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

项目摘要/摘要 患有1型糖尿病(T1D)的青少年和青壮年(Aya)有血糖控制不良的风险， 这会增加他们患短期和长期糖尿病并发症的风险。这些风险在过渡期间达到顶峰。 从以儿科为主到以成人为重点的护理，当护理容易支离破碎和缺乏协调时。阿亚的风险 同时，独立管理疾病的新期望也提高了他们的不良结局 治疗，但许多人缺乏这样做的动力。这是劳伦·威斯克的职业发展指导奖， 博士，儿科健康服务研究人员，将在一位杰出的 指导团队，并在有针对性的职业发展活动中获得新知识。在目标1中，Dr。 WISK将使用一项大型国家医疗保险计划(4500万参保者)的数据来描述人口- T1D的AYA在医疗过渡期间的水平利用率和结果趋势，并评估其 个人和系统层面的决定因素；为了实现这一目标，她将获得关于健康的新内容知识 护理服务系统和结构。在目标2中，她将编制人口数据摘要并使用 用定性的方法让Aya和T1D一起评估这些摘要的重要性和可接受性 用于以患者为中心的行为干预。威斯克博士将在行为科学和 健康沟通为基础的以患者为中心的干预设计，以改善阿雅的 参与过渡准备任务的动机。在目标3中，她将接受执行和培训 改进科学，以实施干预措施，评估其对激励采用 关键的过渡准备活动，并确定影响充分和有效利用 临床实践环境中的干预。Wisk博士的K01研究开发和实施了一种行为 改善T1D的AYA过渡准备的干预试验将形成多部位的基础， 纵向试验将在K01期末提交的R01申请中提出。威斯克博士试图 成为一名独立的调查员，拥有全面的设计、实施和 在卫生保健和生命过程过渡期间传播对患有T1D的Aya的干预措施，与 将这些干预措施转化为自我能力的持续改进的额外长期目标 T1D的管理和健康结果。通过拟议的职业发展奖和 伴随着培训活动，她将结合她的培训和研究目标，了解阿雅是如何 使用T1D在过渡期间导航医疗保健系统，以及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，以实现 她的职业目标。Wisk博士处于独特的地位，可以利用这个奖项和高技能导师的支持 团队和制度环境，以启动独立资助的研究事业。

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.