Delivering contextualizing population data to patients to motivate health care transition preparation

项目概要/摘要 患有1型糖尿病（T1 D）的青少年和年轻人（AYA）有血糖控制不良的风险， 糖尿病的发生会增加他们患短期和长期糖尿病并发症的风险。这些风险在转型期间达到顶峰 从以儿科为重点的护理到以成人为重点的护理，此时护理受到分散和缺乏协调的影响。AYA的风险 同时，新的期望提高了对疾病的独立管理， 治疗，但许多人缺乏这样做的动机。这个指导职业发展奖的劳伦Wisk， 博士，一个儿科卫生服务研究人员，将针对这一重要领域的指导下，一个杰出的 在有针对性的职业发展活动中获得的新知识。在目标1中，博士 Wisk将使用来自一个大型国家健康保险计划（超过4500万注册者）的数据来描述人口- 水平的利用和结果的趋势在整个医疗过渡的AYA与T1 D，并评估其 在个人和系统层面的决定因素;为了实现这一目标，她将获得新的内容健康知识 护理提供系统和结构。在目标2中，她将编写人口数据摘要， 采用定性方法，让AYA和T1 D参与评价这些总结的显著性和可接受性， 用于以患者为中心的行为干预。Wisk博士将在行为科学中融入新的技能， 健康沟通作为这种以患者为中心的干预设计的基础，以提高AYA的 参与过渡准备任务的动机。在目标3中，她将接受执行培训， 改进科学，以实施干预措施，评估其有效性，以激励采用 关键的过渡准备活动，并确定战略，以影响充分和有效地利用 在临床实践环境中进行干预。Wisk博士的K 01研究旨在开发和实施一种行为 改善T1 D患者AYA过渡期准备的干预试验将成为多中心， 在K 01期结束时提交的R 01申请中提出的纵向试验。Wisk博士试图 成为一个独立的调查员，在设计，实施和 在T1 D患者的医疗保健和生命过程过渡期间传播对AYA的干预措施， 将这些干预措施转化为自我持续改善的另一个长期目标， T1 D的管理和健康结果。通过拟议的职业发展奖， 伴随着培训活动，她将整合她的培训和研究目标，以了解AYA如何 T1 D患者在过渡期间导航医疗保健系统，哪些因素对激励最有效 在此期间，他们继续参与医疗保健，确保她拥有必要的技能， 她的职业目标Wisk博士是唯一能够利用这个奖项和高技能指导的支持 团队和机构环境，以启动独立资助的研究生涯。

PROJECT SUMMARY/ABSTRACT Adolescents and young adults (AYA) with Type 1 Diabetes (T1D) are at risk for poor glycemic control, which in turn increases their risk for short- and long-term diabetes complications. These risks peak during the transition from pediatric- to adult-focused care, when care is subject to fragmentation and lack of coordination. AYA's risk of poor outcomes is simultaneously elevated by new expectations to independently manage their disease and treatment, but many lack the motivation to do so. This mentored career development award for Lauren Wisk, Ph.D., a pediatric health services researcher, will target this important area with the guidance of an outstanding mentoring team and with new knowledge obtained during targeted career development activities. In Aim 1, Dr. Wisk will use data from a large national health insurance plan (>45 million enrollees) to describe population- level utilization and outcome trends across the health care transition for AYA with T1D, and evaluate their determinants at individual and system levels; to achieve this aim she will gain new content knowledge of health care delivery systems and structures. In Aim 2, she will develop summaries of population data and use qualitative methods to engage AYA with T1D in evaluating those summaries for salience and acceptability for use in a patient-centered, behavioral intervention. Dr. Wisk will incorporate new skills in behavioral science and health communication as the foundation of this patient-centered intervention design to improve AYA's motivation to engage in transition preparation tasks. In Aim 3, she will undertake training in implementation and improvement science in order to implement the intervention, assess its effectiveness for motivating adoption of key transition preparation activities, and determine strategies to influence the full and effective use of the intervention in clinical practice settings. Dr. Wisk's K01 research to develop and implement a behavioral intervention trial to improve transition preparation for AYA with T1D will form the basis of a multi-site, longitudinal trial to be proposed in an R01 application submitted at the end of the K01 period. Dr. Wisk seeks to become an independent investigator with comprehensive expertise in designing, implementing and disseminating interventions for AYA with T1D during their health care and life-course transitions, with the additional long-term objective of translating these interventions into sustained improvements in self- management and health outcomes in T1D. Through the proposed career development award and accompanying training activities, she will integrate her training and research objectives to understand how AYA with T1D navigate the health care system during transition and what factors are most effective for motivating their continued health care engagement during that time, ensuring that she has the skills necessary to achieve her career goals. Dr. Wisk is uniquely positioned to use this award and the support of a highly skilled mentoring team and institutional environment to launch an independently-funded research career.