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: 9313250
• 负责人: Katharine Garvey
• 金额: $ 19.58万
• 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 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9313250
• 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; Emergency department visit; 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; 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; career; career development; emerging adult; expectation; experience; follow-up; glycemic control; health care delivery; health care service utilization; health related quality of life; implementation science; improved; mortality; multidisciplinary; peer support; portability; public health relevance; screening; skills; social; standard care; therapy design; tool; young adult

DESCRIPTION (provided by applicant): 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.

描述（由申请人提供）：患有1型糖尿病（T1D）的年轻人有患血糖控制不良和与糖尿病相关的不良健康结果的风险。人们普遍共识，缺乏从小儿到成人糖尿病护理的协调过渡会导致这种风险。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随访 - 是一个势在必行的目标。儿科内分泌学家和早期卫生服务研究人员M.D. Katharine Garvey，M.P.H.，将针对她受过指导的以患者为导向的研究职业发展奖的该研究不足的领域。 Garvey博士在使用该奖项来启动独立资助的研究职业方面拥有独特的位置。她完成了一项卫生服务研究奖学金，通过该研究获得了流行病学，生物统计学和研究设计方面的经验，并且在T1D卫生保健过渡方面进行了几项初步研究。通过她提出的职业发展，她现在寻求获得高级数据分析（包括索赔数据，纵向数据和定性数据分析）的技能，以及健康干预设计，实施和评估。为了实现这些目标，Garvey博士召集了一个由儿科糖尿病成果研究，通用卫生服务研究和实施科学，定性研究和医疗保健过渡的国家专家领导的多学科指导团队。在AIM 1中，Garvey博士将使用一项全国健康保险计划中的数据，年度入学率> 3000万个人来检查护理利用模式，糖尿病监测实践和临床结果，包括15- <25岁的T1D患者的各种国家样本。在AIM 2中，她将使用定性方法来了解与T1D的T1D，其父母和年轻人T1D的年龄较大的青少年的期望和优先事项。将焦点小组的调查结果与AIM 1中研究的国家样本收集的知识结合在一起，Garvey博士将开发一个结构化的小组医疗访问课程，以增强T1D的自我管理和过渡准备。在AIM 3中，她将实施此课程，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就绪。 Garvey博士的K23研究将构成全功率的T1D过渡干预研究的基础，该研究将在K23时期结束时在R01应用中提出。 Garvey博士试图成为具有T1D青年健康成果和医疗保健提供研究专业知识的独立研究人员，其长期目标是调查青少年期间的干预措施如何导致年轻成年期的自我管理和健康成果的持续改善。通过拟议的职业发展奖，她将获得定量和定性方法和干预研究的重要技能，以确保实现这些目标。

项目成果

Preparation for Transition to Adult Care Among Medicaid-Insured Adolescents.

医疗补助保险青少年过渡到成人护理的准备。

• DOI: 10.1542/peds.2016-2768
• 发表时间: 2017
• 期刊: Pediatrics
• 影响因子: 8
• 作者: Sawicki,GregoryS;Garvey,KatharineC;Toomey,SaraL;Williams,KathrynA;Hargraves,JLee;James,Thomas;Raphael,JeanL;Giardino,AngeloP;Schuster,MarkA;Finkelstein,JonathanA
• 通讯作者: Finkelstein,JonathanA