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

美洲印第安人和阿拉斯加原住民成年人的高级实践药房服务的有效性糖尿病印度卫生服务（IHS）为大约220万美洲印第安人和阿拉斯加提供了资金服务当地人（AI/ANS）.IHS医疗保健资源由于人均支出有限而紧张患有糖尿病和提供者短缺的AI/ANS的高昂成本不成比例。全因死亡率 AI/ANS比非西班牙裔白人高46％，部分归因于较高的死亡率糖尿病。在IHS中，为成人糖尿病的成人提供高级实践药房（APP）服务增加。在2008财政年度（FY）期间，大约1％的AI/ANS使用糖尿病使用了应用。只有5年后来，2013财年9.6％（n = 4,620）至少有1个应用程序访问。迄今为止，IHS还没有机构的能力充分表征应用程序服务的提供，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中应用程序新兴模型的有效性用于治疗糖尿病。自2010年以来，IHS和部落与美洲印第安人中心合作科罗拉多大学的阿拉斯加本地健康，以创建具有健康的纵向数据基础设施超过640,000 AI/ANS的状态，服务利用和治疗费用数据占近30％使用IHS服务的AI/ANS。通过改进的医疗保健提供数据创建的基础设施项目是来自多个IHS平台现有电子数据的合成，目前包括7个数据 15个项目地点的年（2007-2013财年）。我们建议通过更新具有最新数据的基础架构（2017财年），以评估AI/A的成年人的应用程序效率使用纵向数据使使用统计技术成为可能的糖尿病。该研究有3个目标： 1。表征现场内患有糖尿病的成年人的应用程序交付模型，并且随着时间的推移使用现场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）。我们预计最多可能会出现3种模型（例如有针对性，有限和一般）；和 2。对于每个应用程序模型，评估患者应用使用与结果。在每个模型中，我们希望应用程序将改善药物依从性和A1C，BP和 CHL水平，并减少并发症的发作和可预防的住院；和 3。估计应用程序交付成本，与其他卫生服务使用降低使用相关的治疗成本变化，和成本效益。我们希望应用程序模型具有成本效益。 1