An intervention to enhance hypoglycemia communication and preventive action in primary care

项目摘要/摘要 为一半接受胰岛素或胰岛素治疗的美国成人糖尿病患者实现最佳护理 对于分泌剂来说，预防低血糖是至关重要的，因为低血糖会导致大量的发病率和医院利用率。 然而，有限的证据--包括我们自己的初步分析--表明，临床医生通常不会 评估低血糖，很少采取预防措施，如修改糖尿病治疗或提供 预防低血糖的前瞻性指导。内分泌协会呼吁进行干预以改善 临床应用中的低血糖预防，但尚不存在循证干预措施。 在这项提案中，我们将填补在低血糖预防和患者提供者方面的主要空白 在初级保健中进行沟通，并开发可扩展的干预措施来预防低血糖 可以集成到初级保健工作流程中。患者与提供者之间的沟通对于 低血糖预防，因为它需要临床医生收集详细的病史，传达复杂的信息， 并激励患者做出行为改变。拟议的干预将建立在有效干预的基础上。 通过使用患者报告结果测量(PROMS)常规评估来改善慢性病护理 患者的症状，并促使临床医生采取行动解决这些问题。具体研究目标为：目标1) 确定全国退伍军人样本中低血糖评估和预防措施的频率 事务初级保健走访，制定低血糖沟通质量框架。目标2)发展 一种干预措施，将PROMS用于低血糖评估整合到初级保健工作流程中，链接到 提供工具包，以加强低血糖沟通和预防实践。目标3)进行试点 评估开发的低血糖预防干预措施的可行性、保真度和可接受性的研究 这些目标为R01应用程序进行明确的临床试验奠定了基础 这里开发的干预措施，并解决了对可扩展干预措施的迫切需求，这些干预措施可以转化证据- 将预防低血糖的实践纳入初级保健环境。 斯科特·皮拉博士的长期职业目标是成为一名独立的临床医生研究员，开发和 领先的干预研究，改善糖尿病患者的健康和他们的管理 初级保健。他寻求K23指导职业发展奖，以获得关键技能和经验，以 领导一个独立资助的研究项目。他的职业发展计划包括授课和辅导 在定性和沟通研究方法、患者报告结果研究、 以及临床试验的进行和领导。培训将在约翰·霍普金斯大学丰富的环境中进行， 包括普通内科和彭博公共卫生学院。皮拉博士会 接受经验丰富的导师和顾问团队的指导，这些导师和顾问具有患者提供者方面的专业知识 沟通、定性研究和临床试验，他们有指导和资助的记录。

PROJECT SUMMARY / ABSTRACT To achieve optimal care for the half of U.S. adults with diabetes who are treated with insulin or insulin secretagogues, it is crucial to prevent hypoglycemia, which causes substantial morbidity and hospital utilization. However, limited evidence – including our own preliminary analyses – suggests that clinicians do not routinely assess for hypoglycemia and rarely take preventive actions such as modifying diabetes therapy or providing anticipatory guidance for hypoglycemia prevention. The Endocrine Society has called for interventions to improve hypoglycemia prevention in clinical encounters, yet no evidence-based interventions exist. In this proposal, we will fill major gaps in understanding hypoglycemia prevention and patient-provider communication in primary care encounters, and develop a scalable intervention to prevent hypoglycemia that can be integrated into the primary care workflow. Patient-provider communication is especially important for hypoglycemia prevention because it requires clinicians to gather detailed history, convey complex information, and motivate patients to make behavior change. The proposed intervention will build upon effective interventions that improve chronic disease care by using patient reported outcome measures (PROMs) to routinely assess patient symptoms and prompt clinicians to take action addressing them. The specific research aims are: Aim 1) Determine the frequency of hypoglycemia assessment and prevention practices in a national sample of Veterans Affairs primary care visits, and develop a framework for hypoglycemia communication quality. Aim 2) Develop an intervention that integrates PROMs for hypoglycemia assessment into the primary care workflow, linked to a provider toolkit to enhance hypoglycemia communication and prevention practices. Aim 3) To conduct a pilot study to evaluate the feasibility, fidelity, and acceptability of the hypoglycemia prevention intervention developed in Aim 2. These aims lay the groundwork for an R01 application to conduct a definitive clinical trial of the intervention developed here, and address the urgent need for scalable interventions that translate evidence- based practices for hypoglycemia prevention into the primary care setting. Dr. Scott Pilla’s long-term career goal is to become an independent clinician investigator developing and leading interventional research that improves the health of patients with diabetes and their management in primary care. He seeks a K23 mentored career development award to obtain critical skills and experience to lead an independently-funded research program. His career development plan includes didactics and mentored research experience in qualitative and communication research methods, patient reported outcomes research, and the conduct and leadership of clinical trials. This training will occur in the rich environment at Johns Hopkins, including the Division of General Internal Medicine and the Bloomberg School of Public Health. Dr. Pilla will receive guidance from an experienced team of mentors and advisors with expertise in patient-provider communication, qualitative research, and clinical trials, who have a track record of mentoring and funding.