Adapting and assessing the feasibility of a diabetes self-management education and support telehealth intervention for rural populations to reduce disparities in diabetes care

项目摘要 在糖尿病自我管理教育资源较少的农村地区，糖尿病患病率较高 和支持(DSMES)，这是优化糖尿病管理的基石。一种时效性强的DSMES程序 由多学科专家通过远程医疗提供的服务也鼓励护理合作伙伴和同行的支持是 提供创新的解决方案，以增加获得DSME的机会并缩小差距。这项研究是由 研究、有效性、采用、实施和维护(RE-AIM)框架。具体来说， 参与者和护理伙伴将在乡村诊所接受一次性的8小时远程健康干预，在那里 他们得到了来自多学科团队的惯常照顾。农村临床实践将提供反馈 分三轮，进行反复实践层面的改革，以解决流程和/或工作流程问题。我们的整体 目标是调整、实施、改进和评估通过远程医疗提供的省时的DSMES计划 由多学科专家组成的团队，鼓励关怀合作伙伴和同伴支持，以改善A1C和 在农村社区开展糖尿病自我管理，减少差距。我们的多学科团队包括 研究人员和临床医疗保健提供者在糖尿病护理、DSMES交付、社区方面具有经验- 从事研究、实践研究和农村卫生问题。犹他州大学和高平原大学 研究网络为这一特殊的研究提供了一个强有力的环境。拟议的研究将1)调整 退出糖尿病一日计划(D1D)，用于农村社区(农村糖尿病一天计划或 R-D1D)，2)在参与者和实践级别实施、改进和评估R-D1D，以及3)进行 RE-AIM有效性(患者结果)和维持性维度的探索性评估 (实践成果)。我们的最终目标是通过增加可获得性来减少农村人口的健康差距 到使用远程医疗的糖尿病专科护理。初步数据支持D1D干预，但需要 适应农村人口的翻译，然后在实践层面反复改进，以支持长期 维修。这样一种经过测试、被接受的干预措施应该会对糖尿病自身产生有益的影响 跨多个农村地点进行管理。

Project Summary Diabetes prevalence is higher in rural areas that have lower resources to diabetes self-management education and support (DSMES), a cornerstone to optimal diabetes management. A time efficient DSMES program delivered via telehealth by multidisciplinary experts that also encourages care partner and peer support is a creative solution to increasing access to DSMES and reducing disparities. This study is guided by the Research, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Specifically, participants and care partners will receive a one-time, 8-hour telehealth intervention at the rural clinic where they receive their usual care, from the multidisciplinary team. The rural clinical practices will provide feedback in three rounds, with iterative practice-level changes, to address process and/or workflow issues. Our overall objective is to adapt, implement, refine, and evaluate a time efficient DSMES program delivered via telehealth by a team of multidisciplinary experts that encourages care partner and peer support to improve A1C and diabetes self-management in rural communities to reduce disparities. Our multidisciplinary team includes researchers and clinical healthcare providers with experience in diabetes care, DSMES delivery, community- engaged research, practice-based research, and rural health issues. The University of Utah and High Plains Research Network provide a strong environment for this particular study. The proposed study will 1) adapt the exiting Diabetes One-Day Program (D1D) for use in rural communities (Rural Diabetes One-Day Program or R-D1D), 2) implement, refine, and evaluation R-D1D at the participant and practice level, and 3) conduct an exploratory evaluation of the RE-AIM dimensions of effectiveness (patient outcomes) and maintenance (practice outcomes). Our ultimate goal is to reduce health disparities in rural populations by increasing access to diabetes specialty care using telehealth. Preliminary data support the D1D intervention, but will require adaptation to translate for rural populations, then iterative refinement at the practice level to support long-term maintenance. Such a tested, accepted intervention should have a beneficial effect on diabetes self- management across multiple rural locations.