Financial Incentives And Nurse Coaching to Enhance Diabetes Outcomes - FINANCE-DM

财务激励和护士指导可提高糖尿病治疗效果 - FINANCE-DM

• 批准号: 9914277
• 负责人: Leonard E. Egede
• 金额: $ 65.67万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-15 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9914277
• 关键词: Address; Adult; Affect; African American; Behavior; Body Weight decreased; Case Manager; Centers for Disease Control and Prevention (U.S.); Cessation of life; Chronic Disease; Clinical; Control Groups; Data; Diabetes Mellitus; Diet; Disease; Disease Management; Effectiveness; Ethnic group; Feedback; Financial Support; Glycosylated hemoglobin A; Goals; Health; Health behavior; High Prevalence; Hispanics; Home environment; Incentives; Intervention; Literature; Long-Term Effects; Low-Density Lipoproteins; Measures; Metabolic Control; Monitor; Non-Insulin-Dependent Diabetes Mellitus; Nurses; Nursing Education; Outcome; Patients; Quality of life; Randomized; Randomized Controlled Trials; Research; Research Support; Resources; Risk; Self Care; Smoking; Structure; Testing; Training and Education; United States; Walkers; active control; behavioral economics; caucasian American; cost effective; cost effectiveness; diabetes education; diabetes mellitus nursing; diabetes self-management; dietary adherence; effective intervention; efficacy testing; ethnic minority population; exercise adherence; financial incentive; follow-up; glycemic control; improved; intervention effect; medication compliance; novel; post intervention; program costs; racial and ethnic; secondary endpoint; skills training

Ethnic minorities (African Americans –AA and Hispanics -HA) with Type 2 diabetes (T2DM) have higher prevalence of diabetes, poorer metabolic control and greater risk for complications and death compared to White Americans; and the literature shows that effective interventions for T2DM need to have multiple components including: nurse diabetes education and skills training, home monitoring with feedback, and maintain high intensity. Recent evidence from behavioral economics research supports the use of financial incentives to improve health-related behaviors and the effectiveness of financial incentives to improve health behaviors has been demonstrated across different diseases and behaviors including smoking, weight loss, dietary behavior, medication adherence, and diabetes self-management, with the most beneficial result lasting up to 18 months post-intervention. Preliminary data from our group suggest that structured financial incentives in combination with nurse education and home telemonitoring is feasible and effective in adults with T2DM. However, there are three important unanswered questions: 1) Are financial incentives layered upon nurse education and home telemonitoring superior to nurse education and home telemonitoring alone in improving metabolic control long term? 2) Are the effects of financial incentives on metabolic control sustained once the incentives are withdrawn? and 3) Are financial incentives efficacious within and across racial/ethnic groups? To address these gaps in the literature, we propose a randomized controlled trial to test the efficacy of a Financial Incentives And Nurse Coaching to Enhance Diabetes Outcomes (FINANCE-DM) intervention comprised of: 1) nurse education, 2) home telemonitoring, and 3) structured financial incentives; compared to an active control group (nurse education and home telemonitoring alone) at 12 months. The study also will evaluate whether intervention effects are sustained 6 months after the financial incentives are withdrawn (i.e. 18 months post randomization); and whether the intervention is differentially efficacious across racial/ethnic groups.

患有 2 型糖尿病 (T2DM) 的少数族裔（非裔美国人 – AA 和西班牙裔 – HA）患病率较高 与其他人相比，糖尿病患病率较高，代谢控制较差，并发症和死亡风险较高 美国白人；文献表明，针对 T2DM 的有效干预措施需要采取多种措施 组成部分包括：糖尿病护士教育和技能培训、带有反馈的家庭监测，以及 行为经济学研究的最新证据支持使用金融手段。 改善健康相关行为的激励措施以及改善健康的经济激励措施的有效性 行为已在不同的疾病和行为中得到证实，包括吸烟、减肥、 饮食行为、药物依从性和糖尿病自我管理，最有益的结果是持久的 我们小组的初步数据显示，干预后长达 18 个月的时间里，结构化的财务激励措施是有效的。 结合护士教育和家庭远程监护对于成人 T2DM 来说是可行且有效的。 然而，还有三个重要的悬而未决的问题：1）经济激励措施是否基于护理？ 教育和家庭远程监护在改善方面优于单独的护士教育和家庭远程监护 2) 经济激励对代谢控制的影响是否会持续？ 激励措施被撤销吗？ 3) 经济激励措施在种族/族裔群体内部和之间是否有效？ 为了解决文献中的这些空白，我们提出了一项随机对照试验来测试金融方法的有效性 提高糖尿病治疗效果的激励措施和护士辅导 (FINANCE-DM) 干预措施包括：1) 护士教育，2）家庭远程监控，3）与主动控制相比的结构化财务激励； 该研究还将评估是否会在 12 个月时进行小组（仅护士教育和家庭远程监控）。 干预效果在经济激励措施取消后 6 个月内持续有效（即经济激励措施取消后 18 个月） 随机化）；以及干预措施在不同种族/民族群体中是否有效。