Optimizing Care to Prevent Diabetes and Promote Cardiovascular Health Among Younger Adults with Severe Mental Illness

优化护理以预防患有严重精神疾病的年轻人的糖尿病并促进心血管健康

• 批准号: 10584516
• 负责人: Esti Iturralde
• 金额: $ 20.93万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-01 至 2027-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10584516
• 关键词: Address; Adult; Age; Antipsychotic Agents; Behavioral; Bipolar Disorder; California; Cardiometabolic Disease; Cardiovascular Diseases; Cardiovascular system; Caring; Cessation of life; Clinical; Clinical Data; Clinical Trials Design; Cluster randomized trial; Complex; Computational algorithm; Conduct Clinical Trials; Counseling; Data; Development; Diabetes Mellitus; Doctor of Philosophy; Electronic Health Record; Ethnic Population; Evidence based intervention; Face; Feedback; Fellowship; Foundations; Funding; Future; General Population; Goals; Guidelines; Health; Health system; Healthcare Systems; Individual; Intervention; K-Series Research Career Programs; Laboratories; Learning; Life Style; Link; Major Depressive Disorder; Mental Health; Mentored Patient-Oriented Research Career Development Award; Mentors; Metabolic; Metabolic syndrome; Methods; Michigan; Minnesota; Modeling; National Institute of Mental Health; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Participant; Pathway interactions; Patient-Centered Care; Patients; Performance; Persons; Pharmaceutical Preparations; Pilot Projects; Population; Pragmatic clinical trial; Predictive Analytics; Prevention; Prevention strategy; Process; Psychological Factors; Psychologist; Psychopharmacology; Psychotic Disorders; Public Health; Qualitative Methods; Recommendation; Research; Research Personnel; Resources; Risk; Risk Factors; Risk Reduction; Science; Services; Site; Target Populations; Testing; Training; Training Support; Translating; Translations; Vulnerable Populations; Work; cardiometabolic risk; cardiometabolism; cardiovascular disorder prevention; cardiovascular disorder risk; cardiovascular health; career; career development; clinical care; clinical decision support; clinical effect; data resource; design; diabetes risk; disorder prevention; evidence base; experience; feasibility testing; feasibility trial; field study; health care delivery; implementation science; improved; individualized medicine; insight; intervention participants; novel; obesogenic; patient engagement; pharmacologic; pilot test; population based; population health; predictive modeling; preference; premature; prevent; programs; racial diversity; racial population; rapid weight gain; risk prediction model; severe mental illness; side effect; smoking cessation; smoking initiation; stakeholder perspectives; success; support tools; telehealth; telehealthcare; therapy design; tool; treatment as usual; uptake; young adult

PROJECT SUMMARY People with severe mental illness (SMI) face double the risk for type 2 diabetes compared to the general population, contributing to higher rates of cardiovascular disease and premature death. Common use of antipsychotic medications contributes to these health risks due to prevalent metabolic side effects. Many younger adults with SMI do not receive targeted, evidence-based cardiometabolic disease prevention care. Underused strategies include: prescribing alternative, less obesogenic psychotropic medications; lifestyle change supports; additional risk-reducing medications; and smoking cessation therapies. Our preliminary qualitative data with patients and clinicians identified a need for tools to match prevention care to individuals’ risk level and preferences, and tools suited to population-based care strategies. Clinical Decision Support (CDS) tools are computer algorithms that use patients’ data, predictive analytics, and clinical guidelines to promote evidence-based care by helping patients and clinicians navigate complex treatment decisions. Through this mentored K23 career development award, Esti Iturralde, PhD will build upon her background as a clinical psychologist and behavioral diabetes researcher. Through planned mentoring, coursework, and career development activities, Dr. Iturralde will gain a strong understanding of psychopharmacology and cardiometabolic health, advanced predictive analytics, and implementation science, including methods for stakeholder-engaged intervention design and pragmatic clinical trials. As a researcher in the Kaiser Permanente Northern California (KPNC) Division of Research (DOR), she will leverage robust, longitudinal electronic health record (EHR) data (> 50,000 adults from diverse racial/ethnic groups) and stakeholder insights (patients, clinicians, and health system decision-makers) within health systems including KPNC and 2 others belonging to the NIMH-funded Mental Health Research Network (HealthPartners Institute and Henry Ford Health System). The proposed research will support the training goals while contributing to the development of a novel CDS tool seeking to increase targeted, evidence-based diabetes and cardiovascular disease prevention care for adults under age 45 who are starting antipsychotic medications. Specific research aims are to: (1) inform predictive analytics of the CDS tool by developing and validating diabetes risk prediction models for the target population; (2) engage stakeholders in the design of CDS tool messaging and implementation pathways; and field-test CDS tool messaging through a pragmatic clinical trial conducted within an existing KPNC telehealth-based population management program serving this population. A future R01 application will build on the results from this project to further refine and test the CDS tool within multiple health systems. The linked research and training aims will directly prepare Dr. Iturralde for success as an embedded health system researcher and prepare her to lead a programmatic line of studies developing and implementing data-driven, feasible, scalable interventions improving the cardiometabolic health of people with SMI.

项目摘要 患有严重精神疾病（SMI）的人面临两倍的2型糖尿病的风险 人口，导致心血管疾病和过早死亡的率更高。共同用途 由于普遍的代谢副作用，抗精神病药物会导致这些健康风险。许多 患有SMI的年轻人没有接受针对性的，循证的心脏代谢疾病预防护理。 未使用的策略包括：开出替代性，少性肥胖精神药物；生活方式 变更支持；额外的降低风险药物；和戒烟疗法。我们的初步 与患者和临床医生的定性数据确定需要工具将预防护理与个人匹配 风险水平和偏好以及适合基于人群的护理策略的工具。临床决策支持 （CD）工具是使用患者数据，预测分析和临床指南的计算机算法 通过帮助患者和临床医生制定复杂的治疗决策，促进循证护理。 通过这个问题的K23职业发展奖，Esti Iturralde博士将以她的背景为基础 临床心理学家和行为糖尿病研究人员。通过计划的心理，课程和职业 开发活动，Iturralde博士将对心理药理学和 心脏代谢健康，高级预测分析和实施科学，包括 利益相关者参与的干预设计和务实的临床试验。作为Kaiser的研究员 北加利福尼亚州永久研究（KPNC）研究部（DOR），她将利用强大的纵向 电子健康记录（EHR）数据（来自潜水员种族/族裔群体的50,000名成年人）和利益相关者 卫生系统中的洞察力（患者，临床医生和卫生系统决策者），包括KPNC和2 其他属于NIMH资助的心理健康研究网络（HealthPartners Institute and Henry）的人 福特卫生系统）。拟议的研究将支持培训目标，同时为 开发一种新颖的CD工具，旨在增加针对性的循证糖尿病和心血管 为45岁以下的成年人开始抗精神病药的疾病预防护理。具体研究 目的是：（1）通过开发和验证糖尿病风险预测来告知CD工具的预测分析。 目标人群的模型； （2）让利益相关者参与CD工具消息的设计和 实施途径；通过在内部进行的务实临床试验和现场测试CD工具消息传递 现有的基于KPNC远程医疗的人口管理计划为这一人群提供服务。未来的R01 应用程序将基于该项目的结果，以进一步完善和测试多个健康中的CDS工具 系统。链接的研究和培训目标将直接为Iturralde博士做好准备，以成功地作为嵌入式 卫生系统研究人员并准备她领导编程研究线开发和实施 数据驱动的，可行的，可扩展的干预措施，改善了SMI患者的心脏代谢健康。