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.

项目概要 尽管现代治疗在过去几十年中取得了进步，但大多数患有 1 型糖尿病 (T1D) 的青少年都失败了 达到通过血红蛋白 A1c 测量的推荐血糖控制目标。 仍然是长期结果的最重要的预测因素，因此需要辅助干预措施。 方法是加强多学科护理服务，这是传统上以医院为基础的管理方法 T1D，通过与支持青少年及其居住地家庭的社区组织合作。 学校环境提供了这样的机会，因为孩子们工作日近一半的醒着时间都花在学校里 在学校护士的照顾下，提供一致和受监督的环境，尽管其能力有限。 根据设计，之前以 T1D 学校为中心的干预措施的研究表明，有利于加强学校 然而，我们之前的工作已经发现，这种关系仍然不是最佳的。 学校护士认为他们为 T1D 做出了宝贵的贡献，但这些贡献往往未被认可，而服务提供者 希望学校卫生人员提供更多反馈，可以通过以下方式来加强这种伙伴关系。 协作护理模式，之前针对初级保健和学校的心理健康状况进行了研究。 这种针对 T1D 的模型可以提供一种基于系统的方法来支持学校护士、患有 T1D 的青少年及其 该 K23 指导奖的总体目标是开发和试点学校合作项目。 March 博士将发现 T1D 的协同护理 (SPACE) 干预因素。 使用混合方法实施校本协作护理（目标 1），设计 T1D 空间 通过迭代的、社区合作的过程进行干预（子目标 2A），选择有效的措施 与 1 型糖尿病儿童的父母一起评估 SPACE（子目标 2B），并测试 SPACE 对 T1D 干预的效果 试点整群随机对照试验，主要结果为可行性（目标 3）。 将解决以其他为重点的实施措施（例如可接受性、可用性等），以及探索性的 目标是描述性地评估未来全动力试验的候选人结果。 与每个研究目标相一致，包括促进对应用实施科学的理解 这些研究将遵循原则，培养以用户为中心的设计技能，并培养临床试验能力。 提供初步数据以支持未来 R 级研究，检查影响 T1D 实施的因素 对全国学校进行干预，并在一个全动力、集群随机、 此外，跨学科指导和职业发展。 活动将促进 March 博士向独立资助机制的过渡。 马奇将拥有成为一名独立医生所需的培训、经验和初步数据—— 科学家主导的研究与 NIDDK 的战略使命相一致，即推进利益相关者参与的研究 在社区环境中传播和实施循证治疗方法。