Financial Incentives And Nurse Coaching to Enhance Diabetes Outcomes - FINANCE-DM

财务激励和护士指导可提高糖尿病治疗效果 - FINANCE-DM

• 批准号: 10375456
• 负责人: Leonard E. Egede
• 金额: $ 65.67万
• 依托单位: MEDICAL COLLEGE OF WISCONSIN
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-15 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10375456
• 关键词: Address; Adult; Affect; African American population; Behavior; Body Weight decreased; Case Manager; Centers for Disease Control and Prevention (U.S.); Cessation of life; Chronic Disease; Clinical; Control Groups; Data; Diabetes Mellitus; Disease; Disease Management; Effectiveness; Ethnic group; Feedback; Financial Support; Glycosylated hemoglobin A; Goals; Health behavior; High Prevalence; Hispanic Populations; Home; Incentives; Intervention; Literature; Long-Term Effects; Low-Density Lipoproteins; Measures; Metabolic Control; Monitor; Non-Insulin-Dependent Diabetes Mellitus; Nurses; Nursing Education; Outcome; Patients; Quality of life; Randomized; Randomized Controlled Trials; Research; Research Support; Resources; Risk; Self Care; Smoking; Structure; Testing; Training and Education; United States; Walkers; active control; behavioral economics; caucasian American; cost effective; cost effectiveness; diabetes education; diabetes mellitus nursing; diabetes self-management; dietary; dietary adherence; effective intervention; efficacy testing; ethnic minority; exercise adherence; financial incentive; follow-up; glycemic control; improved; intervention effect; medication compliance; minority patient; novel; post intervention; program costs; racial and ethnic; secondary endpoint; skills training; telemonitoring

Ethnic minorities (African Americans –AA and Hispanics -HA) with Type 2 diabetes (T2DM) have higher prevalence of diabetes, poorer metabolic control and greater risk for complications and death compared to White Americans; and the literature shows that effective interventions for T2DM need to have multiple components including: nurse diabetes education and skills training, home monitoring with feedback, and maintain high intensity. Recent evidence from behavioral economics research supports the use of financial incentives to improve health-related behaviors and the effectiveness of financial incentives to improve health behaviors has been demonstrated across different diseases and behaviors including smoking, weight loss, dietary behavior, medication adherence, and diabetes self-management, with the most beneficial result lasting up to 18 months post-intervention. Preliminary data from our group suggest that structured financial incentives in combination with nurse education and home telemonitoring is feasible and effective in adults with T2DM. However, there are three important unanswered questions: 1) Are financial incentives layered upon nurse education and home telemonitoring superior to nurse education and home telemonitoring alone in improving metabolic control long term? 2) Are the effects of financial incentives on metabolic control sustained once the incentives are withdrawn? and 3) Are financial incentives efficacious within and across racial/ethnic groups? To address these gaps in the literature, we propose a randomized controlled trial to test the efficacy of a Financial Incentives And Nurse Coaching to Enhance Diabetes Outcomes (FINANCE-DM) intervention comprised of: 1) nurse education, 2) home telemonitoring, and 3) structured financial incentives; compared to an active control group (nurse education and home telemonitoring alone) at 12 months. The study also will evaluate whether intervention effects are sustained 6 months after the financial incentives are withdrawn (i.e. 18 months post randomization); and whether the intervention is differentially efficacious across racial/ethnic groups.

少数民族（非洲裔美国人 - AA和西班牙裔–HA）患有2型糖尿病（T2DM） 与 白人美国人；文献表明，对T2DM的有效干预措施需要具有多个 组件包括：护士糖尿病教育和技能培训，反馈的家庭监控以及 保持高强度。行为经济学研究的最新证据支持财务的使用 提高与健康相关行为的激励措施以及改善健康的经济激励措施的有效性 在不同的疾病和行为中都证明了行为，包括吸烟，减肥， 饮食行为，药物依从性和糖尿病自我管理，最有益的结果持久 干预后长达18个月。我们小组的初步数据表明结构化的经济激励措施 与护士教育和家庭远程监控结合使用，在T2DM的成年人中是可行且有效的。 但是，有三个重要的未解决问题：1）对护士的经济激励措施 教育和家庭远程监控者优于护士教育和家庭远程监控，仅在改进 代谢控制长期？ 2）一旦经济激励对代谢控制的影响，一旦 激励措施被撤回？ 3）在种族/族裔群体内部和跨种族中，经济激励措施是否有效？到 解决文献中的这些差距，我们提出了一项随机对照试验，以测试财务的效率 激励措施和护士教练以增强糖尿病结果（Finance-DM）干预完成：1） 护士教育，2）家庭远程监控和3）结构化的经济激励措施；与主动对照相比 小组（仅由护士教育和家庭远程监控）12个月。该研究还将评估是否 撤回经济激励措施后6个月的干预效果将持续下来（即18个月后 随机化）；以及在种族/族裔群体之间的干预措施是否有效。