Bridging Barriers to Diabetes Care with Telemedicine

描述（由申请人提供）： 根据最近2002年的估计，每年糖尿病的费用约为1 320亿美元。糖尿病的负担是相当大的，特别是对不同种族的人口。注重自我管理教育的疾病管理计划在改善代谢控制方面是有效的。因此，美国糖尿病协会临床护理指南强调代谢控制的重要性，以防止并发症和改善生活质量的人与这种疾病。不幸的是，这些进展并没有导致临床实践的广泛接受。因此，我们建议转化研究，以评估远程医疗技术，使用交互式视频会议（糖尿病远程护理）作为一种新的手段，以增加卫生专业人员在农村社区的可用性，有效地提供糖尿病自我管理教育计划，并作为一种手段，在初级保健设置提供视网膜筛查。我们的目标是：1）制定和实施一项为期12个月的干预措施，糖尿病远程护理，以提高对糖尿病临床护理指南的遵守，并改善位于种族多样化，农村和医疗服务不足社区的两个社区卫生中心的糖尿病控制，2）进行为期一年的随机临床试验（RCT）在200名患者中正式评估糖尿病远程护理与家庭护理相比的有效性，样本中有> 60%的非洲裔美国人，和3）确定糖尿病远程护理与家庭护理相比的成本效益和满意度。参与者从南卡罗来纳州农村的两个社区健康中心招募，并根据患者随机化时间表进行随机化。糖尿病远程护理（结构化课程）由一名注册护士/认证糖尿病教育者（RN-CDE）和一名经验丰富的注册营养师组成的团队提供，并由其他卫生专业人员提供支持，这些卫生专业人员通过互动视频会议与偏远地区农村卫生中心的参与者（单个和小组）联系起来。主要结果是代谢控制（A1c，血脂），血压和使用远程医疗促进视网膜筛查能力的措施。次要结果包括满意度、生活质量、健康信念和知识。经济分析将包括对资源利用、成本和卫生设施的评估。此外，还将确定与常规护理相比，糖尿病远程护理的每A1c成本和估计终身成本效用的增量降低。远程医疗可能是传统保健提供系统的一种有效替代办法，从而改善糖尿病教育和控制。

DESCRIPTION (provided by applicant): According to recent 2002 estimates, the yearly cost of diabetes was approximately $132 billion. The burden of diabetes is considerable, particularly for ethnically diverse populations. Disease management programs that focus on self-management education have been effective in improving metabolic control. Accordingly, the American Diabetes Association clinical care guidelines stress the importance of metabolic control to prevent complications and improve quality of life for persons with this disease. Unfortunately, these advances have not resulted in widespread acceptance into clinical practice. Therefore, we propose translational research to evaluate telemedicine technology using interactive video conferencing (Diabetes TeleCare) as a novel means to increase the availability of health professionals in rural communities for the effective delivery of a diabetes self management education program and as a means to provide retinal screenings in the primary care setting. Our aims are to 1) develop and implement a 12-month intervention, Diabetes TeleCare to improve adherence to diabetes clinical care guidelines and improve diabetes control in two community health centers located in ethnically diverse, rural and medically underserved communities, 2) conduct a one-year randomized clinical trial (RCT) of 200 patients to formally evaluate the effectiveness of Diabetes TeleCare compared to Usual Care in a sample with >60% African-Americans, and 3) determine the cost-effectiveness and satisfaction of Diabetes TeleCare compared to Usual Care. Participants are recruited from two community health centers in rural South Carolina and randomized according to a patient randomization schedule. Diabetes TeleCare (a structured curriculum) is delivered by a team consisting of a registered nurse/certified diabetes educator (RN-CDE) and an experienced registered dietitian, with support by other health professionals who are linked by interactive video conferencing to participants (single and group) in rural health centers at distant locations. The primary outcomes are measures of metabolic control (A1c, lipids), blood pressure, and use of the telemedicine-facilitated retinal screening capacity. Secondary outcomes include satisfaction, quality of life, health beliefs, and knowledge. The economic analysis will include an assessment of resource utilizaton, cost, and health utilities. In addition, incremental reductions in costs per A1c and the estimated lifetime cost-utility of Diabetes TeleCare compared to usual care will be determined. Telemedicine may be an effective alternative to traditional health care delivery systems resulting in improved diabetes education and control.