ARISE (Achieving Routine Intervention and Screening for Emotional health)

ARISE（实现情绪健康的常规干预和筛查）

基本信息

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
项目类别：
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

项目摘要

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 3000 万人，非洲裔美国人和西班牙裔美国人分别为 1.4 和 1.2 与非西班牙裔白人相比，患有糖尿病的可能性要高出一倍。与糖尿病管理相关——与血糖控制不良有关，并且对非洲人的影响尤为严重患有 2 型糖尿病 (T2DM) 的美国人和成人西班牙裔美国人。 (ADA) 发布了促进筛查和解决糖尿病困扰 (DD) 的指南，将其作为一项关键措施然而，只有 24% 的成人糖尿病患者表示他们的医疗保健团队询问他们如何进行治疗糖尿病影响了他们的生活，系统地识别和解决 DD 可能是一项重要策略。改善弱势群体的糖尿病结局并解决糖尿病社区差异。卫生中心 (CHC) 可以成为这一努力的重要合作伙伴，为 250 万成年人提供初级保健；超过 70% 的 CHC 患者收入低于联邦贫困线 100%，57% 患有糖尿病。没有研究系统地实施 DD 筛查和治疗干预措施。为了填补这一空白，我们开发了现实世界的初级保健环境或使用基于指南的方法。 ARISE（实现情绪健康的常规干预和筛查）干预基于已发表的内容。指南中，ARISE 结合了经过验证的筛查工具，借鉴了经证明可以改善的干预措施 DD 并根据患者的 DD 领域进行个性化设置，包括标准化的筛查流程。患有 DD 的成年 T2DM 患者，为健康中心工作人员提供有关如何解决患者痛苦的培训遭遇，以及基于被识别为来源的域的行动步骤和推荐的算法本研究旨在将 ARISE 与强化常规护理（针对医疗保健团队的教学培训）进行比较。 DD）在 CHC 中使用 I 型混合有效性实施设计，通过集群随机实用设计首先，我们将使用该表格将 ARISE 纳入两个 CHC（一个城市和一个农村）的临床工作流程。综合健康干预框架的功能领域为了适应这一情况，我们将在 12 个 CHC（6 个 ARISE 和 6 个增强型常规护理）来测试 ARISE 与增强型常规护理在 T2DM 且 A1c>8% 原发性成年患者中的比较。次要结果将包括 A1C 从基线到 12 个月的变化。 ARISE 组内 DD 从基线到 6 个月的变化以及患者收缩压的变化，我们将评估两组的低密度脂蛋白（LDL）和体重指数（BMI）。 ARISE 干预措施的实施和维护我们将利用获得的知识来实现最佳发展。全国各地的社区卫生中心 (CHC) 的实践，负责照顾美国最大份额的医疗资源易受伤害的 T2DM 患者。