Implementing Scalable, PAtient-centered Team-based Care for Adults with Type 2 Diabetes and Health Disparities (iPATH)

为患有 2 型糖尿病和健康差异的成人实施可扩展、以患者为中心的团队护理 (iPATH)

基本信息

批准号：
10660735
负责人：
Sara Jean Singer
金额：
$ 78.19万
依托单位：
STANFORD UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-07-21 至 2028-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10660735
关键词：
Acceleration Address Adopted Adult Affect American COVID-19 pandemic California Caring Case Study Chronic Care Clinic Clinical Data Cluster randomized trial Data Data Analyses Data Collection Data Reporting Diabetes Mellitus Effectiveness Elements Ensure Environment Equity Ethnic Origin Evaluation Exploration, Preparation, Implementation, and Sustainment Federally Qualified Health Center Feedback Geographic Locations Glycosylated hemoglobin A Goals Guidelines High Prevalence Hybrids Inequity Interview Investments Massachusetts Medical Economics Methodology Methods Modeling National Committee for Quality Assurance Non-Insulin-Dependent Diabetes Mellitus Not Hispanic or Latino Ohio Outcome Patient Care Patients Pilot Projects Population Prevalence Preventive care Privatization Process Puerto Rico Quality of Care Race Recommendation Research SARS-CoV-2 infection Science Shoulder Social Environment Source Standardization Symptoms Technology Testing United States Agency for Healthcare Research and Quality United States National Institutes of Health Universities Variant acute care behavioral economics care delivery data sharing diabetes control ethnic minority experience flexibility health care quality health disparity health disparity populations health equity high risk implementation determinants implementation/effectiveness improved innovation minority patient novel novel strategies organizational readiness pandemic disease patient centered medical home patient oriented patient safety poor health outcome post-COVID-19 post-pandemic pre-pandemic racial disparity racial minority remote health care socioeconomic disparity socioeconomics team-based care tool

项目摘要

PROJECT SUMMARY / ABSTRACT A collaborative network of research teams from Stanford, Harvard, The Ohio State University, and Impactivo, LLC propose practice-relevant research focused on diabetes care in federally qualified health centers (FQHCs). Some 37.3 million Americans have type 2 diabetes and significant racial and socioeconomic disparities persist in care quality and patient safety. FQHCs serve 1 in 7 U.S. racial/ethnic minorities and shoulder a higher prevalence of diabetes (21% FQHC, 11% U.S.), offering a promising venue for innovating in equity-focused diabetes care. The iPATH project will refine and implement an approach to practice transformation originally conceived to support FQHCs’ pursuit of National Committee for Quality Assurance recognition as patient-centered medical homes. A pilot demonstrated significant decreases (average 31% reduction) in poorly controlled diabetes (A1c>9%) among patients at 7 clinics affiliated with an FQHC in Puerto Rico in 2017-20. Improvements in patients’ diabetes control were sustained pre- to post- Covid-19 pandemic. Aim 1. Refine the iPATH implementation approach by identifying organizational conditions and processes at FQHCs that promoted or impeded the effectiveness of type 2 diabetes care for NIH- designated U.S. health disparity populations pre- and post-pandemic. Research teams will simultaneously conduct 12 in-depth regional case studies, enabling contrast between FQHCs considered high- performing and low-performing for diabetes control. Teams will identify actionable, how-to implementation factors for ensuring chronic, preventive, and acute care for patients with diabetes. Employing an innovative Rapid Data Collection and Reporting methodology, teams will rapidly collect, analyze, and share data to accelerate dissemination of customized feedback to FQHC leaders and to inform adaptation and implementation of the iPATH practice transformation. Aim 2. Implement a multi-level, multi-component, technology-enabled practice transformation strategy to improve type 2 diabetes for patients at 8 multi-clinic FQHCs. Teams will adapt, tailor, implement, test, and spread an equity-focused practice transformation strategy across FQHCs located in California, Massachusetts, Ohio, and Puerto Rico. The iPATH implementation approach will be modularized and customizable to accommodate organizational readiness, patient needs, and social contexts, tailoring practice transformation efforts to each unique FQHC. Aim 3. Comprehensively evaluate the iPATH implementation approach with a hybrid type 2 study, including a stepped wedge cluster randomized trial. Including formative, process, and summative evaluation elements guided by the Exploration-Preparation-Implementation-Sustainment model, the study will evaluate impact of practice transformation and identify process elements affecting implementation effectiveness. Analyses will leverage FQHC data by race and ethnicity to examine health disparities.

项目概要/摘要来自斯坦福大学、哈佛大学、俄亥俄州立大学的研究团队的协作网络 Impactivo, LLC 提出与实践相关的研究，重点关注联邦合格健康中的糖尿病护理约 3730 万美国人患有 2 型糖尿病，并且存在显着的种族和社会经济问题。 FQHC 服务于美国七分之一的少数族裔和少数族裔，但在护理质量和患者安全方面仍然存在差异。糖尿病患病率较高（FQHC 为 21%，美国为 11%），为创新提供了一个充满希望的场所 - 专注于糖尿病公平护理的 iPATH 项目将完善并实施一种实践方法。转型最初是为了支持 FQHC 追求国家质量保证委员会的目标对以患者为中心的医疗之家的认可度显着下降（平均 31%）。波多黎各 FQHC 附属 7 家诊所的患者中糖尿病控制不佳 (A1c>9%) 的情况有所减少 Rico 在 2017-20 年期间，患者的糖尿病控制在 Covid-19 大流行之前持续改善。目标 1. 通过确定组织条件和完善 iPATH 实施方法 FQHC 中促进或阻碍 NIH 2 型糖尿病护理有效性的流程指定的美国健康差异人群大流行前后的研究小组将。同时进行 12 个深入的区域案例研究，以便在被认为是高品质的 FQHC 之间进行对比糖尿病控制方面表现良好和表现不佳的团队将确定可操作的实施方法。确保对糖尿病患者进行长期、预防性和急性护理的因素。快速数据收集和报告方法，团队将快速收集、分析和共享数据加速向 FQHC 领导者传播定制反馈，并为适应和调整提供信息实施iPATH实践转型。目标2.实施多层次、多组成部分、技术驱动的实践转型 8 个多诊所 FQHC 团队将调整、定制、改善患者的 2 型糖尿病策略。在位于以下地区的 FQHC 实施、测试和推广以公平为中心的实践转型战略加利福尼亚州、马萨诸塞州、俄亥俄州和波多黎各 iPATH 实施方法将采用模块化方式。并可根据组织准备情况、患者需求和社会环境进行定制对每个独特的 FQHC 进行转型努力。目标 3. 通过混合 2 类研究全面评估 iPATH 实施方法，包括阶梯式楔形聚类随机试验，包括形成性、过程性和总结性试验。评估要素以探索-准备-实施-维持模式为指导，该研究将评估实践转型的影响并确定影响实施的流程要素有效性。分析将利用按种族和民族划分的 FQHC 数据来检查健康差异。