Community to Clinic Navigation to Improve Diabetes Outcomes

社区到诊所导航以改善糖尿病治疗结果

基本信息

批准号：
9750672
负责人：
Nancy E. Schoenberg
金额：
$ 64.78万
依托单位：
UNIVERSITY OF KENTUCKY
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：
2017-08-01 至 2022-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9750672
关键词：
Address Affect American Appalachian Region Biometry Blood Pressure Church Clinic Clinical Communities Community Health Aides Complications of Diabetes Mellitus Data Diabetes Mellitus Diagnosis Education Environment Epidemic Evidence based intervention Focus Groups Future Glycosylated hemoglobin A Goals Health Health care facility Healthcare Individual Influentials Intervention Interview Kentucky Lipids Low income Mediator of activation protein Non-Insulin-Dependent Diabetes Mellitus Outcome Participant Patients Persons Pilot Projects Population Positioning Attribute Prediabetes syndrome Protocols documentation Randomized Randomized Controlled Trials Recruitment Activity Research Research Activity Rural Rural Population Self Management Social support Talents Testing Training Vulnerable Populations Work adverse outcome arm base behavioral outcome clinical care community center community setting cost effectiveness design diabetes control evidence base glycemic control health care quality health care service organization health disparity health professional shortage areas improved improved outcome innovation low socioeconomic status meetings member outreach primary outcome programs randomized trial recruit relative cost rural dwellers satisfaction self-management program social theories waist circumference

项目摘要

ABSTRACT Reducing adverse outcomes from Type 2 Diabetes Mellitus (T2DM) requires optimal self-management and appropriate clinical care.1 Combining an evidence-based intervention to improve diabetes self-management with individually-tailored patient navigation to improve appropriate clinical care holds great promise. Only one known randomized controlled trial has been tested that combines these two most essential components of diabetes control. That trial resulted in improvements to glycemic control, blood pressure, and diabetes self- management, but was implemented in a clinical setting.2 We aim to enhance this work by recruiting from and locating most research activities in community-based settings to insure involvement of the most vulnerable, hardest to reach populations who may not be receiving regular health care and by leveraging Community Health Workers and Patient Navigators, who are essential and sustainable outreach workers in health care professional shortage areas. We propose testing a refined intervention, “Community to Clinic Navigation” (CCN), shown to be promising, feasible, and acceptable in our pilot study. Given that Appalachian and rural residents maintain disproportionately high rates of T2DM and suffer tremendous burdens from diabetic complications,3 this setting provides a perfect opportunity to test the intervention with a hard to reach population while addressing health inequities. We will administer a 3 arm group randomized design including (1) Diabetes Self-management Program, DSMP only; (2) tailored Patient Navigation, PN only; and (3) the combined DSMP + PN: Community to Clinic Navigation program, CCN. Outcomes include biometrics (HbA1c, BMI, blood pressure, lipids, waist circumference); diabetes self-management and clinic attendance, as mediators of the primary outcomes; cost effectiveness and participant satisfaction. Persons with diabetes will be recruited through churches and other community venues. Our project leverages sustainable assets available in most health disparity communities-- faith organizations, community centers, federally qualified health clinics, strong social ties, and talented local lay people who can be trained to educate and navigate those diagnosed with T2DM. Our sustained involvement in Appalachian Kentucky positions our team to appropriately and efficiently test this promising program with strong potential for future dissemination to other traditionally underserved environments.

抽象的减少2型糖尿病（T2DM）的广告结果需要最佳的自我管理和 1结合基于证据的干预措施以改善糖尿病自我管理通过单独量身定制的患者导航以改善适当的临床护理，这有很大的希望。只有一个已测试已知的随机对照试验，结合了这两个最重要的组成部分糖尿病控制。该试验改善了血糖控制，血压和糖尿病自我管理，但在临床环境中实施。2我们旨在通过从和在基于社区的环境中找到大多数研究活动，以确保最脆弱的参与最难接触可能没有获得定期医疗保健并利用社区的人群卫生工作者和患者导航员，他们是卫生保健领域必不可少且可持续的外展工作者专业短缺地区。我们建议测试精致的干预措施，“诊所导航社区”（CCN），证明是有希望的，可行，在我们的试点研究中可以接受。鉴于阿巴拉契亚人和粗糙的居民维持 T2DM的比例不成比例，并且因糖尿病并发症而遭受巨大的烧伤，3此环境提供了一个绝佳的机会，可以在解决健康的同时以难以到达的人群来测试干预措施不平等。我们将管理一个3 ARM组随机设计，包括（1）糖尿病自我管理程序，仅DSMP；（2）量身定制的患者导航，仅PN；（3）组合的DSMP + PN：社区到诊所导航计划，CCN。结果包括生物识别技术（HBA1C，BMI，血压，脂质，腰部圆周）;糖尿病自我管理和诊所出勤，作为主要结果的介体；成本有效性和参与满意度。患有糖尿病的人将通过教堂和其他社区场所。我们的项目利用大多数健康差异社区可持续资产 - 信仰组织，社区中心，联邦合格的健康诊所，牢固的社会联系和才华横溢的地方可以接受培训以教育和导航被诊断为T2DM的人。我们持续参与阿巴拉契亚肯塔基州的职位，我们的团队适当有效地测试了这一诺言具有强大潜力将来传播到其他传统服务不足的环境的计划。