Research Project 1

项目摘要/摘要 南亚裔美国人的糖尿病患病率高于非西班牙裔白人和其他亚洲人 群体，以及种族/少数民族群体。然而，在文化和语言上适应的人很少 针对这一人群的糖尿病管理干预措施。社区卫生工作者(CHW)的方法有 在非裔美国人和拉丁裔人群中证明了控制糖尿病的有效性，但尚未得到证实 在南亚社区进行了系统的适应和测试。最近为扩展电子健康所做的努力 记录医疗保健提供组织中的(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 为服务不足的人群提供融合服务。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，没有在护理的背景下解决。通过搭建社区桥梁 和卫生保健系统，社区卫生服务可以帮助解决这些决定因素。有效链接主要服务器的机制 保健系统、社区卫生服务和社区资源可以通过卫生信息技术加速 (点击)工具。 由纳迪亚·伊斯拉姆博士领导的拟议项目利用了成熟的多部门和社区- 参与合作，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的有效性和实施过程，以支持 南亚糖尿病失控患者的糖尿病管理。综合干预应对 NIMHD《少数民族健康与健康框架》中描述的多层次和多领域的影响 差异：1)基于电子病历的登记系统，以识别未得到控制的糖尿病患者；2)文化和 旨在改善糖尿病患者自我管理的语言适应CHW领导的干预措施 使用以个人和家庭为基础的方法；3)与文化相关的社区一级资源的联系 使用HIT工具；以及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与常规护理相比的有效性；以及2)使用 系统评估执行进程和确定因素的混合方法 在临床和社区环境中影响干预措施的采用、保真度和维持。 使用阶梯式楔形设计，我们将在25年内招募3994名南亚糖尿病患者 初级保健实践设置。这项研究将为在高危人群中管理糖尿病的努力提供参考。我们 还将产生一个可复制和可持续的模式，用于医疗保健和社区环境 让弱势群体参与进来，有可能被复制以预防和管理其他 慢性病，包括心血管疾病和癌症。

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.