Using CERs to Optimize Quality of Life for Persons with Diabetes and Chronic Pain

使用 CER 优化糖尿病和慢性疼痛患者的生活质量

• 批准号: 8008653
• 负责人: Monika M Safford
• 金额: $ 149.78万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2013-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8008653
• 关键词: Using; CERs; Optimize; Quality; Life

DESCRIPTION (provided by applicant): Comparative effectiveness research results, such as AHRQ's Comparative Effectiveness Reviews (CER), should reach all Americans, even hard-to-reach vulnerable groups. We propose a study in the Alabama Black Belt, which includes mostly African Americans (AA), 1/3 living below the Federal poverty line and facing distance, cost and mistrust barriers to receiving healthcare services. We target a very common clinical problem in need of quality improvement: patients with chronic pain, osteoarthritis (OA) and diabetes (DM). While medication management, including CER content, is a mainstay of OA and DM therapy, biopsychosocial approaches based on cognitive-behavioral therapy (CBT) principles can improve functioning and reduce reliance on medications, which have risks for DM patients. We will examine the implementation of five CERs in clinical decision-making in the course of testing the effectiveness of a community health worker (CHW)- delivered program to improve functional status and DM metabolic parameters. To test the hypothesis that intervention group patients will have improved outcomes compared with controls, we aim to: 1: ADAPT Five CERs on OA and DM to enhance use and value in decision-making, using formative evaluation to assess needs. We will work iteratively with (1) primary care providers, to incorporate adapted materials into a state-of-the-art interactive, multimodal CME program; and (2) with Black Belt residents, to develop culturally relevant patient education materials, and incorporate them into a CHW-delivered DM-pain intervention designed to empower and activate patients, based on CBT principles. 2: TEST the CHW-delivered 16-week intervention in a group randomized trial including 400 patients with chronic pain, OA and DM. The trial will have 80% power to detect differences in functional status scores as low as 0.7, A1c >0.4%, systolic blood pressure >4 mmHg, and low density lipoprotein cholesterol >6 mg/dl (primary outcomes). Secondary outcomes include CER utilization in clinical decision-making, pain, and self- care behaviors. Providers in both arms will receive CME on the CERs. Intervention arm patients will receive the CHW empowerment intervention on pain and DM self-care with integrated CER content, and "attention" control arm patients will receive a didactic health education program without empowerment. 3: DISSEMINATE the CER products of the study through AHRQ and the UAB CME department to physicians nationally, and through the UAB School of Nursing's on-line curriculum to nurses worldwide. Dissemination products include (1) Robust evidence on whether CHWs improve CER implementation in a hard-to-reach vulnerable group; (2) On-line CME for primary care physicians and nurses on five CER topics; (3) On-line CHW training curriculum to improve health outcomes for individuals with chronic pain, OA and DM; (4) Consumer information materials tailored for southern rural AA communities on five CER topics. The trial leverages tools and infrastructure of an ongoing study and will inform policy decisions on CHWs. PUBLIC HEALTH RELEVANCE: We propose a randomized trial to test a Community Health Worker (CHW) intervention to improve chronic pain and diabetes for patients with pain, diabetes and osteoarthritis in vulnerable, hard-to-reach patients living in Alabama's rural and impoverished Black Belt. The trial will test whether the CHW intervention has greater impact than provider education alone. In the course of the trial, we will examine how five Comparative Effectiveness Reviews can be adapted to best impact clinical decision-making to improve health outcomes.

描述（由申请人提供）：比较有效性研究结果，例如 AHRQ 的比较有效性审查 (CER)，应该惠及所有美国人，甚至是难以接触到的弱势群体。我们提议在阿拉巴马州黑带地区进行一项研究，该地区主要包括非裔美国人 (AA)，其中 1/3 生活在联邦贫困线以下，在接受医疗服务方面面临距离、成本和不信任障碍。我们针对的是一个非常常见、需要质量改进的临床问题：患有慢性疼痛、骨关节炎 (OA) 和糖尿病 (DM) 的患者。虽然包括 CER 内容在内的药物管理是 OA 和 DM 治疗的支柱，但基于认知行为治疗 (CBT) 原则的生物心理社会方法可以改善功能并减少对药物的依赖，而药物对 DM 患者存在风险。在测试社区卫生工作者 (CHW) 实施的改善功能状态和 DM 代谢参数计划的有效性的过程中，我们将检查五个 CER 在临床决策中的实施情况。为了检验干预组患者与对照组患者相比将获得更好结果的假设，我们的目标是： 1：调整关于 OA 和 DM 的 5 个 CER，以增强决策中的使用和价值，使用形成性评估来评估需求。我们将与 (1) 初级保健提供者反复合作，将改编材料纳入最先进的交互式、多模式 CME 计划； (2) 与黑带居民一起开发与文化相关的患者教育材料，并将其纳入 CHW 提供的 DM 疼痛干预措施中，旨在根据 CBT 原则赋予患者权力并激活患者。图 2：在一项纳入 400 名慢性疼痛、OA 和 DM 患者的随机分组试验中测试 CHW 提供的为期 16 周的干预措施。该试验将有 80% 的功效检测低至 0.7 的功能状态评分差异、A1c > 0.4%、收缩压 > 4 mmHg 和低密度脂蛋白胆固醇 > 6 mg/dl（主要结果）。次要结果包括临床决策、疼痛和自我护理行为中 CER 的利用。两个分支的提供者都将获得 CER 上的 CME。干预臂患者将接受 CHW 对疼痛和 DM 自我护理的赋权干预，并包含综合 CER 内容，“注意力”控制臂患者将接受不赋权的教学健康教育计划。 3：通过 AHRQ 和 UAB CME 部门向全国医生传播该研究的 CER 产品，并通过 UAB 护理学院的在线课程向世界各地的护士传播。传播产品包括 (1) 关于社区卫生工作者是否改善难以接触到的弱势群体的 CER 实施的有力证据； (2) 针对初级保健医生和护士的五个 CER 主题的在线 CME； (3) 在线社区卫生工作者培训课程，以改善慢性疼痛、骨关节炎和糖尿病患者的健康结果； (4) 为南方农村 AA 社区量身定制的关于五个 CER 主题的消费者信息材料。该试验利用了正在进行的研究的工具和基础设施，并将为社区卫生工作者的政策决策提供信息。 公共卫生相关性：我们提出一项随机试验，以测试社区卫生工作者 (CHW) 的干预措施，以改善生活在阿拉巴马州农村和贫困黑带地区的弱势、难以接触到的患有疼痛、糖尿病和骨关节炎的患者的慢性疼痛和糖尿病。该试验将测试社区卫生工作者的干预是否比单独的提供者教育具有更大的影响。在试验过程中，我们将研究如何调整五项比较有效性审查，以最大程度地影响临床决策，从而改善健康结果。