Toward Technology Equity: Extending Telemedicine to Latino Patients with Type II Diabetes

项目摘要 拉美裔人受II型糖尿病的影响不成比例。他们的年龄调整后发病率为每1000人中9.7人 这一比例几乎是非拉丁裔白人的两倍。一旦被诊断出患有糖尿病，拉美人的情况更糟 与非拉丁裔患者相比，血糖控制和糖尿病相关并发症。这些不平等是由 多种相互关联的生物、文化和社会因素。特别是，缺乏获得持续护理和困难的机会 导航医疗系统是造成这些差异的关键驱动因素。通过将护理延伸到诊所以外的地方， 远程医疗为应对这些挑战提供了机会。远程医疗为患者提供视频和电话 从远程设置访问。然而，目前的实施战略在远程医疗方面造成了重大差距 拉丁美洲人，特别是那些英语水平有限(LEP)的人的访问和使用。这个K23的目标是解决 通过评估文化和语言上量身定做的实施战略如何能够增加 拉丁裔糖尿病患者使用远程医疗。我的中心假设是，通过应用以人为中心的设计 在实施科学的支持下，我们可以改善远程医疗的使用，这是解决 糖尿病差异。拟议的项目将以以下三个具体目标来检验中心假设。目标1将 评估现有电子健康记录数据、远程医疗平台和工作流，以确定多个级别 远程医疗的贡献者在拉丁裔糖尿病患者中使用差距。目标2将让利益相关者参与制定 针对患者和临床医生的多层次、量身定制的干预措施，以促进远程医疗在拉丁裔护理中的应用 糖尿病患者。AIM 3将对多水平、量身定制的干预措施进行试点随机对照试验 在拉丁裔糖尿病患者和他们的临床医生中。通过创新应用以人为本的设计 和实施科学，这项建议解决了重叠的医疗信息技术和糖尿病差异 在拉丁裔患者中，特别是那些患有LEP的患者。 拟议的研究得到了严格的培训计划和经验丰富的指导团队的补充，将 确保我过渡到独立。培训计划的重点是混合效应Logistic回归、实施 科学、以人为本的设计和试验设计。该提案将构成R01申请的基础，该申请的中心是 更大规模的临床试验，测试实施干预措施对拉丁裔患者临床结局的影响 糖尿病。

PROJECT ABSTRACT Latinos are disproportionately affected by type II diabetes. They have an age-adjusted incidence rate of 9.7 per 1000 persons, nearly double the rate for non-Latino Whites. Once diagnosed with diabetes, Latinos experience worse glycemic control and diabetes-related complications compared to non-Latino patients. These inequities are driven by multiple interrelated biological, cultural, and social factors. In particular, a lack of access to consistent care and difficulty navigating the healthcare system are critical drivers of these disparities. By extending care beyond the clinic, telemedicine presents an opportunity to address these challenges. Telemedicine offers patients video and telephone visits from remote settings. However, current implementation strategies have created significant gaps in telemedicine access and use among Latinos, especially those who are limited English proficient (LEP). The goal of this K23 is to address this critical need by evaluating how a culturally and linguistically tailored implementation strategy can increase telemedicine use by Latino patients with diabetes. My central hypothesis is that by applying a human-centered design approach supported by implementation science, we can improve telemedicine use, an important part of addressing diabetes disparities. The proposed project will test the central hypothesis with the following 3 specific aims. Aim 1 will evaluate existing electronic health record data, telemedicine platforms, and workflows to identify multilevel contributors to telemedicine use gaps among Latino patients with diabetes. Aim 2 will engage stakeholders to develop a multilevel, tailored intervention targeted at patients and clinicians to promote telemedicine use in the care of Latino patients with diabetes. Aim 3 will conduct a pilot randomized controlled trial of the multilevel, tailored intervention among Latino patients with diabetes and their clinicians. Through an innovative application of human-centered design and implementation science, this proposal addresses overlapping health information technology and diabetes disparities among Latino patients, especially those who are LEP. The proposed research is complemented by a rigorous training plan and a highly experienced mentorship team that will ensure my transition to independence. The training plan focuses on mixed-effect logistic regression, implementation science, human-centered design, and trial design. This proposal will form the basis for an R01 application centering on a larger clinical trial testing the effect of the implementation intervention on clinical outcomes among Latino patients with diabetes.