Integrating Medical and Social Care to Reduce Diabetes Inequities: Lessons from the Bridging the Gap Program.
Integrating Medical and Social Care to Reduce Diabetes Inequities: Lessons from the Bridging the Gap Program.
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整合医疗和社会护理以减少糖尿病不平等：弥合差距计划的经验教训。
DOI：
10.1007/s11606-022-07977-5
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发表时间：
2023
影响因子：
5.7
通讯作者：
Chin,MarshallH
中科院分区：
文献类型：
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作者：
Williams,JoniS;Walker,RebekahJ;Peek,MonicaE;Chin,MarshallH
在美国，少数种族和族裔群体以及低收入成年人口始终承受着与糖尿病相关的发病率和死亡率的不成比例的负担。 1, 2 虽然仍在继续进行调查以揭示这些差异的原因，但有证据表明，社会和环境因素占健康结果的 50-60%。 1 这些因素导致医疗保健和糖尿病结果的差异，需要在不同影响层面进行规划和干预，以减少差异、改善健康结果并实现健康公平。 1, 2 虽然健康的社会决定因素既不是积极的也不是消极的，但不利的社会条件（通常被称为并被认为是社会风险因素）始终被发现会对糖尿病结果产生负面影响。 3 以世界卫生组织健康问题社会决定因素框架为指导，这些不利的社会条件既包括粮食不安全和住房不稳定等个人物质状况，也包括存在于更多中间社会决定因素之前和之前的结构性健康决定因素。 4 结构性不平等和结构性种族主义源于权力差异，机构和系统内的歧视性做法强化了财富和资源的分配。 4, 5 因此，结构性决定因素通过经济机会、教育或医疗保健机会的差异使健康不平等长期存在。 4, 5 专注于整合医疗和社会护理的跨部门合作对于解决结构性决定因素、转向人口健康和基于价值的护理以及彻底改变糖尿病管理和护理至关重要。 1, 2 然而，证明社会和医疗融合影响的证据仍然有限，值得更多关注。 6 默克基金会此前资助了减少糖尿病差异联盟，其中五名受资助者证明，解决慢性病护理模式的卫生系统和社区组成部分的多层次干预措施可以减少糖尿病护理和结果的差异。 7 在此经验的基础上，默克基金会创建了一个后续计划“弥合差距：减少糖尿病护理方面的差异”，该计划更加强调整合医疗和社会护理，并与付款人合作开发可持续的财务模式。弥合差距资助了八个城市、农村和边境团队，以及芝加哥大学的国家项目办公室，该办公室负责管理该计划并为这些团队提供技术援助。本刊增刊
I n the United States, minoritized racial and ethnic groups and lower income adult populations consistently bear the disproportionate burden of diabetes-related morbidity and mortality. 1, 2 While investigations to uncover the reasons for these disparities continue, evidence shows that social and environmental factors account for 50–60% of health outcomes. 1 These factors contribute to disparities in healthcare and diabetes outcomes, calling for programming and interventions at various levels of influence to reduce disparities, improve health outcomes, and achieve health equity. 1, 2 While social determinants of health are neither positive nor negative, adverse social conditions, generally referred to and recognized as social risk factors, are consistently found to influence diabetes outcomes negatively. 3 Using the World Health Organization framework for social determinants of health as a guide, these adverse social conditions include both individual material circumstances such as food insecurity and housing instability, and the structural determinants of health that exist upstream of and antecedent to more intermediary social determinant factors. 4 Structural inequalities and structural racism result from power differences where discriminatory practices within institutions and systems reinforce the distribution of wealth and resources. 4, 5 Thus, structural determinants perpetuate inequalities in health through differences in economic opportunities, education, or healthcare access. 4, 5 Cross-sector collaborations focused on integrating medical and social care are critical to address structural determinants, shift to population health and value-based care, and revolutionize diabetes management and care. 1, 2 However, evidence demonstrating the impact of social and medical integration remains limited and warrants increased attention. 6 The Merck Foundation previously funded the Alliance to Reduce Disparities in Diabetes in which five grantees demonstrated that multi-level interventions to address the health system and community components of the Chronic Care Model could reduce disparities in diabetes care and outcomes. 7 Building upon that experience, the Merck Foundation created a successor program, Bridging the Gap: Reducing Disparities in Diabetes Care, that emphasized more strongly integrating medical and social care and developing sustainable financial models in collaboration with payers. Bridging the Gap funded eight urban, rural, and frontier teams, and the National Program Office based at the University of Chicago, which ran the initiative and provided technical assistance to the teams. This supplement of the Journal of
新的 DPB1 等位基因。
影响因子：
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作者：
H. Madsen;L. Ryder;L. Fugger;N. Odum;B. Jakobsen;A. Svejgaard
通讯作者：
A. Svejgaard
德国西南部白种人群体的 HLA-DPB1 寡核苷酸分型。
影响因子：
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作者：
T. Eiermann;J. Fakler;C. Müller;M. Ballas;S. Goldmann
通讯作者：
S. Goldmann
DPB1*WA2 和 DPB1*WA3——新的西非 HLA DPB1 等位基因，与黑人群体中常见的等位基因 DPB1*0101 密切相关。
影响因子：
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作者：
Meyer,CG;Schnittger,L;Gallin,M;Erttmann,KD;Brattig,N;Begovich,AB;Erlich,HA;Horstmann,RD
通讯作者：
Horstmann,RD