Effectiveness of advanced practice pharmacy services among American Indian and Alaska Native adults with diabetes

高级实践药房服务对美洲印第安人和阿拉斯加原住民成人糖尿病患者的有效性

基本信息

批准号：
9379777
负责人：
SPERO MARTIN MANSON
金额：
$ 25.66万
依托单位：
UNIVERSITY OF COLORADO DENVER
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-07-01 至 2020-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9379777
关键词：
Address Adult Affect Alaska Native American Indians Area Blood Pressure Cardiovascular Diseases Caring Characteristics Cholesterol Chronic Clinical Pharmacists Clinics and Hospitals Collaborations Colorado Communities Comorbidity Complex Data Death Rate Diabetes Mellitus Diagnosis Economics Effectiveness Electronic Health Record End stage renal failure Ethnic group Face Funding General Population Geography Goals Health Health Resources Health Services Health Services Accessibility Health Status Health education Health system Healthcare Heart Diseases High Prevalence Home environment Household Income Intervention Laboratories Leadership Length of Stay Life Style Medical Medical center Methods Modeling Monitor Morbidity - disease rate Native-Born Nature Non-Insulin-Dependent Diabetes Mellitus Not Hispanic or Latino Outcome Patient risk Patient-Focused Outcomes Patients Persons Pharmaceutical Preparations Pharmaceutical Services Pharmacists Pharmacy facility Physicians Play Policies Population Prevalence Primary Health Care Provider Reporting Research Infrastructure Resources Risk Risk Factors Role Rural Services Site Stroke Structure Supervision System Techniques Testing Time Translating Treatment Cost Tribes United States Indian Health Service Universities Update Visit cardiovascular disorder risk cost cost effective cost effectiveness early onset electronic data experience health care delivery high risk improved improved outcome insight institutional capacity medication compliance meetings mortality multidisciplinary patient oriented patient registry prevent racial and ethnic service utilization telehealth time use tribal leader urban Native American

项目摘要

Effectiveness of advanced practice pharmacy services among American Indian and Alaska Native adults with diabetes The Indian Health Service (IHS) funds services for approximately 2.2 million American Indians and Alaska Natives (AI/ANs).IHS health care resources are strained due to limited per capita spending, the disproportionate high costs of treating AI/ANs with diabetes, and provider shortages. All-cause mortality of AI/ANs is 46% higher than that of non-Hispanic whites, attributable in part to higher mortality associated with diabetes. Within IHS, the provision of advanced practice pharmacy (APP) services for adults with diabetes has increased. During fiscal year (FY) 2008, approximately 1% of AI/ANs with diabetes used APP. Just 5 years later, 9.6% (n=4,620) had at least 1 APP visit in FY2013. To date, IHS has not had the institutional capacity to fully characterize the provision of APP services, nor study its effectiveness or costs. Given the need to both improve outcomes for patients with diabetes and effectively utilize limited IHS resources, this study's goal is to describe and assess the effectiveness of emerging models of APP within IHS for treatment of diabetes. Since 2010, IHS and Tribes have collaborated with the Centers for American Indian and Alaska Native Health at the University of Colorado to create a longitudinal data infrastructure with health status, service utilization, and treatment cost data for over 640,000 AI/ANs who represent nearly 30% of AI/ANs who use IHS services. The infrastructure, created through the Improving Health Care Delivery Data Project, is a synthesis of existing electronic data from multiple IHS platforms and currently includes data for 7 years (FY2007-2013) for 15 project sites. We propose to continue this collaboration by updating the infrastructure with recent data (FY2014-2017) to evaluate APP effectiveness among AI/AN adults with diabetes using statistical techniques made possible by the longitudinal data. The study has 3 aims: 1. Characterize APP delivery models for adults with diabetes within sites and over time using site characteristics and patient health risk profiles (e.g., glycemic level [A1c], blood pressure [BP], cholesterol [CHL], cardiovascular disease). We anticipate that up to 3 models may emerge (e.g., Targeted, Limited, and General); and 2. For each APP model, evaluate the nature and extent of the relationship between patient APP use and outcomes. Within each model, we expect that APP will improve medication adherence and A1c, BP, and CHL levels, and reduce onset of complications and preventable hospital stays; and 3. Estimate APP delivery costs, treatment cost changes associated with lower use of other health services, and cost-effectiveness. We expect the APP models to be cost-effective. 1

高级实践药房服务对美洲印第安人和阿拉斯加原住民成年人的有效性糖尿病印第安人健康服务 (IHS) 资助为大约 220 万美洲印第安人和阿拉斯加人提供服务当地人 (AI/AN)。由于人均支出有限，IHS 医疗保健资源紧张，治疗患有糖尿病的 AI/AN 的成本过高，而且医疗服务提供者短缺。全因死亡率 AI/AN 的死亡率比非西班牙裔白人高 46%，部分原因是与以下疾病相关的死亡率较高糖尿病。在 IHS 内，为成人糖尿病患者提供高级实践药房 (APP) 服务增加。 2008 财年 (FY) 期间，大约 1% 患有糖尿病的 AI/AN 使用 APP。仅仅5年后来，9.6% (n=4,620) 在 2013 财年至少访问过 1 次 APP。迄今为止，IHS 尚不具备机构能力充分描述APP服务的提供，也不研究其有效性或成本。鉴于需要改善糖尿病患者的预后并有效利用有限的 IHS 资源，本研究的目标是描述和评估 IHS 内新兴 APP 模型的有效性用于治疗糖尿病。自 2010 年以来，IHS 和 Tribes 与美国印第安人中心合作和科罗拉多大学的阿拉斯加原住民健康中心合作创建一个健康纵向数据基础设施超过 640,000 名 AI/AN 的状态、服务利用率和治疗成本数据，这些数据占了近 30% 使用 IHS 服务的 AI/AN。通过改善医疗保健服务数据创建的基础设施项目是来自多个 IHS 平台的现有电子数据的综合，目前包括 7 个项目的数据年（2007-2013 财年）15 个项目地点。我们建议通过更新使用最新数据（2014-2017 财年）的基础设施来评估 APP 在患有以下疾病的 AI/AN 成年人中的有效性利用纵向数据的统计技术使糖尿病成为可能。该研究有 3 个目标： 1. 描述成人糖尿病患者在网站内以及随着时间的使用网站的 APP 交付模式特征和患者健康风险概况（例如血糖水平 [A1c]、血压 [BP]、胆固醇[CHL]、心血管疾病）。我们预计可能会出现最多 3 种模型（例如，有针对性、有限性和一般性）；和 2. 对于每个 APP 模型，评估患者 APP 使用与患者之间关系的性质和程度结果。在每个模型中，我们预计 APP 将改善药物依从性以及糖化血红蛋白 (A1c)、血压 (BP) 和 CHL 水平，并减少并发症的发生和可预防的住院时间；和 3. 估计 APP 交付成本、与其他卫生服务使用率降低相关的治疗成本变化，和成本效益。我们预计 APP 模式具有成本效益。 1