Community to Clinic Navigation to Improve Diabetes Outcomes

摘要 减少 2 型糖尿病 (T2DM) 的不良后果需要最佳的自我管理和 适当的临床护理。1 结合循证干预措施改善糖尿病自我管理 通过个性化定制的患者导航来改善适当的临床护理具有广阔的前景。只有一个 已知的随机对照试验已经过测试，结合了这两个最重要的组成部分 糖尿病控制。该试验改善了血糖控制、血压和糖尿病自我治疗 管理，但在临床环境中实施。2我们的目标是通过从和 将大多数研究活动安排在社区环境中，以确保最弱势群体的参与， 最难接触到可能无法接受定期医疗保健的人群并利用社区 卫生工作者和患者导航员，他们是卫生保健领域重要且可持续的外展工作者 专业紧缺领域。 我们建议测试一种精细的干预措施“社区到诊所导航”（CCN），该干预措施被证明是有希望的， 可行，并且在我们的试点研究中是可以接受的。鉴于阿巴拉契亚和农村居民保持 T2DM 发病率极高，并承受着糖尿病并发症的巨大负担，3 这种情况 提供了一个绝佳的机会，可以在解决健康问题的同时测试难以接触到的人群的干预措施 不平等。我们将实施 3 组随机设计，包括 (1) 糖尿病自我管理 程序，仅限 DSMP； (2) 量身定制的患者导航，仅限 PN； (3) 合并后的 DSMP PN：社区 到诊所导航程序，CCN。结果包括生物识别（HbA1c、BMI、血压、血脂、腰围 周长）；糖尿病自我管理和就诊，作为主要结局的中介因素；成本 有效性和参与者满意度。糖尿病患者将通过教堂和其他机构招募 社区场所。我们的项目利用了大多数健康差距社区可用的可持续资产—— 信仰组织、社区中心、联邦合格的健康诊所、牢固的社会关系和才华横溢的当地 可以接受培训的非专业人士可以对被诊断为 T2DM 的患者进行教育和指导。我们持续的 参与阿巴拉契亚肯塔基州使我们的团队能够适当有效地测试这一有希望的 该计划具有强大的潜力，未来可以传播到其他传统上服务不足的环境。

ABSTRACT Reducing adverse outcomes from Type 2 Diabetes Mellitus (T2DM) requires optimal self-management and appropriate clinical care.1 Combining an evidence-based intervention to improve diabetes self-management with individually-tailored patient navigation to improve appropriate clinical care holds great promise. Only one known randomized controlled trial has been tested that combines these two most essential components of diabetes control. That trial resulted in improvements to glycemic control, blood pressure, and diabetes self- management, but was implemented in a clinical setting.2 We aim to enhance this work by recruiting from and locating most research activities in community-based settings to insure involvement of the most vulnerable, hardest to reach populations who may not be receiving regular health care and by leveraging Community Health Workers and Patient Navigators, who are essential and sustainable outreach workers in health care professional shortage areas. We propose testing a refined intervention, “Community to Clinic Navigation” (CCN), shown to be promising, feasible, and acceptable in our pilot study. Given that Appalachian and rural residents maintain disproportionately high rates of T2DM and suffer tremendous burdens from diabetic complications,3 this setting provides a perfect opportunity to test the intervention with a hard to reach population while addressing health inequities. We will administer a 3 arm group randomized design including (1) Diabetes Self-management Program, DSMP only; (2) tailored Patient Navigation, PN only; and (3) the combined DSMP + PN: Community to Clinic Navigation program, CCN. Outcomes include biometrics (HbA1c, BMI, blood pressure, lipids, waist circumference); diabetes self-management and clinic attendance, as mediators of the primary outcomes; cost effectiveness and participant satisfaction. Persons with diabetes will be recruited through churches and other community venues. Our project leverages sustainable assets available in most health disparity communities-- faith organizations, community centers, federally qualified health clinics, strong social ties, and talented local lay people who can be trained to educate and navigate those diagnosed with T2DM. Our sustained involvement in Appalachian Kentucky positions our team to appropriately and efficiently test this promising program with strong potential for future dissemination to other traditionally underserved environments.