VIDA: Virtual Diabetes Group Visits Across Health Systems

VIDA：跨卫生系统的虚拟糖尿病小组访问

• 批准号: 10654829
• 负责人: Arshiya Ahmed Baig
• 金额: $ 62.05万
• 依托单位: UNIVERSITY OF CHICAGO
• 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 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10654829
• 关键词: Address; Adopted; Adoption; Adult; Advocate; Affect; African American; African American population; Amputation; Appointment; Area; Black race; Blood Glucose; Blood Pressure; Body mass index; COVID-19 pandemic; Cardiovascular Diseases; Caring; Chicago; Chronic; Chronic Kidney Failure; Clinic; Clinical; Cluster randomized trial; Color; Communities; Community Health; Community Health Networks; Complex; Complications of Diabetes Mellitus; Comprehensive Health Care; Diabetes Mellitus; Diet; Education; Effectiveness; Enrollment; Equity; Federally Qualified Health Center; Glycosylated Hemoglobin; Health; Health Personnel; Health system; Heart Diseases; Hispanic; Hispanic Americans; Hispanic Populations; Hospitals; Hypertension; Illinois; Individual; Intervention; Interview; Kidney Diseases; Latino; Learning; Low income; Maintenance; Medical; Mental Depression; Midwestern United States; Modeling; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Outcome; Patient Appointment; Patients; Persons; Pharmaceutical Preparations; Prevalence; Primary Health Care; Privatization; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Self Management; Site; Social support; System; Training; Translational Research; Uninsured; United States; Universities; Visit; Work; acceptability and feasibility; clinical care; clinical research site; comorbidity; diabetes management; effectiveness/implementation design; effectiveness/implementation hybrid; glycemic control; health care service utilization; implementation evaluation; implementation facilitators; implementation outcomes; improved; medically underserved; metropolitan; peer; people of color; pilot test; primary care clinic; primary care setting; primary outcome; programs; secondary outcome; telehealth; treatment as usual; trend; virtual; virtual group; virtual model; virtual platform

PROJECT SUMMARY Of the 30 million adults with DM in the United States, 97% have at least one comorbid condition (e.g. hypertension, heart disease, kidney disease). DM and DM-related complications disproportionately affect people of color. The prevalence of DM is higher among Hispanics (12.5%) and African-Americans (11.7%) compared to non-Hispanic whites (7.5%); Hispanics and African-Americans have higher rates of diabetes-related complications, including amputations and CKD. Group visits (GVs) can provide patients with comprehensive care for their multimorbid chronic condition. Diabetes GVs—shared appointments where patients receive self- management education in a group setting and an individual medical visit—can improve glycemic control, decrease healthcare utilization, and provide social support and co-learning among peers. While virtual appointments have become a routine part of clinical care during the COVID-19 pandemic, group visits via virtual platforms remain uncommon and understudied. Before the model can be widely adopted, important questions about the effectiveness and implementation of the virtual diabetes GV model need to be addressed. We propose to build on an established program of in-person diabetes GVs and a virtual diabetes GV pilot by the University of Chicago and MidWest Clinician’s Network. We aim to implement the virtual GV model (VIDA: Virtual Diabetes Group Visits Across Health Systems) in two distinct health systems in the Chicago region: ACCESS and Advocate Aurora Health (AAH). ACCESS is one of the largest federally qualified health centers (FQHCs) in the U.S. with 35 sites across the Chicago metropolitan area, providing care for 175,000 medically underserved and low-income patients each year, including over 25,000 patients with diabetes. Advocate Aurora Health (AAH) is a large, diverse, integrated private not-for profit health system with more than 129 primary care clinics in Illinois serving over 117,000 patients with diabetes. The ability to train, implement and evaluate virtual group visits across two distinct health systems provides a unique opportunity to learn about adaptation and the barriers and facilitators for program implementation. This study will use a type I hybrid effectiveness-implementation design via a pragmatic cluster randomized trial to assess changes in clinical outcomes among adults with T2DM in virtual diabetes GVs versus usual care. We will first adapt and implement VIDA at one ACCESS FQHC center and one AAH primary care clinic using the Form and Function domains of the Complex Health Intervention Framework. We will assess integration of VIDA into clinical workflow and determine the type of and amount of training and technical support needed to assist staff in integrating virtual diabetes GV into the clinical setting. We will then conduct a pragmatic cluster randomized trial of virtual GVs across 9 intervention sites (180 adult patients with T2DM with A1C >9%) and 9 control sites (360 matched patients) and assess change in A1C from baseline to 12-months and change in other clinical outcomes including systolic blood pressure and body mass index. We will assess adoption, implementation, and maintenance of virtual GVs across systems using RE-AIM framework.

项目摘要 在美国有3000万DM的成年人中，有97％的人至少有一个合并症（例如 高血压，心脏病，肾脏疾病）。 DM和与DM相关的并发症对人们的影响不成比例 颜色。与西班牙裔（12.5％）和非裔美国人（11.7％）相比，DM的患病率更高 非西班牙裔白人（7.5％）；西班牙裔和非裔美国人的糖尿病率较高 并发症，包括截肢和CKD。小组访问（GVS）可以为患者提供全面的 照顾他们的多病慢性病。糖尿病GVS - 签约，患者接受自我 在小组环境和个人医疗访问中进行管理教育 - 可以改善血糖控制， 减少医疗保健利用，并在同龄人之间提供社会支持和共学习。虽然虚拟 约会已成为共同19日大流行期间临床护理的常规一部分，通过Virtual 平台仍然很常见和理解。在广泛采用模型之前，重要的问题 关于虚拟糖尿病模型的有效性和实施，需要解决。我们建议 建立在大学现场糖尿病GV和大学的虚拟糖尿病飞行员的基础上 芝加哥和中西部临床医生的网络。我们旨在实施虚拟GV模型（VIDA：虚拟糖尿病 芝加哥地区两个不同卫生系统的跨卫生系统的小组访问：访问和 倡导Aurora Health（AAH）。访问是最大的联邦合格卫生中心（FQHC）之一 美国在整个芝加哥都会区拥有35个地点，为175,000个医疗服务不足的护理提供了护理 每年低收入患者，包括超过25,000名糖尿病患者。倡导Aurora Health（AAH）是 伊利诺伊州的大型，潜水员，综合的私人非营利性健康系统，拥有超过129个初级保健诊所 为超过117,000名糖尿病患者提供服务。训练，实施和评估虚拟小组访问的能力 在两个不同的卫生系统中，提供了一个独特的机会，可以了解适应和障碍和 计划实施的促进者。这项研究将使用I型混合有效性 - 实现设计 通过务实的聚类随机试验来评估T2DM成年人的临床结果的变化 虚拟糖尿病GVS与通常的护理。我们将首先在一个访问FQHC中心适应并实施VIDA 以及一个使用复杂健康干预的形式和功能域的AAH初级保健诊所 框架。我们将评估VIDA整合到临床工作流程中，并确定 需要培训和技术支持，以帮助员工将虚拟糖尿病GV整合到临床环境中。我们 然后将在9个干预地点（180名成年患者）进行虚拟GV的务实簇随机试验 具有T2DM，A1C> 9％）和9个对照位点（360名匹配的患者），并评估A1C的变化。 到12个月，以及其他临床结果的变化，包括收缩压和体重指数。我们 将使用RE-AIM框架来评估在系统跨系统中虚拟GV的采用，实施和维护。