Northern Manhattan diabetes community health

曼哈顿北部糖尿病社区健康

• 批准号: 7314597
• 负责人: Olveen Carrasquilo
• 金额: $ 89.76万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-28 至 2012-09-27
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7314597
• 关键词: Address; Adult; Affect; Age; Area; Blood Pressure; Caribbean natives; Caribbean region; Caring; Cholesterol; Chronic Disease; Clinical Trials Design; Communities; Community Health; Community Outreach; Condition; Control Groups; Data; Diabetes Mellitus; Diagnosis; Diastolic blood pressure; Economic Burden; Effectiveness; General Population; Goals; Health education; Hemoglobin; Hispanics; Home visitation; House Call; Individual; Intervention; Latin America; Latino; Low-Density Lipoproteins; Mails; Managed Care; Measures; Medicaid; Medical; Mexican; Minority; Modeling; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Numbers; Outcome; Pamphlets; Patients; Pharmaceutical Preparations; Pre-Post Tests; Primary Health Care; Public Health; Randomized; Randomized Controlled Trials; Rate; Research Design; Risk Factors; Role; Self Management; System; Telephone; Theoretical model; Time; United States; Universities; Urban Health; Visit; Work; abstracting; aged; base; chronic care model; clinical research site; clinically significant; diet and exercise; follow-up; glycemic control; health care delivery; health care model; health economics; improved; interest; lifestyle intervention; medication compliance; model design; programs; success

Abstract The objective of the Northern Manhattan Diabetes Community Outreach Project (NOCHOP) is to examine the effectiveness of a community health worker (CHW) intervention at addressing glycemic control among Latinos with poorly controlled Type 2 diabetes. The rationale for the proposal is twofold. First, diabetes is a major public health crisis and is twice as likely to affect Latinos versus non-Hispanic whites. Second, diabetes interventions that are based on traditional models of health care delivery have not proven to be very effective among Latinos. For example, only 30% of patients in our predominantly Latino community have their diabetes under good control (Hemoglobin AIC (HgA1c) <7.0). Our group, however, has worked with a promising model of intervention that utilizes CHWs based at one of the major community partners of Columbia University's Center for the Health of Urban Minorities (CHUM), namely, Alianza Inc. Pilot data from this program has shown clinically significant pre-post test improvements in HgA1C. Using the Chronic Care Model as an overarching framework, the study design of NOCHOP is a randomized controlled trial of 360 Latinos, mostly of Caribbean descent, aged 35-70 years with HgA1C >=8.0. At a minimum, subjects in the intervention group will receive four home visits, ten group level visits and monthly phone calls by CHWs based at Alianza. The control groups will receive three separate mailings of bilingual diabetes health education materials. The primary outcome is glycemic control at 12-month follow-up, as measured by HgA1c. The secondary outcomes are changes in cholesterol and blood pressure (BP). We will also collect exploratory data on potential mechanisms through which our intervention resulted in hypothesized improvements including medication adherence, medication Intensification, diet and exercise. If successful, our project will make an important contribution to ongoing national and local debates about the sustainability of CHW programs. In particular, data from this study would be extremely useful for local Medicaid managed care plans who have expressed strong interests in data from rigorously designed clinical trials addressing the role of CHWs in delivering culturally appropriate and effective diabetes care.

抽象的 曼哈顿北部糖尿病社区外展项目（NOCHOP）的目的是检查 社区卫生工作者（CHW）干预在解决拉丁裔血糖控制方面的有效性 控制不良的2型糖尿病。该提案的理由是双重的。首先，糖尿病是主要的 公共卫生危机，影响拉丁美洲人与非西班牙裔白人的可能性是两倍。其次，糖尿病 基于传统的医疗保健交付模式的干预措施尚未证明非常有效 在拉丁美洲人中。例如，我们主要是拉丁裔社区中只有30％的患者患有糖尿病 在良好的控制下（血红蛋白AIC（HGA1C）<7.0）。但是，我们的小组与有希望的模型合作 在哥伦比亚大学的主要社区合作伙伴之一中利用CHW的干预措施 城市少数民族健康中心（CHUM），即Alianza Inc.该计划的飞行员数据 显示了HGA1C的临床意义前测试改进。使用慢性护理模型作为 总体框架，NOCHOP的研究设计是360个拉丁裔的随机对照试验，主要是 加勒比血统，年龄35-70岁，HGA1C> = 8.0。干预组中的受试者至少将 在Alianza的CHWS接待四次主场访问，十个小组级访问和每月电话。这 对照组将收到三本双语糖尿病健康教育材料的邮件。这 主要结果是通过HGA1C测量的12个月随访中的血糖控制。次要结果 是胆固醇和血压（BP）的变化。我们还将收集有关潜在的探索性数据 我们的干预导致假设改进的机制，包括药物 依从性，药物加强，饮食和运动。如果成功，我们的项目将成为重要的 对正在进行的有关CHW计划可持续性的国家和地方辩论的贡献。尤其， 这项研究的数据对于表达的当地医疗补助托管计划非常有用 对严格设计的临床试验的数据浓厚的兴趣，该试验涉及CHW在交付中的作用 在文化上适当有效的糖尿病护理。