Uptake of Evidence-Based Behavioral Intervention for Pediatric Type 1 Diabetes

对儿童 1 型糖尿病采取循证行为干预措施

• 批准号: 10402397
• 负责人: Julia Elizabeth Winterrowd Price
• 金额: $ 14.33万
• 依托单位: ALFRED I. DU PONT HOSP FOR CHILDREN
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-15 至 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10402397
• 关键词: Acute; Address; Adherence; Adolescent; Affect; Area; Attitude; Awareness; Behavior Therapy; Behavioral; Behavioral Research; Belief; Caring; Cessation of life; Childhood; Chronic; Chronic Disease; Clinic; Complex; Conduct Clinical Trials; Consolidated Framework for Implementation Research; Data; Development; Diabetes Mellitus; Diabetic Coma; Diabetic Ketoacidosis; Disease; Educational Materials; Effectiveness; Effectiveness of Interventions; Electronic Health Record; Endocrinology; Environment; Evaluation; Evidence based practice; Exhibits; Family; Feedback; Funding; Goals; Health; Health Personnel; Healthcare; Healthy People 2020; Heart Diseases; Individual; Institution; Insulin-Dependent Diabetes Mellitus; Interview; K-Series Research Career Programs; Knowledge; Lead; Leadership; Literature; Logistics; Low income; Medical; Mentors; Methods; Outcome; Parents; Patient Schedules; Patient-Focused Outcomes; Patients; Pattern; Pediatric Hospitals; Penetration; Persons; Price; Process; Provider; Public Health Informatics; Quality of life; Randomized; Regimen; Research; Research Methodology; Research Personnel; Research Support; Resources; Risk; Sampling; Services; Site; Specific qualifier value; System; Testing; Training; Treatment Protocols; United States; Youth; acceptability and feasibility; base; behavioral health; burden of illness; care delivery; cerivastatin; design; diabetes mellitus therapy; effectiveness implementation study; effectiveness trial; efficacious intervention; ethnic minority; evidence base; experience; experimental study; glycemic control; health care disparity; implementation facilitators; implementation science; implementation strategy; implementation trial; improved; innovation; physical conditioning; pilot trial; population health; programs; psychosocial; skills; standard care; testing uptake; theories; uptake

PROJECT SUMMARY/ABSTRACT Type 1 diabetes (T1D) is one of the most prevalent pediatric chronic illnesses and requires a complex treatment regimen. Youth with T1D, particularly those from ethnic minority and lower income backgrounds, struggle to adhere to treatment demands; fewer than 30% achieve recommended levels of glycemic control. Youth with poorly controlled T1D are at risk for health complications. Behavioral Family Systems Therapy for Diabetes (BFST-D), a family-based behavioral intervention, is efficacious in improving health outcomes for youth with T1D and initial effectiveness data suggest a brief version of BFST-D (bBFST-D) is associated with improved glycemic control when delivered as part of standard care. However, few receive these services, particularly those most at-risk, which complicates further evaluation of bBFST-D effectiveness when delivered as part of standard care. Increasing the uptake of bBFST-D may lead to improved overall health of this population. Implementation strategies are methods for integrating evidence-based practices into standard care. The proposed K23 career development award aims to address these gaps in research and provides the means by which Dr. Julia Price will complete scholarly training and practical experience to become an independent investigator in pediatric T1D. The proposed study will develop a toolkit of implementation strategies to increase the reach of bBFST-D by first conducting qualitative interviews with stakeholder groups to identify barriers and facilitators of this care (Aim 1). The Consolidated Framework for Implementation Research (CFIR) will guide these interviews. Second, using results from Aim 1 and drawing from literature identifying conceptually unique implementation strategies, a toolkit of implementation strategies will be developed (Aim 2). Iterative feedback from a Diabetes Advisory Board comprised of stakeholders will facilitate this development process and support identification of three implementation strategies to pilot. Third, the feasibility and acceptability of the selected strategies will be evaluated through a single-case experiment at the PIs institution, and exploratory outcomes (effectiveness of these strategies, change in patient health outcomes among those attending bBFST-D as part of standard care) will also be examined (Aim 3). To explore potential healthcare disparities, provider referral patterns across youth demographic variables will be examined. Through a combination of formal didactics and direct mentored training experiences with her mentoring team (Drs. Kazak, Deatrick, Haire-Joshu, Bunnell, Wysocki), Dr. Price will acquire skills and expertise in the following areas: 1) mixed methods research, 2) implementation science, 3) optimizing electronic health record use for research and for implementing evidence- based healthcare, and 4) designing and conducting clinical trials. Nemours, a national leader in pediatric T1D behavioral research and health informatics, will provide Dr. Price with the ideal environment to successfully complete the proposed project and achieve her goals of becoming an independent investigator and applying for R01 funding to conduct a large multisite randomized hybrid implementation-effectiveness trial of bBFST-D.

项目摘要/摘要 1型糖尿病（T1D）是最普遍的小儿慢性疾病之一，需要复杂 治疗方案。 T1D的青年，尤其是来自少数民族和较低收入背景的年轻人， 努力遵守治疗需求；少于30％的血糖控制水平。 控制不良的T1D青年有健康并发症的风险。行为家庭系统治疗 糖尿病（BFST-D）是一种基于家庭的行为干预措施，有效地改善健康结果 具有T1D和初始有效性数据的青年表明，BFST-D（BBFST-D）的简短版本与 作为标准护理的一部分，可以改善血糖控制。但是，很少有人会收到这些服务， 特别是那些最高风险的人，这会使BBFST-D有效性进一步评估 作为标准护理的一部分。增加BBFST-D的摄取可能会改善整体健康状况 人口。实施策略是将基于证据的实践整合到标准护理中的方法。 拟议的K23职业发展奖旨在解决研究中的这些差距，并提供手段 朱莉娅·普莱斯（Julia Price）博士将完成学术培训和实践经验，成为独立 小儿T1D的研究者。拟议的研究将制定实施策略的工具包，以增加 首先与利益相关者群体进行定性访谈，以识别障碍和 此护理的促进者（AIM 1）。实施研究的合并框架（CFIR）将指导 这些访谈。其次，使用AIM 1的结果并从文献中绘制从概念上识别独特的 实施策略，将制定实施策略的工具包（AIM 2）。迭代反馈 来自利益相关者组成的糖尿病咨询委员会将促进这一发展过程和支持 确定三种实施策略。第三，选定的可行性和可接受性 策略将通过PIS机构的单案实验进行评估，并进行探索结果 （这些策略的有效性，参加BBFST-D的患者健康状况的变化作为一部分 还将检查标准护理）（AIM 3）。为了探索潜在的医疗保健差异，提供者推荐 将检查青年人口变量的模式。通过形式教学和 直接指导的指导团队（Kazak博士，Deatrick，Haire-Joshu，Bunnell，Bunnell， Wysocki），Price博士将在以下领域获得技能和专业知识：1）混合方法研究，2） 实施科学，3）优化电子健康记录用于研究和实施证据 - 基于医疗保健，4）设计和进行临床试验。 Nemours，小儿T1D的国家领导者 行为研究和健康信息学将为Price提供理想的环境，以成功 完成拟议的项目，并实现成为独立调查员并申请的目标 为了进行R01的资金，可以对BBFST-D进行大型多站点随机混合实施效应试验。