Improving Diabetes Efforts Across Language and Literacy

描述（由申请人提供）：UCSF合作研究网络是一个不断发展的初级保健临床医生和实践网络，照顾不同的患者群体。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。安全网实践为卫生知识普及程度有限、英语熟练程度有限的人群提供护理，这些人群的沟通障碍导致了慢性病结局的差异。IDEALL项目（通过语言和读写能力改善糖尿病的努力）是一项三组随机对照试验，在crn附属的安全网络卫生系统，旧金山社区卫生网络（CHNSF）中，以通信技术为基础的干预（自动电话糖尿病管理）和以人际为导向的干预（团体医疗访问）。目前的提案旨在(1)扩大这些自我管理支持策略在CHNSF内的4-5个初级保健实践中的更多患者和提供者的曝光；(2)比较这两种干预措施相互之间的相对效果以及与通常的初级保健的相对效果；(3)探讨干预措施对患者预后的影响以及实施和维持的成功程度的背景因素。IDEALL项目感兴趣的结果将包括患者参与程度、干预的参与程度、糖尿病指数的变化（如糖尿病自我效能、血糖控制）和相关资源的使用。感兴趣的候选调节变量包括患者/家庭水平、临床医生水平、实践水平和组织水平；附加的上下文因素将存在于各层次之间的界面中，例如患者-临床医生界面、临床医生-实践界面、患者-实践界面和组织-实践界面。衡量主要成果将包括定量数据；背景因素将通过定量和定性方法的结合来收集，分析将通过混合方法进行。我们计划运用我们所学到的有效性和背景因素来帮助我们评估干预措施在其他CRN实践中的可转移性，从而确定目标并促进未来的实施和维护工作。该建议提供了一个机会，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络交付系统内优先人群健康状况的改善，也可以确定影响目标人群有效性的复杂患者-临床-实践-组织生态的那些特征。

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.