Implementing a Diabetes Screening and Referral Service Developed for Dental Clinics Within an Urban Alaska Native Health Care Setting

实施为阿拉斯加城市原住民医疗机构内的牙科诊所开发的糖尿病筛查和转诊服务

• 批准号: 10676936
• 负责人: Barbara Stillwater
• 金额: $ 21.77万
• 依托单位: SOUTHCENTRAL FOUNDATION
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-24 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10676936
• 关键词: Address; Administrator; Adoption; Adult; Age; Alaska; Alaska Native; American Indians; Appointment; Area; Award; Belief; Blood Glucose; Blood Tests; Characteristics; Clinic; Clinical Research; Code; Communities; Complex; Complications of Diabetes Mellitus; Comprehensive Health Care; Consolidated Framework for Implementation Research; Data; Dental; Dental Care; Dental Clinics; Development; Diabetes Mellitus; Diagnosis; Dissemination and Implementation; Early Intervention; Enrollment; Evaluation; Fasting; Feedback; Foundations; Glycosylated Hemoglobin; Grant; Health; Health Educators; Health system; Healthcare Systems; Home; Human Resources; Hygiene; Incidence; Individual; Institution; Intervention; Interview; Life Style; Maintenance; Medical; Medical center; Methods; Modeling; Monitor; Native American Research Center for Health; Native-Born; Patient Outcomes Assessments; Patients; Perception; Periodontal Diseases; Persons; Phase; Population; Populations at Risk; Prevalence; Prevention; Preventive service; Primary Care; Process; Protocols documentation; Provider; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Research; Research Personnel; Risk; Risk Factors; Rural; Sampling; Services; Site; Specialist; Surveys; System; Testing; Visit; Walking; Work; care systems; cohort; cultural competence; design; diabetes control; diabetes risk; disparities in morbidity; dissemination science; early screening; evidence base; experience; follow-up; health care service; health care settings; health data; health organization; implementation framework; implementation outcomes; implementation research; implementation science; improved; multidisciplinary; multiple chronic conditions; novel; point of care; pragmatic trial; prevent; primary care clinic; primary care provider; primary care services; referral services; screening; screening and brief intervention; screening services; service delivery; tool; tribal health; tribal healthcare; virtual

PROJECT SUMMARY/ABSTRACT – RP1 Alaska Native and American Indian (ANAI) people are at increased risk for diabetes (DM) with documented prevalence of risk factors. Recent studies show that DM prevalence and incidence are rising and rates of pre- DM among the ANAI population in Alaska are as great, if not greater, than other U.S. groups. Additionally, 40% of DM is undiagnosed, thus increasing risk for DM complications. Since DM complications begin to develop during pre-DM, early screening and intervention can prevent or delay DM onset and its complications. “Implementing a Diabetes Screening and Referral Service Developed for Dental Clinics within an Urban Alaska Native Health Care Setting” is a 4-year study that will use implementation science frameworks to assess acceptability, applicability, feasibility, and consequences of DM testing within Southcentral Foundation (SCF) Dental Clinics. SCF is a Tribal health organization providing primary care and dental services to ANAI people living within the urban Anchorage, Alaska area – home to nearly half of the ANAI population statewide. Research indicates that in a given year, 27% of adults who do not have contact with a medical provider did visit a dental provider. The well-documented bidirectional relationship between DM and periodontal disease suggests that dental visits offer a largely untapped opportunity to screen persons at risk for DM and refer them to primary care providers for follow up and treatment. This opportunity is enhanced at SCF because dental and primary care services are provided within the same closed Tribal health system. We propose a within-site post design, and phased approach to study the implementation of an evidenced- based preventive service – DM screening, brief intervention, and referral to primary care – delivered in a novel setting, dental clinics. Experienced clinical and implementation research experts will work with multiple stakeholders using two theoretical and complimentary dissemination and implementation science frameworks: Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) and the Consolidated Framework for Implementation Research (CFIR) to accomplish three specific aims (SAs): SA1: Identify barriers and facilitators to implementing a diabetes screening and referral service within SCF Dental and Primary Care Clinics. SA2: Develop a dental clinic diabetes screening and referral service that minimizes barriers and utilizes facilitators identified in SA1. SA3: Pilot, assess, and iteratively refine a diabetes screening and referral service delivered through SCF Dental Clinics.

项目摘要/摘要 – RP1 阿拉斯加原住民和美洲印第安人 (ANAI) 人群患糖尿病 (DM) 的风险增加，有记录 最近的研究表明，糖尿病的患病率和发病率正在上升，而且患病率也在上升。 阿拉斯加 ANAI 人口中的糖尿病比例与美国其他群体一样高（甚至更高），高达 40%。 DM 未得到诊断，从而增加了 DM 并发症的风险，因为 DM 并发症开始出现。 在糖尿病前期，早期筛查和干预可以预防或延缓糖尿病的发病及其并发症。 “实施为城市牙科诊所开发的糖尿病筛查和转诊服务 阿拉斯加原住民医疗保健环境”是一项为期 4 年的研究，将使用实施科学框架来评估 Southcentral 基金会 (SCF) 内 DM 测试的可接受性、适用性、可行性和后果 牙科诊所是一个部落卫生组织，为 ANAI 人提供初级护理和牙科服务。 居住在阿拉斯加安克雷奇市区的居民承认，这里居住着近一半的 ANAI 人口。 研究表明，在某一年，27% 没有与医疗服务提供者接触过的成年人 拜访牙科服务提供者 糖尿病与牙周病之间的双向关系已有充分记录。 表明牙科就诊提供了一个基本上尚未开发的机会来筛查糖尿病高危人群并将其转诊 由于牙科和治疗，SCF 增加了初级保健提供者的跟进和治疗机会。 初级保健服务是在同一个封闭的部落卫生系统内提供的。 我们提出了一种现场后设计和分阶段的方法来研究已证实的实施 以预防为基础的服务——糖尿病筛查、简短干预和转诊至初级保健——以新颖的方式提供 经验丰富的临床实施和研究专家将与多个机构合作。 利益相关者使用两个理论和互补的传播和实施科学框架： 范围、有效性、采用、实施、维护 (RE-AIM) 和综合框架 实现三个具体目标 (SA) 的实施研究 (CFIR)： SA1：识别障碍和促进因素 在 SCF 牙科和初级保健诊所 SA2 内实施糖尿病筛查和转诊服务： 开发牙科诊所糖尿病筛查和转诊服务，最大限度地减少障碍并利用促进者 SA1 中确定：试点、评估和迭代完善所提供的糖尿病筛查和转诊服务。 通过 SCF 牙科诊所。