VIDA: Virtual Diabetes Group Visits Across Health Systems

项目总结 在美国的3000万成人糖尿病患者中，97%的人至少有一种共病(例如：糖尿病)。 高血压、心脏病、肾病)。糖尿病和糖尿病相关并发症对人们的影响不成比例 一种颜色。西班牙裔(12.5%)和非裔美国人(11.7%)的DM患病率高于 非西班牙裔白人(7.5%)；西班牙裔和非裔美国人患糖尿病的比例更高 并发症，包括截肢和CKD。团体访问(GV)可以为患者提供全面的 照顾他们患有多种疾病的慢性疾病。糖尿病GVS-共享预约，患者接受自我 小组管理教育和个人就诊--可以改善血糖控制， 降低医疗保健利用率，并提供社会支持和同龄人之间的共同学习。虽然是虚拟的 在新冠肺炎大流行期间，预约已成为临床护理的常规部分，团体探视通过虚拟 平台仍然不常见，也没有得到足够的研究。在该模型能够被广泛采用之前，有一些重要的问题 关于虚拟糖尿病GV模型的有效性和实施需要解决。我们建议 建立在该大学已建立的亲自糖尿病GV项目和虚拟糖尿病GV试点项目的基础上 芝加哥和中西部临床医生网络。我们的目标是实现虚拟GV模型(VIDA：虚拟糖尿病 跨卫生系统的小组访问)在芝加哥地区的两个不同的卫生系统中：Access和 倡导Aurora Health(AAH)。Access是美国最大的联邦合格健康中心之一 美国在芝加哥大都市区有35个地点，为17.5万名医疗服务不足的人提供护理， 每年都有低收入患者，包括超过25,000名糖尿病患者。倡导Aurora Health(AAH)是 在伊利诺伊州拥有129多家初级保健诊所的大型、多样化、综合的非营利性私人医疗系统 为超过11.7万名糖尿病患者提供服务。培训、实施和评估虚拟团体访问的能力 跨两个不同的卫生系统提供了一个独特的机会来了解适应和障碍 计划实施的促进者。本研究将采用第一类混合效能实施设计。 通过一项实用的整群随机试验评估成年T2 DM患者临床结果的变化 虚拟糖尿病GV与常规护理相比。我们将首先在One Access FQHC中心调整和实施VIDA 以及使用复杂健康干预的形式和功能域的一个AAH初级保健诊所 框架。我们将评估VIDA与临床工作流程的整合，并确定VIDA的类型和数量 协助工作人员将虚拟糖尿病GV纳入临床环境所需的培训和技术支持。我们 然后，我将在9个干预地点(180名成年患者)对虚拟GV进行务实的整群随机试验 T2 DM合并A1C和GT；9%)和9个控制点(360例匹配的患者)，并评估A1C从基线开始的变化 至12个月，以及其他临床结果的变化，包括收缩压和体重指数。我们 将使用RE-AIM框架跨系统评估虚拟全球车的采用、实施和维护。

PROJECT SUMMARY Of the 30 million adults with DM in the United States, 97% have at least one comorbid condition (e.g. hypertension, heart disease, kidney disease). DM and DM-related complications disproportionately affect people of color. The prevalence of DM is higher among Hispanics (12.5%) and African-Americans (11.7%) compared to non-Hispanic whites (7.5%); Hispanics and African-Americans have higher rates of diabetes-related complications, including amputations and CKD. Group visits (GVs) can provide patients with comprehensive care for their multimorbid chronic condition. Diabetes GVs—shared appointments where patients receive self- management education in a group setting and an individual medical visit—can improve glycemic control, decrease healthcare utilization, and provide social support and co-learning among peers. While virtual appointments have become a routine part of clinical care during the COVID-19 pandemic, group visits via virtual platforms remain uncommon and understudied. Before the model can be widely adopted, important questions about the effectiveness and implementation of the virtual diabetes GV model need to be addressed. We propose to build on an established program of in-person diabetes GVs and a virtual diabetes GV pilot by the University of Chicago and MidWest Clinician’s Network. We aim to implement the virtual GV model (VIDA: Virtual Diabetes Group Visits Across Health Systems) in two distinct health systems in the Chicago region: ACCESS and Advocate Aurora Health (AAH). ACCESS is one of the largest federally qualified health centers (FQHCs) in the U.S. with 35 sites across the Chicago metropolitan area, providing care for 175,000 medically underserved and low-income patients each year, including over 25,000 patients with diabetes. Advocate Aurora Health (AAH) is a large, diverse, integrated private not-for profit health system with more than 129 primary care clinics in Illinois serving over 117,000 patients with diabetes. The ability to train, implement and evaluate virtual group visits across two distinct health systems provides a unique opportunity to learn about adaptation and the barriers and facilitators for program implementation. This study will use a type I hybrid effectiveness-implementation design via a pragmatic cluster randomized trial to assess changes in clinical outcomes among adults with T2DM in virtual diabetes GVs versus usual care. We will first adapt and implement VIDA at one ACCESS FQHC center and one AAH primary care clinic using the Form and Function domains of the Complex Health Intervention Framework. We will assess integration of VIDA into clinical workflow and determine the type of and amount of training and technical support needed to assist staff in integrating virtual diabetes GV into the clinical setting. We will then conduct a pragmatic cluster randomized trial of virtual GVs across 9 intervention sites (180 adult patients with T2DM with A1C >9%) and 9 control sites (360 matched patients) and assess change in A1C from baseline to 12-months and change in other clinical outcomes including systolic blood pressure and body mass index. We will assess adoption, implementation, and maintenance of virtual GVs across systems using RE-AIM framework.