Enhancing Self-Management Support in Diabetes through Patient Engagement

通过患者参与加强糖尿病的自我管理支持

基本信息

批准号：
9322578
负责人：
Danielle Marie Hessler
金额：
$ 65.7万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-09-01 至 2020-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9322578
关键词：
Address Adopted Adoption Age Area Attention Behavior Behavior Control Behavioral Caring Characteristics Clinical Clinical Research Community Health Centers Complications of Diabetes Mellitus Diabetes Mellitus Diet Distress Effectiveness Effectiveness of Interventions Emotions Ethnic Origin Evidence based program Gender Glycosylated hemoglobin A Goals Health Health behavior Healthcare Systems Home environment Hybrids Insulin Intervention Maintenance Medical Medical Care Team Medical center Motivation Non-Insulin-Dependent Diabetes Mellitus Outcome Patients Physical activity Primary Health Care Process Program Effectiveness Protocols documentation Randomized Research Resources Risk Role Self Management Structure Technology Testing Time Use Effectiveness Vulnerable Populations behavior change chronic care model compare effectiveness cost cost effectiveness demographics depressive symptoms design diabetes risk diet and exercise ethnic diversity evidence base glycemic control improved information gathering medication compliance motivational enhancement therapy patient home care patient oriented pragmatic trial primary care setting primary outcome programs psychosocial public health relevance relative effectiveness secondary outcome tool

项目摘要

DESCRIPTION (provided by applicant): The Patient Centered Medical Home (PCMH) and the Chronic Care Model (CCM) are complementary clinical intervention frameworks that are commonly invoked to support better type 2 diabetes (T2DM) outcomes in primary care. Self-management Support (SMS) is a core component of both the PCMH and CCM, and focuses on the central role of patients in managing their illness by engaging with and adopting healthy behaviors that promote optimal clinical outcomes. Despite its recognized importance, SMS programs for diabetes continue to demonstrate limited effectiveness in the real-world of primary care. SMS is comprised of two complementary and interactive components: (1) patient engagement (e.g., the process of eliciting and responding to patients emotions and motivations related to health behaviors), and (2) behavioral change tools (e.g., selecting specific goals, creating action plans). While several sophisticated SMS programs have been developed for T2DM, the vast majority are designed with a narrow focus on behavioral change tools, largely ignoring unique aspects of the patient context that drive and maintain health behavior. Considerable clinical research suggests that the addition of a structured, evidenced-based program of patient engagement can maximize the effectiveness of SMS programs for patients with T2DM in primary care. To date, however, there has been no systematic study of the degree to which fully integrating enhanced patient engagement as part of SMS will increase the initiation and maintenance of behavior change over time, and for which kinds of patients enhanced patient engagement is essential. To address this gap, we propose to compare a state-of-the-art, evidence-based SMS behavior change tool program, called Connection to Health (CTH), with an enhanced CTH program that includes a practical, time-efficient patient engagement protocol, to create a program with an integrated and comprehensive approach to SMS, which we call "Enhanced Engagement CTH" (EE-CTH). The current study will directly test the added benefit of EE-CTH to CTH with regard to self-management behaviors and glycemic control in resource-limited community health centers, where vast numbers of patients with T2DM from ethnically diverse and medically vulnerable populations receive their care. We will use an effectiveness-implementation hybrid design, employing the RE-AIM framework to test these two SMS programs for T2DM. This will provide critical information that will support dissemination and implementation of effective SMS programs in resource-limited primary care settings, serving diverse and medically vulnerable populations with much to gain from improved SMS.

描述（由适用提供）：以患者为中心的医疗住所（PCMH）和慢性护理模型（CCM）是完整的临床干预框架，通常被调用以支持基层医疗中更好的2型糖尿病（T2DM）结果。自我管理支持（SMS）是PCMH和CCM的核心组成部分，并专注于患者通过与健康行为互动并采用促进最佳临床结果的健康行为来管理疾病的核心作用。尽管具有公认的重要性，但SMS糖尿病计划仍表现出在原始保健现实世界中的有效性有限。 SMS由两个完整且互动的组成部分组成：（1）患者参与度（例如，引起和响应患者的情绪和与健康行为相关的患者的情绪和动机）以及（2）行为改变工具（例如，选择特定的目标，创建动作，创建了几个精致的SMS计划，而具有t2dm的范围的范围为狭窄的行为，这些动作是为了制定了一些精致的范围，该方面涉及狭窄的行为，这些方面涉及狭窄的行为，这些方面是行为的范围，而行为则是范围的行为。并保持健康行为。为了解决这一差距，我们建议比较一个最先进的基于证据的SMS行为改变工具计划，称为与健康联系（CTH），并具有增强的CTH程序，其中包括一种实用，时间效率高的患者参与方案，以创建一种具有集成和全面的SMS方法的程序，我们称之为“增强的参与CTH”（EE-ee-cth）。当前的研究将直接测试EE-CTH对CTH的额外好处，在资源有限的社区卫生中心中，在自我管理行为和血糖控制方面，来自种族多样化和医疗脆弱人群的大量T2DM患者获得了护理。我们将使用RE-AIM框架来测试T2DM的这两个SMS程序，我们将使用有效性实施混合设计。这将提供关键信息，这些信息将支持在资源有限的初级保健环境中传播和实施有效的SMS计划，为潜水员和医学脆弱的人群提供服务，并从改善的SMS中获得很多收益。