Clinic to Community Connections: Enhancing Prenatal to Postpartum Care Transitions to Prevent Type 2 Diabetes in Low Income Women with Gestational Diabetes

诊所与社区的联系：加强产前到产后护理的过渡，以预防患有妊娠期糖尿病的低收入妇女患 2 型糖尿病

• 批准号: 10377539
• 负责人: Cynthia J Herrick
• 金额: $ 15.88万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-15 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10377539
• 关键词: Address; Adoption; Age; Attention; Attitude; Award; Caring; Chronic Disease; Clinic; Clinical Endocrinology; Clinical Investigator; Collection; Communication; Communities; Community Health Aides; Complement; Custom; Data; Development; Development Plans; Diabetes Mellitus; Diabetes prevention; Distress; Education; Educational Curriculum; Effectiveness; Effectiveness of Interventions; Endocrinology; Exercise; Federally Qualified Health Center; Foundations; Funding; Future; Gestational Diabetes; Glucose; Goals; Healthcare; Healthcare Systems; High Risk Woman; Hyperglycemia; Individual; Insurance Coverage; Intervention; Intervention Studies; K-Series Research Career Programs; Knowledge; Learning; Life Style Modification; Link; Low Income Population; Low income; Maintenance; Maternal-fetal medicine; Medical Nutrition Therapy; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Modality; Modeling; Non-Insulin-Dependent Diabetes Mellitus; Nutritionist; Obesity; Outcome Study; Patient Education; Patients; Physicians; Play; Population; Positioning Attribute; Postpartum Period; Postpartum Women; Pregnancy; Pregnant Women; Preparation; Provider; Public Health; Publications; Randomized Controlled Trials; Research; Research Activity; Resource-limited setting; Resources; Retrospective cohort; Risk; Role; Science; Self Efficacy; Standardization; System; Testing; Time; Training; Training Activity; Underserved Population; United States; Visit; Vulnerable Populations; Woman; Work; barrier to care; care coordination; care delivery; care fragmentation; career development; community engaged research; community partnership; copayment; cost effectiveness; diabetes education; diabetes educator; diabetes risk; diabetes self-management; education resources; effectiveness evaluation; follow-up; glycemic control; health care delivery; health care model; health literacy; high risk population; implementation fidelity; implementation outcomes; implementation science; improved; innovation; low socioeconomic status; medical vulnerability; multidisciplinary; nutrition; nutrition education; patient oriented research; pilot trial; population health; postpartum care; pragmatic trial; prenatal; prevent; programs; risk perception; screening; therapy development; trial design

Project Summary/Abstract Type 2 diabetes is a growing public health challenge and gestational diabetes predicts this preventable chronic disease at an early age. Half of all women with gestational diabetes will go on to develop type 2 diabetes without intervention. There are clear opportunities to intercede during and after pregnancy to prevent type 2 diabetes; however, it is difficult to operationalize these interventions in low resource settings and traditional healthcare models. The purpose of this Mentored Patient-Oriented Research Career Development Award is to empower the candidate to develop a research program that uses innovative approaches to care delivery to maximize diabetes prevention in vulnerable populations. To achieve this goal, mentorship and training in this award are proposed to support: 1) additional training in methods of community-engaged research, intervention development for pregnant and postpartum women, tailoring education materials for low health literacy, implementation science, and pragmatic trial design; 2) protected time to conduct the planned patient-oriented research; and 3) the collection and publication of preliminary data to facilitate the next steps in the research program. The research plan in this award is supported by the career development plan and interdisciplinary team of mentors, advisors and collaborators. The proposed work seeks to 1) develop and refine a diabetes self-management education and medical nutrition therapy curriculum for low-income women with gestational diabetes that can be delivered by clinic staff and community health workers; and 2) conduct a pilot trial of this curriculum to assess reach, preliminary effectiveness, adoption, implementation fidelity, and maintenance. The anticipated outcome of this study is high-quality pilot data that will provide the foundation for an R01 application to conduct a larger pragmatic randomized controlled trial to assess effectiveness, cost-effectiveness, and sustainability of the intervention. We hypothesize that a community-engaged intervention delivered by community health workers and clinic staff through the prenatal to postpartum transition of care will decrease diabetes-related distress, increase diabetes knowledge and self-efficacy, and improve diabetes attitudes and risk perception for the development of type 2 diabetes among women, ultimately enhancing post-partum screening and follow-up care. If true, this care model could have a significant positive impact on care delivery for populations in resource-limited settings. The training and research activities delineated in this proposal complement the candidate’s background in clinical endocrinology and population health and will position her to make substantial contributions to health care delivery systems change. Ultimately, this work will lead to new models to improve care transitions and care coordination for diabetes prevention and care in our highest risk populations.

项目总结/文摘