过成为 T1D 团队护理方法的一部分，利用其独特的技术使用 建立信任，增加 YA-URM 自主权、能力和社会支持，同时也填补 青少年社区卫生工作者将通过提供技术来解决常见的技术使用障碍。 YA-URM 具有 T1D 技术教育、目标设定、同伴支持和社会需求管理，同时 将保险审批工作从提供商手中转移出去，并更好地协调患者与提供商的优先事项。 为期 6 个月的随机对照试验，其中 YA-URM 将被随机分配至 T1DTechCHW 或常规护理组。 将从纽约布朗克斯的一个大型安全网卫生系统的内分泌科和初级保健实践中招募人员。 我们的具体目标是： 1) 评估 T1DTechCHW 对技术启动和持续使用超过 6 年的影响 2) 使用 Proctor 实施分类法评估 T1DTechCHW 实施 结果：可行性、采用性、保真度和成本 为了加强严谨性：我们利用现有的集成。 CHW 计划；让利益相关者参与进来，以提高可接受性和采用率，并提高普遍性； 这项小型 R01 试验是测试初级保健和内分泌实践的下一步。 可持续模型旨在解决差异的根本原因，并将推动 T1D 差异研究领域的发展。