Bridging Income Generation with Group Integrated Care (BIGPIC)

通过团体综合护理 (BIGPIC) 架起创收桥梁

基本信息

批准号：
8911042
负责人：
Rajesh Vedanthan
金额：
$ 73.99万
依托单位：
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-04-01 至 2020-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8911042
关键词：
Address African Blood Pressure Cardiovascular Diseases Cardiovascular system Caring Cessation of life Characteristics Chronic Disease Clinical Cluster randomized trial Communities Country Development Diabetes Mellitus Economic Burden Effectiveness Effectiveness of Interventions Ensure Focus Groups Generations Goals Government Health Health Services Accessibility Hypertension Income Individual Intervention Kenya Knowledge Mediating Mediation Medical Modeling Morbidity - disease rate Outcome Outcome Measure Patients Population Prediabetes syndrome Principal Investigator Qualitative Research Quality of Care Research Research Methodology Research Personnel Research Project Grants Research Technics Resources Risk Factors Risk Reduction Rural Rural Health Savings Self Efficacy Social Network Social support Staging Testing Trust Visit Vulnerable Populations Work arm blood pressure regulation cardiovascular disorder risk cardiovascular risk factor clinical care cohesion contextual factors cost cost effective cost effectiveness design diabetes risk diabetic disability-adjusted life years experience health economics implementation research improved innovation knowledge base member mortality novel primary outcome public health relevance secondary outcome trial comparing

项目摘要

DESCRIPTION (provided by applicant): Bridging Income Generation with Group Integrated Care (BIGPIC) Cardiovascular disease (CVD) is the leading cause of mortality in the world. Diabetes, a major risk factor for CVD, is increasingly prevalent and responsible for substantial cardiovascular morbidity and mortality. Elevated blood pressure (BP) increases CVD risk among individuals with diabetes and pre-diabetes; BP control is therefore a powerful way to reduce CVD risk. Cost-effective, context-specific, and culturally appropriate interventions are critical, and both group medical visits and microfinance have the potential to achieve this. In partnership with the Government of Kenya, the Academic Model Providing Access to Healthcare Partnership has expanded its clinical scope of work in rural western Kenya to include diabetes and hypertension, and has piloted group care and microfinance initiatives with promising early results. However, the effectiveness of these strategies individually, and in combination, on improving CVD risk is not known. Thus, the overall objective of this proposal is to utilize a transdisciplinary implementation research approach to address the challenge of reducing CVD risk in low-resource settings. Specifically, we propose to test the hypothesis that group medical visits integrated into microfinance groups will be effective and cost-effective in reducing CVD risk among individuals with diabetes and at increased risk for diabetes in western Kenya. We further hypothesize that changes in social network characteristics may mediate the impact of these interventions, and that baseline social network characteristics may moderate the impact. Aim 1 is to identify contextual factors, facilitators, and barriers that may impact integration of group medical visits and microfinance groups in this setting, using novel qualitative research techniques. We will then design a contextually and culturally appropriate integrated group medical visit-microfinance model for CVD risk reduction. Aim 2 is to evaluate the effectiveness of group medical visits and microfinance groups for CVD risk reduction among individuals with diabetes or at increased risk of diabetes, by conducting a four-arm cluster randomized trial comparing: 1) usual clinical care; 2) usual clinical care plus microfinance groups only; 3) group medical visits only; and 4) group medical visits integrated into microfinance groups. The primary outcome will be one-year change in systolic BP, and a key secondary outcome will be change in QRISK2 CVD risk score. We will also conduct mediation analysis and moderation analysis to evaluate the influence of social network characteristics on intervention outcomes. Aim 3 is to evaluate the incremental cost-effectiveness of each intervention arm of the trial. The research will be accomplished by an Early Stage Principal Investigator with extensive experience in implementation research in low-resource settings, supported by a transdisciplinary team of investigators with diverse and complementary expertise. Our goal is to add to the existing knowledge base of innovative, scalable, and sustainable strategies to reduce CVD risk in diabetes and other chronic diseases in low-resource settings worldwide.

描述（由申请人提供）：通过团体综合护理架起创收桥梁 (BIGPIC) 心血管疾病 (CVD) 是世界上导致死亡的主要原因糖尿病是 CVD 的一个主要危险因素，其发病率日益普遍，并导致大量心血管疾病发病。血压升高会增加糖尿病和糖尿病前期患者的 CVD 风险；因此，控制血压是降低 CVD 风险的有效方法，具有成本效益、针对具体情况。文化上适当的干预措施至关重要，团体医疗就诊和小额信贷都有可能实现这一目标。与肯尼亚政府合作，提供医疗保健合作伙伴关系的学术模式已将其在肯尼亚西部农村的临床工作范围扩大到包括糖尿病。和高血压，并已试点团体护理和小额信贷举措，并取得了有希望的早期结果。然而，这些策略单独或组合起来对改善心血管疾病风险的有效性尚不清楚。因此，该提案的总体目标是利用跨学科的方法。应对挑战的实施研究方法具体而言，我们建议检验以下假设：将团体医疗就诊纳入小额信贷小组对于降低肯尼亚西部糖尿病患者和糖尿病风险较高的个人的 CVD 风险将是有效且具有成本效益的。我们进一步认为，社交网络特征的变化可能会调节这些干预措施的影响，而基线社交网络特征可能会缓和这种影响，目标 1 是确定可能影响团体医疗就诊和小额信贷整合的背景因素、促进因素和障碍。在此设置中的组，然后，我们将设计一个适合具体情况和文化的综合团体医疗就诊-小额信贷模型，以降低 CVD 风险。目标 2 是评估团体医疗就诊和小额信贷团体对于降低糖尿病或糖尿病患者的 CVD 风险的有效性。糖尿病风险增加，通过进行四臂整群随机试验比较：1) 常规临床护理；2) 仅常规临床护理加小额信贷组；3) 仅团体医疗就诊；4) 纳入小额信贷的团体医疗就诊；主要结果将是收缩压的一年变化，关键的次要结果将是 QRISK2 CVD 风险评分的变化。我们还将进行中介分析和调节分析，以评估社交网络特征对干预结果的影响。目标 3 是评估试验中每个干预组的增量成本效益。该研究将由在资源匮乏环境中具有丰富实施研究经验的早期首席研究员完成，并得到跨学科研究团队的支持。和互补的专业知识。我们的目标是增加现有的创新、可扩展和可持续战略知识库，以降低全球资源匮乏地区糖尿病和其他慢性疾病的 CVD 风险。