Patient centered intervention to improve care among diabetic older americans

由于糖尿病是一种慢性疾病，在少数民族老年人中具有大量相关发病率，并且是一种自我管理在预防并发症方面尤为重要的疾病，因此我们开始实施和评估文化上定制的以患者为中心的干预措施，以通过提高患者知识、自我管理技能和社区居住的少数民族糖尿病老年人的赋权来改善血糖控制。该项目的具体目标是：（1）确定一种侧重于增加糖尿病护理知识、增强能力和自我管理技能的多层面、文化定制的干预措施是否会导致更好的血糖、血脂血压和体重控制，减少急性糖尿病相关症状，并改善与健康相关的生活质量; 2）确定这种干预是否会导致护理过程的改善; 3）确定与常规护理相比，干预的成本效益。为了评估干预措施的有效性，研究小组将进行一项对照临床试验，随机抽取600名患有糖尿病的老年非裔美国人和拉丁美洲人，他们在马丁·路德·金·德鲁大学医学中心下属的6家公共诊所接受治疗。随机化将在患者水平进行。本试验的主要终点将是血糖控制的差异，反映为主动干预组与常规护理对照组随时间推移血红蛋白A1 c的平均差异。该试验还将跟踪干预前后的一些重要次要终点：自我管理技能，糖尿病知识，糖尿病特异性症状，生活质量，低密度脂蛋白水平，血压，体重，护理质量和医疗保健服务使用。这项研究还将收集有关可能改变干预措施有效性的变量的数据，如文化适应、保险状况和福利结构以及社会支持。这些数据将提供必要的信息，以评估老年非裔美国人和拉丁美洲糖尿病患者干预的有效性和成本效益。由于干预措施的有效性和具体设计可能会受到文化因素的影响，因此，该临床试验将在非洲裔美国人和拉丁美洲人中进行预先计划的亚组分析。拟议干预措施的内容将根据一项受资助的试点研究的结果确定，该研究目前正在设计干预措施，并评估它对患有糖尿病的非洲裔美国人和拉丁美洲老年人是否可以接受和可行。总之，通过设计和测试干预措施，并评估它是否可以接受和可行的非裔美国人和拉丁美洲老年糖尿病患者。总之，通过设计和测试一种专注于患者而不是护理系统的干预措施，我们希望用所需的技能，知识和授权来武装老年糖尿病患者，以获得最佳的血糖控制和医疗保健过程，无论他们的护理环境中有多少资源。

Because diabetes is a chronic condition with substantial associated morbidity among minority elders and is a condition in which self- management is particularly crucial in the prevention of complications, we set out to implement and evaluate culturally tailored patient-centered intervention to improve glycemic control by improving patient knowledge, self-management skills, and empowerment among community-residing minority older adults with diabetes. Specific aims of the project are: 1) to determine whether a multidimensional, culturally tailored intervention that focuses on increasing knowledge about diabetes care, empowerment, and self-management skills, will lead to better glycemic, lipid blood pressure, and weight control, fewer acute diabetes- related symptoms, and improvements in health-related quality of life; 2) to determine whether this intervention will lead to improvements in process of care; 3) to determine the cost-effectiveness of the intervention when compared to usual care. To evaluate the effectiveness of the intervention, the research team will conduct a controlled clinical trial that will randomize 600 older African American and Latino persons with diabetes who are cared for in 6 public clinics affiliated with the Martin Luther King-Drew University Medical Center. Randomization will occur at the patient level. The primary endpoint for the trial will be differences in glycemic control as reflected by mean difference in hemoglobin A1c over time for the active intervention versus usual care control group. The trial will also track a number of important secondary endpoints both before and after exposed to the intervention: self-management skills, knowledge about diabetes, diabetes-specific symptoms, quality of life, low density lipoprotein levels, blood pressure, weight, quality of care, and health care service use. The study will also collect data on variables that are likely to modify the effectiveness of the intervention, such as acculturation, insurance status and benefit structure, and social support. These data will provide the needed information to evaluate both the effectiveness and the cost effectiveness of the intervention among older African Americans and Latinos with diabetes. Because the effectiveness and specific design of the intervention is likely to be influenced by cultural factors, the cultural factors, the clinical trial will be powered for pre-planned sub-group analyses among African Americans and Latinos. The content of the proposed intervention will be determined by the result of a funded pilot study that is currently designing the intervention and assessing whether it is acceptable and feasible for African American and Latino older persons with diabetes. In summary, by designing and testing the intervention and assessing whether it is acceptable and feasible for African American and Latino older persons with diabetes. In summary, by designing and testing an intervention that focuses on the patient rather than the system of care, we hope to arm older diabetes with the needed skills, knowledge, and empowerment to have the best possible glycemic control and process of health care regardless of the resources available in their care setting.