Community to Clinic Navigation to Improve Diabetes Outcomes

摘要 减少2型糖尿病（T2DM）的不良结局需要最佳的自我管理， 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，前景广阔。只有一 已经测试了已知的随机对照试验，其结合了这两个最基本的组分， 糖尿病控制该试验改善了血糖控制、血压和糖尿病自我控制， 管理，但在临床环境中实施。2我们的目标是加强这项工作， 将大多数研究活动安排在以社区为基础的环境中，以确保最弱势群体的参与， 最难接触到可能无法接受常规医疗保健的人群， 卫生工作者和患者导航员，他们是卫生保健中必不可少的可持续外展工作者 专业人才短缺。 我们建议测试一种改进的干预措施，"社区到诊所导航"（CCN），显示出有希望， 在我们的试点研究中是可行的和可接受的。考虑到阿巴拉契亚和农村居民 不成比例的高T2DM发病率，并承受糖尿病并发症的巨大负担，3这种情况 提供了一个完美的机会，在解决健康问题的同时， 不平等我们将进行3组随机设计，包括（1）糖尿病自我管理 程序，仅DSMP;（2）定制的患者导航，仅PN;和（3）组合的DSMP + PN：社区 到诊所导航计划CCN结果包括生物识别数据（HbA1c、BMI、血压、血脂、腰围 周长）;糖尿病自我管理和门诊就诊，作为主要结局的中介;成本 有效性和参与者满意度。糖尿病患者将通过教会和其他机构招募。 社区场馆。我们的项目利用了大多数健康差距社区的可持续资产-- 信仰组织，社区中心，联邦合格的卫生诊所，强大的社会关系，和有才华的当地 非专业人员可以接受培训，以教育和指导那些诊断为T2DM的人。我们持续 在阿巴拉契亚肯塔基州的参与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.