ARISE (Achieving Routine Intervention and Screening for Emotional health)

ARISE（实现情绪健康的常规干预和筛查）

• 批准号: 10655877
• 负责人: Arshiya Ahmed Baig
• 金额: $ 63.84万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2028-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10655877
• 关键词: Address; Adoption; Adult; Affect; African American population; Algorithms; American; Anxiety; Behavior; Blood Glucose; Blood Pressure; Body mass index; Caring; Charge; Clinic; Clinical; Complex; Country; Diabetes Mellitus; Disparity; Disparity population; Distress; Emotional; Exercise; Family; Fright; Glycosylated Hemoglobin; Guidelines; Guilt; Habits; Health; Health Personnel; Hispanic; Hispanic Populations; Hypoglycemia; Income; International; Intervention; Intervention Studies; Interview; Knowledge; Learning; Life; Link; Low-Density Lipoproteins; Maintenance; Medical Care Team; Mental Depression; Meta-Analysis; Neighborhood Health Center; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Outcome; Patients; Persons; Pharmaceutical Preparations; Population; Prevalence; Primary Care; Process; Publishing; Quality of life; Race; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Reporting; Risk; Rural; Services; Source; Standardization; Stress; Structure; Surveys; Testing; Training; Visit; Vulnerable Populations; Work; acceptability and feasibility; arm; behavioral health; clinical care; diabetes distress; diabetes management; diabetes self-management; diet and exercise; dietary; effectiveness/implementation design; ethnic minority; evidence base; evidence based guidelines; federal poverty level; follow-up; glycemic control; health disparity; health training; implementation evaluation; implementation outcomes; improved; instrument; lectures; medical vulnerability; medication compliance; patient oriented; patient screening; people of color; pragmatic randomized trial; pragmatic study; primary care setting; primary outcome; profession allied to medicine; programs; relative effectiveness; screening; secondary outcome; social; transportation access; treatment as usual

ABSTRACT Diabetes mellitus (DM) affects 30 million people in the U.S. African-Americans and Hispanics are 1.4 and 1.2 times more likely to have DM compared to non-Hispanic whites. Diabetes distress—stress, fear, and guilt related to managing diabetes—is linked to poor glycemic control and disproportionately affects African Americans and Hispanic adults with type 2 diabetes mellitus (T2DM). The American Diabetes Association (ADA) has published guidelines promoting screening for and addressing diabetes distress (DD) as a critical part of clinical care. However, only 24% of adults with diabetes report their health care team asked them how diabetes affected their lives. Efforts to systematically identify and address DD could be an important strategy to improve diabetes outcomes among disadvantaged populations and address diabetes disparities. Community health centers (CHCs) can be important partners in this effort; CHCs provide primary care for 2.5 million adults with diabetes. More than 70% of CHC patients have income below 100% of the federal poverty level and 57% are people of color. No studies have systematically implemented DD screening and treatment interventions into a real-world primary care setting or used a guideline based approach. To fill this gap, we developed the ARISE (Achieving Routine Intervention and Screening for Emotional health) intervention. Based on published guidelines, ARISE incorporates validated screening instruments, draws from interventions shown to improve DD and is individualized to patients’ domains of DD. ARISE includes a standardized process for screening adult patients with T2DM for DD, training for health center staff on how to address distress in the patient encounter, and an algorithm for action steps and referrals based on the domains identified as sources of distress. This study aims to compare ARISE to enhanced usual care (didactic training for health care teams on DD) in CHCs using a type I hybrid effectiveness-implementation design via a cluster randomized pragmatic trial. First, we will adapt ARISE into clinical workflows in two CHCs (one urban and one rural) using the Form and Function domains of the Complex Health Intervention Framework. Using the lessons learned from the adaptation, we will conduct a cluster randomized pragmatic trial across 12 CHCs (six ARISE and six enhanced usual care) to test ARISE vs. enhanced usual care among adult patients with T2DM and A1c>8%. Primary outcome will be change in A1C from baseline to 12-months between arms. Secondary outcomes will include change in DD from baseline to 6-months within the ARISE arm and change in patients’ systolic blood pressure, low density lipoprotein (LDL), and body mass index (BMI) across the two arms. We will assess the adoption, implementation, and maintenance of the ARISE intervention. We will use knowledge gained to develop best practices for CHCs across the country that are charged with caring for the largest share of America’s medically vulnerable patients with T2DM.

抽象的 糖尿病（DM）影响美国非裔美国人的3000万人，而西班牙裔则为1.4和1.2 与非西班牙裔白人相比，具有DM的可能性更高。糖尿病困扰 - 压力，恐惧和内gui 与管理糖尿病有关 - 与血糖控制不良有关，并且对非洲的影响不成比例 美国人和西班牙裔成年人患有2型糖尿病（T2DM）。美国糖尿病协会 （ADA）已发布指南，促进筛查和解决糖尿病困扰（DD）作为关键 临床护理的一部分。但是，只有24％的成年人报告其医疗团队问他们如何 糖尿病影响了他们的生活。系统地识别和解决DD的努力可能是一个重要的策略 改善灾难人群中的糖尿病结果并解决糖尿病差异。社区 卫生中心（CHC）可能是这项工作的重要合作伙伴； CHC为250万成年人提供初级保健 糖尿病。超过70％的CHC患者的收入低于联邦贫困水平的100％和57％ 是有色人种。没有研究系统地实施DD筛查和治疗干预措施 进入现实世界中的初级保健环境或使用基于指南的方法。为了填补这一空白，我们开发了 出现（实现常规干预和情绪健康的筛查）干预。根据已出版 指南，ARISE纳入了经过验证的筛选工具，是根据显示改进的干预措施的 DD，并被个性化与患者的DD领域。出现包括筛选的标准化过程 DD的T2DM的成人患者，卫生中心员工培训如何解决患者的困扰 相遇，以及基于确定为域的域的行动步骤和推荐算法 困扰。这项研究旨在比较以增强常规护理（医疗团队的教学培训 DD）在CHC中使用I型混合有效性 - 实践设计通过群集随机务实 审判。首先，我们将适应使用该表格的两个CHC（一个城市和一个粗糙）中的临床工作流程 复杂的健康干预框架的功能域。使用从 适应，我们将在12个CHC上进行簇随机务实试验（六个CHC和6个增强 在T2DM和A1C> 8％的成年患者中，测试的常规护理）进行测试与增强的护理。基本的 结果将是A1C从基线到两臂之间的12个月的变化。次要结果将包括 DD从基线到6个月内的DD变化，并且患者的收缩压变化， 低密度脂蛋白（LDL）和两个臂的体重指数（BMI）。我们将评估采用， 实施和维护出现干预措施。我们将利用获得的知识来发展最佳 全国CHC的实践，负责照顾美国医学上最大的份额 T2DM脆弱患者。