Community to Clinic Navigation to Improve Diabetes Outcomes

社区到诊所导航以改善糖尿病治疗结果

• 批准号: 10224172
• 负责人: Nancy E. Schoenberg
• 金额: $ 55.04万
• 依托单位: UNIVERSITY OF KENTUCKY
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10224172
• 关键词: Address; Affect; American; Appalachian Region; Biometry; Blood Pressure; Body mass index; Church; Clinic; Clinical; Communities; Community Health Aides; Complications of Diabetes Mellitus; Data; Diabetes Mellitus; Diagnosis; Dissemination and Implementation; Education; Environment; Epidemic; Evidence based intervention; Focus Groups; Future; Glycosylated hemoglobin A; Goals; Health; Health care facility; Healthcare; Individual; Influentials; Intervention; Interview; Kentucky; Lipids; Low income; Mediator of activation protein; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Participant; Patients; Persons; Pilot Projects; Population; Positioning Attribute; Prediabetes syndrome; Protocols documentation; Randomized; Randomized Controlled Trials; Recruitment Activity; Research; Research Activity; Rural; Rural Population; Self Management; Social support; Talents; Testing; Training; Vulnerable Populations; Work; adverse outcome; arm; base; behavioral outcome; clinical care; community center; community setting; cost effectiveness; design; diabetes control; diabetes self-management; evidence base; glycemic control; health care quality; health care service organization; health disparity; health disparity populations; health inequalities; health professional shortage areas; improved; improved outcome; innovation; low socioeconomic status; meetings; member; outreach; primary outcome; programs; randomized trial; recruit; relative cost; rural dwellers; satisfaction; self-management program; social; theories; underserved community; waist circumference

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.

摘要 减少2型糖尿病(T2 DM)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 通过个性化的患者导航来改善适当的临床护理具有很大的前景。只有一个 已知的随机对照试验已经测试，它结合了这两个最基本的成分 糖尿病控制。该试验的结果是血糖控制、血压和糖尿病自我改善。 管理，但在临床环境中实施2我们的目标是通过招聘和 将大多数研究活动定位在基于社区的环境中，以确保最弱势群体的参与， 最难接触到可能没有得到定期医疗保健的人群，并通过利用社区 卫生工作者和患者导航员，他们是卫生保健中必不可少的和可持续的外展工作者 专业人才短缺地区。 我们建议测试一种精细化的干预措施，“社区到诊所导航”(CCN)，显示出很有前景， 在我们的初步研究中，这是可行的，也是可以接受的。鉴于阿巴拉契亚和农村居民坚持 2型糖尿病发病率高得不成比例，糖尿病并发症造成巨大负担，3这一环境 提供了一个完美的机会，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 计划，仅限DSMP；(2)量身定制的患者导航，仅限PN；以及(3)组合的DSMP+PN：社区 至临床导航计划，CCN。结果包括生物测量(HbA1c、BMI、血压、血脂、腰围 周长)；糖尿病自我管理和门诊就诊，作为主要结果的中介因素；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可用的可持续资产-- 宗教组织、社区中心、联邦合格的医疗诊所、强大的社会关系和有才华的地方 可以接受培训的业馀人员，以教育和引导那些被诊断为T2 DM的人。我们的持续 参与阿巴拉契亚肯塔基州的活动使我们的团队能够适当和有效地测试这一前景 未来有很大潜力传播到其他传统上服务不足的环境的方案。

项目成果

The mediating/moderating role of cultural context factors on self-care practices among those living with diabetes in rural Appalachia.

• DOI: 10.1186/s12889-021-11777-7
• 发表时间: 2021-10-02
• 期刊: BMC public health
• 影响因子: 4.5
• 作者: Smalls BL;Adegboyega A;Combs E;Rutledge M;Westgate PM;Azam MT;De La Barra F;Williams LB;Schoenberg NE
• 通讯作者: Schoenberg NE