Improving Diabetes Efforts Across Language and Literacy

描述(由申请人提供)：加州大学旧金山分校合作研究网络是一个由初级保健临床医生和实践组成的日益增长的网络，为不同的患者群体提供护理。CRN致力于通过使用信息技术、循证工具和系统的自我管理支持，在实践层面上进行创新。随着最近旧金山社区卫生网络(CHNSF)提供者加入CRN，该网络对优先人群的关注有所增加。安全网做法为健康素养有限、英语水平有限、沟通障碍造成慢性病结果差异的人群提供护理。IDEALL项目(改善糖尿病在语言和识字方面的努力)是一项三臂随机对照试验，在CRN附属的安全网卫生系统旧金山社区卫生网络(CHNSF)中进行基于通信技术的干预(自动电话糖尿病管理)到面向个人的干预(团体医疗访问)。目前的建议旨在(1)扩大这些自我管理支持战略在CHNSF内总共4-5个初级保健实践中对更多患者和提供者的暴露；(2)比较这两种干预措施彼此以及与常规初级保健服务的相对效果；以及(3)探索缓和干预措施对患者结局的影响以及实施和维护成功的背景因素。IDEALL项目感兴趣的结果将包括患者参与的程度、对干预措施的参与、糖尿病指数的变化(如糖尿病自我效能、血糖控制)和相对资源使用。感兴趣的候选调节变量将包括患者/家庭级别、临床医生级别、执业级别和组织级别的变量；其他背景因素将存在于级别之间的界面，例如患者-临床医生界面、临床医生-执业界面、患者-执业界面和组织-执业界面。对主要成果的衡量将包括量化数据；将通过定量和定性相结合的方法收集背景因素，并将通过混合方法进行分析。我们计划利用我们在有效性和背景因素方面所学到的知识，帮助我们评估干预措施是否可以转移到其他CRN做法上，以便有针对性地促进未来的执行和维护工作。这一提议提供了一个机会，既可以评估疗效研究的结果在多大程度上可以转化为安全网提供系统内优先人群的健康状况的改善，也可以确定影响目标人群有效性的复杂的患者-临床医生-执业-组织生态的特征。

DESCRIPTION (Provided by Applicant): The UCSF Collaborative Research Network is a growing network of primary care clinicians and practices that care for diverse patient populations. The CRN is committed to innovation at the practice level through the use of information technology, evidence-based tools, and systematic self-management support. With the recent addition of Community Health Network of San Francisco (CHNSF) providers to the CRN, the network's focus on priority populations has increased. Safety net practices provide care for populations with a high prevalence of limited health literacy and limited English proficiency, communication barriers that contribute to disparities in chronic disease outcomes. The IDEALL Project (Improving Diabetes Efforts Across Language and Literacy) is a 3-arm randomized controlled trial of a communication technology-based intervention (automated telephone diabetes management) to an interpersonally-oriented intervention (group medical visits) in a CRN-affiliated safety-net health system, the Community Health Network of San Francisco (CHNSF). The current proposal aims to (1) expand exposure of these self-management support strategies to more patients and providers in a total of 4-5 primary care practices within the CHNSF; (2) compare the relative effects of these two interventions with respect to each other as well as to usual primary care; and (3) explore contextual factors that moderate both the effects of the interventions on patient outcomes as well as the success of implementation and maintenance. The outcomes of interest for the IDEALL Project will include extent of patient participation, engagement with the interventions, changes in diabetes indices (such as diabetes self-efficacy, glycemic control), and relative resource use. Candidate moderating variables of interest will include those at the patient/family level, clinician level, practice level, and organization level; additional contextual factors will reside in the interfaces between levels, such as the patient-clinician interface, the clinician-practice interface, the patient-practice interface, and organization-practice interface. Measures of main outcomes will consist of quantitative data; contextual factors will be collected through a combination of quantitative and qualitative methods, and analyses will proceed via a mixed methods approach. We plan to apply what we learn with regard to effectiveness and contextual factors to help us assess the transferability of interventions to other CRN practices so as to target and facilitate future implementation and maintenance efforts. This proposal presents an opportunity both to assess the degree to which results of efficacy studies can be translated into improvements in health status for priority populations within a safety-net delivery system, as well as to identify those characteristics of the complex patient-clinician-practice-organization ecology that influence effectiveness for the target population.