School-Partnered Collaborative Care (SPACE) for Pediatric Type 1 Diabetes

针对儿童 1 型糖尿病的学校合作协作护理 (SPACE)

• 批准号: 10640614
• 负责人: Christine March
• 金额: $ 18.97万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10640614
• 关键词: Address; Administrator; Affect; Area; Attention; Behavior; Caregivers; Caring; Case Study; Child; Child Support; Childhood; Chronic; Clinical Trials; Clinical Trials Design; Collaborations; Communities; Competence; Control Groups; Data; Data Collection; Diabetes Mellitus; Effectiveness; Ensure; Environment; Evaluation; Evidence based practice; Evidence based treatment; Family; Family health status; Feedback; Focus Groups; Fostering; Foundations; Funding Mechanisms; Future; Glycosylated hemoglobin A; Goals; Health; Health Services Accessibility; Hospitals; Hour; Individual; Insulin-Dependent Diabetes Mellitus; Intervention; Interview; Lead; Leadership; Letters; Measures; Medical; Medical center; Mental Health; Mental Health Services; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Mission; Modeling; Modernization; National Institute of Diabetes and Digestive and Kidney Diseases; Nursing Faculty; Outcome; Outcome Measure; Parents; Patient Outcomes Assessments; Patient-Focused Outcomes; Physicians; Policies; Preparation; Primary Care; Primary Schools; Process; Provider; Quality of Care; Randomized; Randomized, Controlled Trials; Recommendation; Reporting; Research; Research Design; Risk; Role; Sampling; School Nursing; Schools; Scientist; Social Workers; Specialist; Surveys; System; Testing; Time; Training; Training Activity; Visit; Work; Youth; aged; arm; behavioral health; care delivery; career development; collaborative care; community organizations; community setting; contextual factors; cost; data integration; design; diabetes management; diabetes self-management; effectiveness/implementation study; effectiveness/implementation trial; experience; feasibility testing; glycemic control; health care delivery; implementation determinants; implementation measures; implementation research; implementation science; improved; interdisciplinary approach; multidisciplinary; nutrition; pilot test; primary outcome; programs; prototype; provider communication; recruit; school district; school health; secondary outcome; skills; success; therapy design; treatment arm; usability; user centered design

Project Summary Despite modern treatment advances over the last several decades, most youth with type 1 diabetes (T1D) fail to meet recommended targets for glycemic control as measured by hemoglobin A1c. As glycemic control remains the single most important predictor for long term outcomes, adjunctive interventions are needed. One approach is to bolster multidisciplinary care delivery, the traditionally hospital-based management approach for T1D, through partnering with community organizations that support youth and families where they live. The school setting provides such an opportunity, as children spend nearly half their weekday waking hours there under the care of school nurses, providing a consistent and supervised environment. Though limited in their design, prior studies of T1D school-centered interventions have suggested a benefit to enhancing school- provider collaboration for management. Yet, this relationship remains sub-optimal. Our prior work has identified that school nurses feel they make valuable contributions for T1D which are often unrecognized, and providers desire more feedback from school health staff. Enhancing this partnership may be accomplished through a Collaborative Care Model, previously studied for mental health conditions in primary care and school. Adapting this model for T1D may offer a systems-based approach to support school nurses, youth with T1D, and their families. The overall objective of this mentored K23 award is to develop and pilot test a School-PArtnered Collaborative carE (SPACE) intervention for T1D. Dr. March will discover the contextual factors affecting implementation of school-based collaborative care using mixed methods (Aim 1), design the SPACE for T1D intervention through an iterative, community-partnered process (sub-Aim 2A), select valid measures to evaluate SPACE with parents of children with T1D (sub-Aim 2B), and test the SPACE for T1D intervention in a pilot cluster-randomized controlled trial with the primary outcome of feasibility (Aim 3). Secondary outcomes will address other implementation-focused measures (e.g., acceptability, usability, etc.), and an exploratory goal will be to descriptively assess candidate outcomes for a future fully powered trial. Paired training activities are cohesive with each research Aim and include to advance understanding in applied implementation science principles, develop skills in user-centered design, and cultivate competences in clinical trials. These studies will provide preliminary data to support future R-level studies examining factors affecting implementation of T1D interventions in schools nationally and testing the SPACE intervention in a fully powered, cluster-randomized, hybrid implementation-effectiveness trial. In addition, cross-disciplinary mentorship and career development activities will foster Dr. March’s transition to independent funding mechanisms. By completing this K23, Dr. March will have the training, experience, and preliminary data needed to become an independent physician- scientist leading studies aligned with NIDDK’s strategic mission to advance stakeholder-engaged research which disseminates and implements evidence-based treatments in community settings.

项目摘要 尽管过去几十年中的现代治疗进展，但大多数患有1型糖尿病（T1D）的青年失败 要满足由血红蛋白A1C测量的血糖控制的推荐靶标。作为血糖控制 仍然是长期结果的最重要的预测因子，需要辅助干预措施。一 方法是增强多学科护理的交付，这是传统的基于医院的管理方法 T1D，通过与支持他们居住的青年和家庭的社区组织合作。这 学校环境提供了一个机会，因为孩子们在那里花了几乎一半的工作日醒来 在学校护士的护理下，提供了一个一致且受到监督的环境。虽然有限 设计，以T1D为中心的干预措施的先前研究提出了增强学校的好处 提供者的管理协作。然而，这种关系仍然是最佳的。我们先前的工作已经确定 那个学校护士认为他们为T1D做出了宝贵的贡献，而T1D通常无法识别，提供者 希望提供更多学校卫生人员的反馈。加强这种伙伴关系可以通过 合作护理模型以前研究过初级保健和学校的心理健康状况。适应 T1D的这种模型可能会提供一种基于系统的方法来支持学校护士，具有T1D的青年及其 家庭。此问题K23奖的总体目标是开发和试点测试 T1D的协作护理（空间）干预。 March博士将发现影响的背景因素 使用混合方法（AIM 1）实施基于学校的协作护理，为T1D设计空间 通过迭代，社区合作的过程（Sub-aim 2a）进行干预，选择有效措施 评估T1D儿童的父母（Sub-Aim 2b），并测试T1D干预的空间 Pilot群集随机对照试验，可行性的主要结果（AIM 3）。次要结果 将解决其他以实施为重点的措施（例如，可接受性，可用性等）和探索性 目标将是对未来全功率试验的候选结果进行描述性评估。配对的培训活动 每个研究的目标都具有凝聚力，包括提高对应用实施科学的理解 原理，以用户为中心的设计技能，并在临床试验中培养能力。这些研究会 提供初步数据，以支持未来的R级研究检查影响T1D实施的因素 在全国范围内对学校进行干预，并在全国范围 混合实施效应试验。此外，跨学科的心态和职业发展 活动将促进三月博士向独立资金机制的过渡。通过完成此K23，博士 三月将拥有成为独立医师所需的培训，经验和初步数据 - 科学家领先的研究与NIDDK的战略使命一致，以推进利益相关者参与研究 在社区环境中传播和实施基于证据的治疗。