Integrating Education Group Support and Case Management for Diabetic Hispanics

将教育团体支持与西班牙裔糖尿病患者案例管理相结合

• 批准号: 7212498
• 负责人: SHARON A BROWN
• 金额: $ 23.08万
• 依托单位: UNIVERSITY OF TEXAS AT AUSTIN
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-15 至 2008-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7212498
• 关键词: Mexican Americans; behavioral /social science research tag; blood glucose; clinical research; clinical trials; cost effectiveness; counseling; culture; diabetes mellitus therapy; focus groups; health care service utilization; health disparity; health services research tag; human subject; human therapy evaluation; noninsulin dependent diabetes mellitus; nurse patient relations; outcomes research; patient care management; patient monitoring device; rural health; self care; telemedicine; therapy compliance

DESCRIPTION (provided by applicant): Starr County is a rural Texas-Mexico border community that is 98% Mexican American and has the highest diabetes-related death rate in Texas. Since 1988 we have demonstrated reductions in HbA1c through culturally competent diabetes self-management education, but effects diminished overtime. Results indicated that socio-cultural and personal barriers remained, preventing individuals from achieving optimal health outcomes. The proposed planning study will explore a strategy relatively untested in rural communities that will provide coordination of all aspects of an individual's diabetes care, including participation in our self-management intervention. We propose to conduct a pilot test of our previously tested 'compressed" self-management intervention enhanced by a nurse case manager in order to: 1) Define and refine the role of the nurse case manager (NCM) for a rural border community by conducting focus groups with a variety of groups in Starr County: a) participants in our previous intervention studies; b) physicians practicing on either side of the border who provide diabetes care for Texas border residents; c) local community health officials; d) other health care providers who provide diabetes care (nurses, dietitians, community health workers employed by local hospitals and clinics); e) key authority figures in the community (such as local Catholic priests, County officials); and f) experienced NCMs. 2) Determine the feasibility of employing a diabetes NCM in order to enhance the positive effects of our self- management interventions by comparing 2 groups: a) a combined strategy involving the nurse CM PLUS the "compressed" version of our diabetes self-management intervention previously tested; and b) "compressed" diabetes self-management intervention ALONE. We will conduct a pilot study in Starr County using a pretest/posttest control group design. 96 participants of current genetic studies will be recruited and assigned to 1 of the interventions. We will collect data at baseline and at 3 and 6 months on outcomes we have measured previously-HbA1c, FBG, lipids, blood pressure, knowledge, health behaviors (physical activity, dietary intake, glucose monitoring, and medication usage), and BMI. We plan to add 2 new variables: 1) health care utilization and 2) cost. Minimal data analysis will be performed during the proposed pilot project, since the intent is to determine intervention feasibility. Basic descriptive analyses (means, frequencies) and non-parametric comparisons will be performed; HLM will be used for exploratory purposes. The proposed study is a critical step in determining effective ways of sustaining the effects of diabetes self-management in Mexican American populations.

描述（由申请人提供）：斯塔尔县是德克萨斯州与墨西哥边境的一个农村社区，98% 是墨西哥裔美国人，是德克萨斯州糖尿病相关死亡率最高的县。自 1988 年以来，我们已经通过文化上的糖尿病自我管理教育证明了 HbA1c 的降低，但效果随着时间的推移而减弱。结果表明，社会文化和个人障碍仍然存在，阻碍个人实现最佳健康结果。拟议的规划研究将探索一种在农村社区相对未经测试的策略，该策略将协调个人糖尿病护理的各个方面，包括参与我们的自我管理干预。我们建议对我们之前测试的“压缩”自我管理干预进行试点测试，由护士案例经理加强，以便：1）通过以下方式定义和完善农村边境社区护士案例经理（NCM）的角色：斯塔尔县各个群体的焦点小组：a) 我们之前干预研究的参与者；b) 在边境两侧为德克萨斯州边境居民提供糖尿病护理的医生；c) 当地社区卫生官员；提供糖尿病护理的护理人员（当地医院和诊所聘用的护士、营养师、社区卫生工作者）； e) 社区中的重要权威人士（例如当地天主教牧师、县官员）；以及 f) 经验丰富的 NCM 2) 确定雇用糖尿病患者的可行性。 NCM 旨在通过比较 2 组来增强我们自我管理干预措施的积极效果：a) 涉及护士 CM 的联合策略加上之前测试过的糖尿病自我管理干预措施的“压缩”版本； b) 单独“压缩”糖尿病自我管理干预。我们将使用预测试/后测试对照组设计在斯塔尔县进行试点研究。当前遗传学研究的 96 名参与者将被招募并分配到其中一项干预措施。我们将收集基线以及 3 个月和 6 个月时的数据，了解我们之前测量的结果 - HbA1c、FBG、血脂、血压、知识、健康行为（体力活动、饮食摄入、血糖监测和药物使用）和 BMI。我们计划添加 2 个新变量：1) 医疗保健利用率和 2) 成本。在拟议的试点项目期间将进行最少的数据分析，因为目的是确定干预的可行性。将进行基本描述性分析（平均值、频率）和非参数比较； HLM 将用于探索目的。这项拟议的研究是确定维持墨西哥裔美国人糖尿病自我管理效果的有效方法的关键一步。