Bronx A1c: Bring it Down for Health

布朗克斯 A1c：为了健康而降低它

基本信息

批准号：
7668867
负责人：
ELIZABETH A. WALKER
金额：
$ 12.73万
依托单位：
ALBERT EINSTEIN COLLEGE OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-05-01 至 2012-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7668867
关键词：
Address Adult Age Behavior Behavioral Caring Case Manager Chronic Clinical Clinical Management Clinical Trials Collaborations Communicable Diseases Computerized Medical Record Coronary heart disease Data Databases Diabetes Mellitus Diabetic Angiopathies Disease Effectiveness of Interventions Electronics Eligibility Determination Epidemic Federally Qualified Health Center Feedback Follow-Up Studies Glycosylated Hemoglobin Glycosylated hemoglobin A Goals Health Health Personnel Health Policy Health behavior Health care facility Hospitalization Income Individual Informed Consent Insulin Insulin-Dependent Diabetes Mellitus Intervention Kidney Diseases Laboratories Left Life Style Link Literature Low income Mails Maintenance Measures Mediating Medical Medical Surveillance Medicine Mental Depression Mental Health Metabolic Control Neighborhoods Neuropathy New York New York City Non-Insulin-Dependent Diabetes Mellitus Outcome Outcome Study Patient Education Patient Self-Report Patients Pattern Perception Policies Population Population Attributable Risks Population Surveillance Prevalence Prevention Printing Problem Solving Process Provider Psychosocial Factor Public Health Quality of Care Randomized Randomized Controlled Trials Rate Records Registries Reporting Research Personnel Research Training Retinal Diseases Risk Risk Reduction Sampling Screening procedure Secondary Prevention Self Management Staging Standards of Weights and Measures Statistically Significant System Telephone Testing Translations Uncertainty United Kingdom United States Department of Veterans Affairs Walkers Woman base cardiovascular disorder risk college cost design diabetes management diabetes risk glycemic control improved innovation medication compliance men mortality patient oriented programs prospective psychosocial response sex therapy design type I and type II diabetes urban area

项目摘要

DESCRIPTION (provided by applicant): Metabolic control of diabetes, measured by hemoglobin A1c (HbA1c), reduces the risk of microvascular complications. Health care providers frequently do not meet standards for managing HbA1c and individuals with diabetes are often not aware of their HbA1c values. To address these issues and reduce population- attributable risk due to elevated HbA1c, the New York City Department of Health and Mental Hygiene (DOHMH) developed an innovative HbA1c registry, which requires all major laboratories to report HbA1c results electronically. We propose to utilize this registry to conduct a randomized controlled trial addressing the following specific aims: 1) to evaluate the incremental effect of a tiered and tailored, patient-centered telephone intervention, in English and Spanish, on the mean HbA1c levels beyond that achieved with print materials mailed to patients and providers by the DOHMH registry intervention; 2) determine what patient demographic and psychosocial factors mediate the effect of the interventions; and 3) provide estimates of implementation costs of the tiered, tailored telephone intervention for comparison with the print intervention. The individual is the unit of sampling, assignment and analysis. After eligibility is assessed and informed consent is obtained by telephone, the individual will be randomly assigned to one of the two groups. The patient telephone intervention will focus on collaborative problem solving for resolving barriers to medication adherence, improving lifestyle behaviors, and communicatiing effectively with their providers. The print materials from the DOHMH will communicate HbA1c results to patients and their providers, with strategies to improve them. The study outcome will be change in HbA1c values from the registry records from baseline to one-year post-randomization. A total of 941 individuals with diabetes will be needed to provide 83% power to detect a statistically significant difference (p<0.05) between groups of at least 0.3% in absolute HbA1c. Psychosocial data on depression, health behaviors, and risk perceptions will be collected by telephone. Intervention cost data will be evaluated for translation of findings and scalability. At study end, we will know the extent to which this intervention will improve metabolic control in a low-income, multi-ethnic sample who are part of the DOHMH HbA1c registry in the South Bronx, New York. These findings will inform public health policies and practices in New York City, as well as other urban areas throughout the nation.

描述（由申请人提供）：由血红蛋白A1C（HBA1C）测量的糖尿病的代谢控制可降低微血管并发症的风险。医疗保健提供者经常不符合管理HBA1C的标准，糖尿病患者通常不知道其HBA1C值。为了解决这些问题并减少由于HBA1C升高而造成的人口风险，纽约市卫生与精神卫生部（DOHMH）开发了创新的HBA1C注册中心，该注册表要求所有主要的实验室以电子方式报告HBA1C结果。我们建议利用该注册表进行一项随机对照试验，以解决以下特定目的：1）评估以英语和西班牙语的分层和量身定制的，以患者为中心的，以患者为中心的，以患者为中心的电话干预，对用DOHMM寄给患者和提供者达到的平均HBA1C水平，该水平的平均HBA1C水平； 2）确定哪些患者人口和社会心理因素介导了干预措施的影响； 3）提供估计分层的，量身定制的电话干预措施的实施成本，以与打印干预进行比较。个人是抽样，分配和分析的单位。评估资格并通过电话获得知情同意后，将随机分配给两个组之一。患者电话干预将集中于解决协作问题，以解决依从性，改善生活方式行为以及与提供者有效沟通的障碍。 DOHMH的印刷材料将通过改善它们的策略将HBA1C结果传达给患者及其提供者。研究结果将是HBA1C值从基线从基线到一年后的一年后的记录变化。在绝对HBA1C中，总共需要941名糖尿病患者提供83％的功率来检测至少0.3％的统计学差异（p <0.05）。有关抑郁症，健康行为和风险看法的社会心理数据将通过电话收集。干预成本数据将进行评估，以翻译发现和可伸缩性。在研究端，我们将知道这种干预措施将在多大程度上改善低收入，多民族样本的代谢控制，这些样本是纽约南布朗克斯市DOHMH HBA1C注册中心的一部分。这些发现将为纽约市以及全国其他城市地区的公共卫生政策和实践提供信息。