Design and Implementation of An Intervention to Improve Prediabetes Management in Primary Care

改善初级保健糖尿病前期管理的干预措施的设计和实施

基本信息

批准号：
9912767
负责人：
Eva Tseng
金额：
$ 19.84万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-04-10 至 2024-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9912767
关键词：
Address Adult Award Awareness Baltimore Behavioral Cardiovascular system Caring Centers for Disease Control and Prevention (U.S.)Chronic Disease Clinic Clinical Clinical Pathways Clinical Protocols Clinical Research Clinical Trials Complications of Diabetes Mellitus Computerized Medical Record Data Data Analytics Data Collection Data Set Data Sources Databases Development Development Plans Diabetes Mellitus Diabetes prevention Diagnosis Diagnostic Effectiveness Environment Evidence based intervention Funding Goals Grant Guidelines Health system Healthcare Healthcare Systems Human Resources Incidence Individual Institution Internal Medicine Intervention Intervention Studies Intervention Trial Interview Knowledge Leadership Learning Learning Module Life Style Life Style Modification Link Medical Mentored Patient-Oriented Research Career Development Award Mentors Metformin Methodology Methods Microvascular Dysfunction Modeling Monitor National Institute of Diabetes and Digestive and Kidney Diseases Neuropathy Online Systems Outcome Patients Performance Persons Pharmaceutical Preparations Play Population Prediabetes syndrome Premature Mortality Prevention Research Prevention trial Primary Health Care Provider Public Health Public Health Schools Reporting Research Research Personnel Research Training Resources Retrospective cohort study Risk Role Scientist Services Testing Time Training Training Activity Translating United States United States National Institutes of Health Universities Visit Woman Work analytical method cardiovascular disorder risk care providers career career development design diabetes prevention program diabetes risk epidemiology study evidence base evidence based guidelines follow-up group intervention high risk implementation science improved informant insurance claims insurance plan lifestyle intervention medical schools meetings patient engagement placebo group prevent primary care setting professor programs research and development routine practice screening skills success successful intervention therapy design tool trial comparing weight loss program

项目摘要

PROJECT SUMMARY/ABSTRACT Diabetes prevention is crucial for reducing the public health burden of diabetes in the United States. 84 million U.S. adults have prediabetes but 90% are undiagnosed. The NIH has prioritized finding efficient ways to translate outcomes achieved in diabetes prevention trials into routine healthcare practice. The National Diabetes Prevention Program recognizes lifestyle change programs meeting specific metrics that help prevent or delay diabetes. However, an effective model for engaging health systems and primary care providers in facilitating screening, testing and referral to these programs is lacking. There is currently no systematic approach to prediabetes management in the primary care setting, but it is essential for addressing the burden of diabetes. To address this need, we propose the following interrelated Specific Aims: 1) To conduct a retrospective cohort study to describe longitudinal primary care provider practices around the diagnosis and treatment of prediabetes using a linked claims and electronic medical record (EMR) dataset, 2) To conduct key informant interviews with stakeholders relevant to diabetes prevention, including leadership from health care system/clinics, insurance plan leaders, providers and patients, to identify barriers and facilitators to implementation, 3) To design and pilot test the diabetes prevention clinical pathway within a primary care clinic in Baltimore, MD, and evaluate its effectiveness on provider screening and intervention, and patient engagement in diabetes prevention over a period of 12 months. Dr. Eva Tseng is an Assistant Professor in the Division of General Internal Medicine and a clinical researcher at The Johns Hopkins University School of Medicine. Her long-term career goal is to become an independent clinician-investigator conducting pragmatic intervention studies with a focus on improving the prevention of diabetes in primary care. The proposed career development plan includes didactic and research training activities that will substantially build her skills in developing and implementing an intervention. These will include training in implementation science, clinical trial methods, quantitative data analytic methods for large claims/EMR databases, as well as qualitative data collection and analytic methods. This training will occur in the rich training environment of the Johns Hopkins Medical Institutions, including the Bloomberg School of Public Health and the Welch Center for Prevention, Epidemiology, and Clinical Research. She will receive guidance from her outstanding team of mentors and advisors with expertise in the methodologies needed for conducting the planned research, and a track record of mentoring and funding. The award and protected time will allow Dr. Tseng to build an independent NIH-funded research career and become a leader in pragmatic approaches to improve the prevention of diabetes in primary care with potential applications to other chronic diseases.

项目概要/摘要糖尿病预防对于减轻美国糖尿病的公共健康负担至关重要。 8400万美国成年人患有糖尿病前期，但 90% 的人未被诊断出来。 NIH 优先考虑寻找有效的翻译方法将糖尿病预防试验纳入常规医疗保健实践中所取得的成果。全国糖尿病协会预防计划认可生活方式改变计划，满足有助于预防或延迟的特定指标糖尿病。然而，让卫生系统和初级保健提供者参与促进这些计划缺乏筛查、测试和转介。目前尚无系统的方法初级保健机构中的糖尿病前期管理，但对于解决糖尿病负担至关重要。为了满足这一需求，我们提出以下相互关联的具体目标：1）进行回顾性队列研究研究描述纵向初级保健提供者围绕糖尿病前期诊断和治疗的实践使用链接的索赔和电子病历 (EMR) 数据集，2) 进行关键知情人访谈与糖尿病预防相关的利益相关者，包括医疗保健系统/诊所、保险的领导计划领导者、提供者和患者，以确定实施的障碍和促进因素，3) 设计和试点在马里兰州巴尔的摩的一家初级保健诊所测试糖尿病预防临床路径，并评估其效果提供者筛选和干预以及患者参与糖尿病预防的有效性期限为12个月。 Eva Tseng 博士是普通内科系的助理教授和临床研究员约翰·霍普金斯大学医学院。她的长期职业目标是成为一名独立的人临床医生-研究者进行务实的干预研究，重点是改善预防初级保健中的糖尿病。拟议的职业发展计划包括教学和研究培训活动，这些活动将实质上培养她制定和实施干预措施的技能。这些将包括实施培训科学、临床试验方法、大型索赔/EMR 数据库的定量数据分析方法，以及定性数据收集和分析方法。本次培训将在丰富的培训环境中进行约翰·霍普金斯大学医疗机构，包括布隆伯格公共卫生学院和韦尔奇中心预防、流行病学和临床研究。她将得到优秀团队的指导具有进行计划研究所需方法的专业知识的导师和顾问，以及指导和资助的跟踪记录。该奖项和受保护的时间将使曾博士能够建立一个 NIH 资助的独立研究事业，并成为以务实方法改善现状的领导者在初级保健中预防糖尿病，并可能应用于其他慢性病。