Internet Intervention For Improving Rural Diabetes Care

描述（由申请人提供）： 背景亚拉巴马的糖尿病患病率为8%，是所有州中最高的之一。我们提出了一项为期5年的随机试验，旨在提高亚拉巴马农村医生对2型糖尿病成人患者的指南依从性。农村亚拉巴马有许多弱势群体和少数民族患者，他们的医疗保健服务有限，与城市患者相比，农村亚拉巴马糖尿病患者接受的护理质量较差，预后较差。目标. (1)评估糖尿病指南实施的障碍，并通过焦点小组和基于病例的小插曲调查确定解决方案;（2）开发和实施互动式互联网干预，定期更新;（3）在随机对照试验中评估干预;（4）评估反馈导致的绩效变化;（5）检查反馈停止后改善指南依从性的可持续性。方法.我们与亚拉巴马大学农村医学项目合作，将200名农村医生随机分配到干预组或对照组。我们的干预为期30个月，为每位医生实时定制，包括基于案例的教育，绩效反馈和基准的互联网学习模块。结果将基于先前开发和验证的糖尿病质量指标。干预措施将包括筛查、诊断、治疗和预防。我们将为每位医生审查10名糖尿病患者的基线和随访病历。在医生层面进行的主要分析将比较研究组之间指南依从性的差异改善。辅助分析将检查医生特征的影响（例如，专业）和患者特征（例如，合并症、种族、性别、年龄和社会经济地位）。在适当的情况下，多变量技术将调整重复测量和医生内的患者聚类。意义这项研究提供了一个技术先进，理论基础，提供者水平的干预，以改善高风险，服务不足的人群的护理。我们的多学科团队有着良好的合作记录，并在将研究转化为实践，农村医学，行为医学和临床糖尿病方面拥有专业知识。该项目将产生一种循证和可复制的尖端干预措施，这种干预措施可以在“真实的世界”中持续，易于传播，并易于针对其他疾病进行修改。

DESCRIPTION (provided by applicant): Background. The prevalence of diabetes in Alabama is 8%, one of the highest among all states. We propose a 5- year randomized trial of an Internet-based intervention designed to improve guideline adherence by rural Alabama physicians caring for adult patients with type 2 diabetes. Rural Alabama has many disadvantaged and minority patients with limited health care access, and rural Alabama patients with diabetes receive poorer quality of care and have worse outcomes compared to urban patients. Objectives. (1) Assess barriers to implementation of diabetes guidelines and identify solutions through focus groups and case-based vignette surveys; (2) Develop and implement an interactive Internet intervention, updated regularly; (3) Evaluate the intervention in a randomized controlled trial; (4) Assess changes in performance attributable to feedback; and (5) Examine the sustainability of improved guideline adherence once feedback ceases. Methods. In partnership with the University of Alabama rural medicine program, we will randomize 200 rural physicians to an intervention or control arm. Our 30-month intervention, customized to the individual physician in real-time, consists of Internet learning modules with casebased education, performance feedback, and benchmarks. Outcomes will be based on previously developed and validated quality measures for diabetes. The intervention will cover screening, diagnosis, treatment, and prevention. We will review baseline and follow up medical records of 10 diabetic patients for each physician. The main analysis, conducted at the physician level, will compare differential improvement in guideline adherence between the study arms. Ancillary analyses will examine the effects of physician characteristics (e.g., specialty) and patient characteristics (e.g., comorbidities, ethnicity, gender, age, and socioeconomic status). When appropriate, multivariable techniques will adjust for repeated measures and clustering of patients within physicians. Significance. This study offers a technologically advanced, theory-grounded, provider-level intervention for improving care of a high-risk, underserved population. Our multidisciplinary team has a proven record of collaboration and contains expertise in translating research into practice, rural medicine, behavioral medicine, and clinical diabetes. This project will produce an evidence-based and replicable cutting-edge intervention that can be sustained in the "real world," readily disseminated, and easily modified for other diseases.