Improving Care Utilization and Outcomes in Transitioning Youth with Diabetes

改善患有糖尿病的青少年的护理利用和结果

• 批准号: 8751484
• 负责人: Katharine Garvey
• 金额: $ 17.89万
• 依托单位: BOSTON CHILDREN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-22 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8751484
• 关键词: Accident and Emergency department; Achievement; Acute; Adherence; Adolescence; Adolescent; Adolescent and Young Adult; Adult; Age; Ambulatory Care; Area; Award; Biometry; Caring; Childhood; Chronic; Clinical; Communities; Complications of Diabetes Mellitus; Consensus; Data; Data Analyses; Development; Diabetes Mellitus; Doctor of Medicine; Economics; Education; Educational Curriculum; Elderly; Elements; Endocrinologist; Enrollment; Ensure; Epidemiology; Evaluation; Fellowship; Focus Groups; Frequencies; Funding; Glean; Goals; Group Structure; Guidelines; Health; Health Services; Health Services Research; Health system; Healthcare; Healthcare Systems; Hospitalization; Hypoglycemia; Individual; Insulin-Dependent Diabetes Mellitus; Interruption; Intervention; Intervention Studies; K-Series Research Career Programs; Kidney Diseases; Knowledge; Lead; Lipids; Master of Public Health; Measures; Medical; Mentored Patient-Oriented Research Career Development Award; Mentorship; Methods; Microvascular Dysfunction; Modeling; Monitor; National Health Insurance; Outcome; Outcomes Research; Outpatients; Parents; Patients; Pattern; Patterns of Care; Positioning Attribute; Preparation; Process; Qualitative Methods; Qualitative Research; Quality of Care; Randomized; Readiness; Regimen; Reliance; Research; Research Design; Research Personnel; Retinal; Retinal Diseases; Risk; Sampling; Sampling Studies; Self Care; Self Efficacy; Self Management; Services; Teenagers; Testing; Urine; Visit; Youth; adverse outcome; base; career; career development; clinical practice; emerging adult; expectation; experience; follow-up; glycemic control; health care delivery; health care service utilization; health related quality of life; implementation science; improved; meetings; mortality; peer; public health relevance; screening; skills; social; standard care; therapy design; tool; young adult

Project Summary/Abstract Young adults with type 1 diabetes (T1D) are at risk for poor glycemic control and adverse diabetes-related health outcomes. There is broad consensus that the lack of coordinated transition from pediatric to adult diabetes care contributes to this risk. A high-quality transition from pediatric to adult diabetes care - encompassing both self-management and uninterrupted follow-up - is an imperative goal. Katharine Garvey, M.D., M.P.H., a pediatric endocrinologist and early health services researcher, will target this understudied area in her Mentored Patient-Oriented Research Career Development Award. Dr. Garvey is uniquely positioned to use this award to launch an independently-funded research career. She completed a fellowship in health services research, through which she gained experience in epidemiology, biostatistics and study design, and she has conducted several preliminary studies in T1D health care transition. Through her proposed career development, she now seeks to gain skills in advanced data analysis (including claims data, longitudinal data, and qualitative data analysis) as well as health intervention design, implementation and evaluation. To achieve these objectives, Dr. Garvey has assembled a multi-disciplinary mentorship team led by national experts in pediatric diabetes outcomes research, general health services research and implementation science, qualitative research, and health care transition. In Aim 1, Dr. Garvey will use data from a national health insurance plan with an annual enrollment of >30 million individuals to examine patterns of care utilization, diabetes monitoring practices, and clinical outcomes in a diverse national sample of 15-<25 year-old T1D patients. In Aim 2, she will use qualitative methods to understand the expectations and priorities of older teens with T1D, their parents, and young adults with T1D. Incorporating focus group findings along with knowledge gleaned from the national sample studied in Aim 1, Dr. Garvey will develop a structured group medical visit curriculum to enhance T1D self-management and transition preparation. In Aim 3, she will implement this curriculum and assess the feasibility of the group medical visit intervention and impact on diabetes self-care and transition readiness. Dr. Garvey's K23 research will form the basis for a fully powered T1D transition intervention study, to be proposed in an R01 application at the end of the K23 period. Dr. Garvey seeks to become an independent researcher with expertise in health outcomes and health care delivery research in youth with T1D, with the long-term objective of investigating how interventions during adolescence can lead to sustained improvements in self-management and health outcomes in young adulthood. Through the proposed career development award, she will acquire important skills in quantitative and qualitative methods and intervention research to ensure achievement of these goals.

项目摘要/摘要 患有1型糖尿病（T1D）的年轻人面临不良血糖控制和与糖尿病相关的不良风险 健康结果。有广泛共识，缺乏从小儿到成人的协调过渡 糖尿病护理有助于这种风险。从小儿到成人糖尿病护理的高质量过渡 - 涵盖自我管理和不间断的后续行动 - 是急需的目标。凯瑟琳·加维（Katharine Garvey）， 小儿内分泌学家和早期卫生服务研究人员M.D.，M.P.H. 她指导的面向患者的研究职业发展奖中的领域。 Garvey博士是独特的 可以使用该奖项来启动独立资助的研究职业。她完成了一项研究金 卫生服务研究，通过该研究获得了流行病学，生物统计学和研究设计的经验， 她已经在T1D医疗保健过渡方面进行了几项初步研究。通过她提议的职业 她现在试图获得高级数据分析的技能（包括索赔数据，纵向数据， 和定性数据分析）以及健康干预设计，实施和评估。 为了实现这些目标，Garvey博士召集了一个由多学科的指导团队 儿科糖尿病结果研究，一般健康服务研究和实施的国家专家 科学，定性研究和医疗保健过渡。在AIM 1中，Garvey博士将使用来自国家的数据 健康保险计划，年度入学率> 3000万个人，以检查护理模式 在15至25岁的各种国家样本中，利用，糖尿病监测实践和临床结果 T1D患者。在AIM 2中，她将使用定性方法来了解老年人的期望和优先事项 与T1D的青少年，他们的父母和T1D的年轻人。结合焦点小组的发现以及 从AIM 1中研究的国家样本中收集的知识，Garvey博士将开发一个结构化组 医疗访问课程，以增强T1D的自我管理和过渡准备。在AIM 3中，她会 实施此课程并评估小组医疗访问干预的可行性并影响 糖尿病自我保健和过渡准备。 Garvey博士的K23研究将构成完全动力的基础 T1D过渡干预研究，将在K23时期结束时在R01应用中提出。 Garvey博士试图成为拥有健康成果和医疗保健专业知识的独立研究人员 T1D青年的交付研究，其长期目标是调查如何在 青春期可以导致年轻人的自我管理和健康成果的持续改善 成年。通过拟议的职业发展奖，她将获得定量的重要技能 以及定性方法和干预研究，以确保实现这些目标。