The Flint Neuropathy Study: assessing diagnostic and management gaps in a Black, low-income population

弗林特神经病研究：评估黑人低收入人群的诊断和管理差距

基本信息

批准号：
10642447
负责人：
Melissa Elafros
金额：
$ 21.83万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-07-01 至 2028-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10642447
关键词：
Address Adoption Adult Affect American Amputation Analgesics Attitude Black American Black race Caring Characteristics Clinic Clinical Clinical Decision Support Systems Cluster randomized trial Computerized Medical Record Data Decision Making Diabetes Mellitus Diagnosis Diagnostic Disease Progression Evidence based intervention Foundations Future Goals Guidelines Health Health system Hyperglycemia Individual Intervention Intervention Trial Interview Knowledge Low Income Population Low income Mentorship Metabolic Metabolic syndrome Methods Michigan Mission Modification Morbidity - disease rate Neuropathy Obesity Outcome Pain Pain management Patients Physicians Pilot Projects Play Population Poverty Practice Management Prevalence Primary Care Physician Public Health Quality of life Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Recommendation Research Research Design Risk Factors Risk Management Role Structure Surveys Symptoms Testing Theoretical Domains framework Training Underserved Population United States National Institutes of Health black patient career clinical efficacy computerized disability electronic medical record tool evidence base evidence based guidelines falls health disparity implementation science improved innovation modifiable risk painful neuropathy patient population pilot test primary care clinic primary care provider screening skills

Address Adoption Adult Affect American Amputation Analgesics Attitude Black American Black race Caring Characteristics Clinic Clinical Clinical Decision Support Systems Cluster randomized trial Computerized Medical Record Data Decision Making Diabetes Mellitus Diagnosis Diagnostic Disease Progression Evidence based intervention Foundations Future Goals Guidelines Health Health system Hyperglycemia Individual Intervention Intervention Trial Interview Knowledge Low Income Population Low income Mentorship Metabolic Metabolic syndrome Methods Michigan Mission Modification Morbidity - disease rate Neuropathy Obesity Outcome Pain Pain management Patients Physicians Pilot Projects Play Population Poverty Practice Management Prevalence Primary Care Physician Public Health Quality of life Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Recommendation Research Research Design Risk Factors Risk Management Role Structure Surveys Symptoms Testing Theoretical Domains framework Training Underserved Population United States National Institutes of Health black patient career clinical efficacy computerized disability electronic medical record tool evidence base evidence based guidelines falls health disparity implementation science improved innovation modifiable risk painful neuropathy patient population pilot test primary care clinic primary care provider screening skills

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项目摘要

ABSTRACT Neuropathy is a highly prevalent, disabling condition that leads to pain and reduced quality of life, yet little is known about neuropathy diagnosis and management in Black, low-income populations. Our preliminary data indicates that 61% of primarily Black, low-income patients >40 years with neuropathy are undiagnosed. Without appropriate diagnosis, optimal management of modifiable risk factors, such as hyperglycemia and obesity, and neuropathic pain is unlikely. Computerized clinical decision support systems (CDSSs) improve primary care physician (PCP) diagnoses and management by delivering evidence-based recommendations based on patient characteristics. This proposal’s overall objective is to assess neuropathy diagnosis and management at two Flint, Michigan clinics (54% Black, 40% <US poverty line), then adapt and pilot an intervention to address determinants of gaps in neuropathy diagnosis and management. We expect that there is substantial a neuropathy diagnostic and management gap among Black, low-income patients and that an adapted CDSS will reduce these gaps. These hypotheses will be tested by pursuing three specific aims: 1) quantify gaps in neuropathy diagnosis and management in a predominantly Black, low-income population, 2) determine PCP-level predictors of gaps in diagnosis and management, and 3) adapt a CDSS intervention emphasizing neuropathy screening, risk factor modification, and pain management and evaluate CDSS reach, adoption, and implementation. The first aim will use a piloted study design to assess neuropathy prevalence and determine gaps in diagnosis and management. The second aim will utilize the Theoretical Domains Framework to assess PCP knowledge, attitudes, and clinic level determinants of neuropathy diagnosis, management of risk factors and neuropathic pain using mixed methods. The final aim involves adapting an existing CDSS intervention for neuropathic pain to include neuropathy diagnosis and risk factor management. This intervention will then be piloted at two clinics in different health systems serving predominantly Black and low-income patients. The proposed research is highly innovative because it examines gaps in neuropathy diagnosis and management among a population most likely to be affected by neuropathy and their usual PCPs, which few studies have done. Even fewer have assessed determinants of gaps in neuropathy diagnosis and management in this patient population. Uncovering determinants of neuropathy diagnosis and management represents a significant impact as this will form the foundation for an intervention aimed at improving neuropathy diagnosis and management in this population and other similar, underserved populations.

抽象的神经病是一种高度普遍的残疾状况，导致疼痛和生活质量降低，但几乎没有关于黑人，低收入人群的神经病诊断和管理的知名度。我们的初步数据表明61％的黑色原发性低收入患者> 40年患有神经病的年龄较高。没有适当的诊断，最佳管理可修改的危险因素，例如高血糖和肥胖和神经性疼痛不可能。计算机化临床决策支持系统（CDSSS）改进基于证据的建议，初级保健物理（PCP）诊断和管理基于患者特征。该提案的总体目标是评估神经病诊断和密歇根州两个Flint的管理（54％黑色，40％<美国贫困线），然后适应并进行试验干预措施以解决神经病诊断和管理中差距的决定者。我们希望在那里是黑人，低收入患者的神经病变诊断和管理差距改编的CDS将减少这些差距。这些假设将通过追求三个具体目标来检验：1）量化主要黑色，低收入人群中神经病诊断和管理中的差距，2）确定诊断和管理中差距的PCP级预测指标，以及3）调整CDSS干预强调神经病筛查，危险因素修饰和疼痛管理，并评估CDS范围，采用和实施。第一个目标将使用试验研究设计来评估神经病患病率并确定诊断和管理方面的差距。第二个目标将利用理论领域评估PCP知识，参与和诊所水平的框架确定神经病诊断的框架，使用混合方法治疗风险因素和神经性疼痛。最终目标包括适应现有的CDSS干预神经性疼痛，包括神经病诊断和风险因素管理。然后，将在不同的卫生系统中的两个诊所试用该干预措施，主要是黑色和低收入患者。拟议的研究具有很高的创新性，因为它检查了神经病的差距最有可能受到神经病及其通常影响的人群的诊断和管理 PCP，很少进行研究。甚至更少评估了神经病诊断中差距的决定者和该患者人群的管理。发现神经病诊断和管理层代表着一个重大影响，因为这将构成针对干预的基础改善该人群的神经病诊断和管理以及其他类似的，服务欠缺的人群。