Research Project 1

研究项目1

• 批准号: 10207429
• 负责人: NADIA S ISLAM
• 金额: $ 8.48万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-30 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10207429
• 关键词: Address; Adherence; Adoption; African American; American; Asian Americans; Asians; Bangladesh; Behavioral; Cardiovascular Diseases; Caring; Chronic Disease; Clinical; Collaborations; Communication; Communities; Community Health Aides; Community Healthcare; Community Integration; Community Services; Diabetes Mellitus; Electronic Health Record; Enrollment; Ethnic group; Family; Feedback; Glycosylated hemoglobin A; Health; Health Personnel; Health behavior; Healthcare Systems; Hispanics; Immigrant; India; Individual; Intervention; Lead; Limited English Proficiency; Linguistics; Link; Maintenance; Malignant Neoplasms; Medical; Medical Care Team; Methods; Minority; Minority Groups; Modeling; Muslim religion; Neighborhoods; New York City; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Outcome; Pakistan; Patient-Centered Care; Patients; Persons; Physicians; Population; Prevalence; Prevention; Primary Health Care; Process; Provider; Race; Registries; Reproducibility; Research Project Grants; Resources; Self Efficacy; Social Work; Social support; South Asian; Subgroup; System; Testing; Transportation; Underserved Population; Vulnerable Populations; Work; base; built environment; care coordination; care systems; community setting; comparison intervention; data infrastructure; design; diabetes control; diabetes management; diabetes self-management; effectiveness evaluation; effectiveness testing; experience; food insecurity; health care delivery; health care settings; health disparity; health information technology; healthcare community; high risk population; improved; minority health; practice setting; primary care setting; primary outcome; racial and ethnic; racial minority; secondary outcome; social disadvantage; therapy design; tool; treatment as usual; treatment guidelines

Project Summary/Abstract South Asian Americans have higher diabetes prevalence compared with non-Hispanic whites, other Asian groups, and racial/ethnic minority groups. However, there are few culturally and linguistically adapted interventions for diabetes management for this population. Community health worker (CHW) approaches have demonstrated efficacy for diabetes control in African American and Latino populations, but have not been systematically adapted and tested in South Asian communities. Recent efforts to expand electronic health record (EHR) systems across health care delivery organizations and harness that data infrastructure for patient-centered care have underscored the potential of strengthening care coordination teams through CHW integration for underserved populations. However, the upstream determinants of diabetes management are often viewed as outside of the clinical setting and not addressed in the context of care. By bridging community and health care systems, CHWs can help address these determinants. Mechanisms to effectively link primary care systems, CHWs, and community resources can be accelerated through health information technology (HIT) tools. Led by Dr. Nadia Islam, the proposed project leverages a well-established multi-sector and community- engaged collaboration to improve diabetes management among New York City South Asians with diabetes. This project will evaluate the effectiveness and implementation process of a multi-level intervention to support diabetes management for South Asian patients with uncontrolled diabetes. The integrated intervention tackles multiple levels and domains of influence as described in the NIMHD Framework on Minority Health & Health Disparities: 1) EHR-based registry system to identify patients with uncontrolled diabetes; 2) Culturally and linguistically adapted CHW-led intervention designed to improve self-management of diabetes among patients using individual and family-based approaches; 3) Linkage to culturally relevant community-level resources using HIT tools; and 4) CHW-integration into primary care teams. The specific aims of the project are to: 1) Test the effectiveness of a multi-level diabetes management intervention compared to usual care; and 2) Use a mixed-methods approach to systematically assess the implementation process and delineate factors influencing adoption, fidelity, and maintenance of the intervention within clinical and community settings. Using a stepped wedge design, we will enroll 3,994 South Asian patients with uncontrolled diabetes in 25 primary care practice settings. This study will inform efforts to manage diabetes in a high-risk population. We will also generate a reproducible and sustainable model for use in healthcare and community settings engaging vulnerable populations that can potentially be replicated for the prevention and management of other chronic diseases, including cardiovascular disease and cancer.

项目概要/摘要 与非西班牙裔白人和其他亚洲人相比，南亚裔美国人的糖尿病患病率更高 群体和种族/族裔少数群体。然而，很少有文化和语言适应的 针对该人群的糖尿病管理干预措施。社区卫生工作者 (CHW) 的方法有 已证明对非裔美国人和拉丁裔人群的糖尿病控制有效，但尚未得到证实 在南亚社区进行了系统的调整和测试。最近扩大电子医疗的努力 跨医疗保健提供组织的记录（EHR）系统，并利用该数据基础设施 以患者为中心的护理强调了通过 CHW 加强护理协调团队的潜力 服务不足的人群的融合。然而，糖尿病管理的上游决定因素是 通常被视为临床环境之外，并且没有在护理背景下得到解决。通过搭建社区桥梁 和卫生保健系统，社区卫生工作者可以帮助解决这些决定因素。有效链接初级的机制 通过卫生信息技术可以加速护理系统、社区卫生工作者和社区资源的发展 （命中）工具。 由 Nadia Islam 博士领导，拟议的项目利用了完善的多部门和社区- 开展合作，改善纽约市南亚糖尿病患者的糖尿病管理。 该项目将评估多层次干预措施的有效性和实施过程，以支持 糖尿病未受控制的南亚患者的糖尿病管理。综合干预解决 NIMHD 少数民族健康框架中描述的多层次和影响领域 差异：1）基于 EHR 的登记系统来识别未受控制的糖尿病患者； 2）文化上和 由社区卫生工作者主导的语言适应干预措施旨在改善患者糖尿病的自我管理 采用基于个人和家庭的方法； 3) 与文化相关的社区级资源的联系 使用 HIT 工具； 4) CHW-融入初级保健团队。该项目的具体目标是：1) 测试多层次糖尿病管理干预措施与常规护理相比的有效性； 2) 使用 系统评估实施过程并界定因素的混合方法 影响临床和社区环境中干预措施的采用、忠诚度和维持。 使用阶梯式楔形设计，我们将在 25 年中招募 3,994 名未受控制的糖尿病南亚患者 初级保健实践环境。这项研究将为高危人群的糖尿病管理工作提供信息。我们 还将生成一个可重复且可持续的模型，用于医疗保健和社区环境 让弱势群体参与进来，这可能会被复制用于预防和管理其他疾病 慢性疾病，包括心血管疾病和癌症。