Bridging Barriers to Diabetes Care with Telemedicine

描述(由申请人提供)： 根据最近2002年的估计，每年糖尿病的成本约为1320亿美元。糖尿病的负担是相当大的，特别是对于不同种族的人群。注重自我管理教育的疾病管理计划在改善代谢控制方面一直很有效。因此，美国糖尿病协会的临床护理指南强调代谢控制的重要性，以预防并发症和改善这种疾病患者的生活质量。不幸的是，这些进展并没有导致临床实践的广泛接受。因此，我们建议进行转化性研究，以评估使用交互式视频会议(糖尿病电信)的远程医疗技术，作为一种新的手段，以增加农村社区卫生专业人员的可用性，有效地提供糖尿病自我管理教育计划，并作为一种手段，在初级保健环境中提供视网膜筛查。我们的目标是：1)开发和实施为期12个月的糖尿病电信干预措施，以提高糖尿病临床护理指南的遵从性，并在两个位于不同种族、农村和医疗服务水平低下的社区的社区健康中心改善糖尿病控制情况；2)对200名患者进行为期一年的随机临床试验(RCT)，以正式评估糖尿病电信疗法的有效性；以及3)以60%的非裔美国人为样本，研究糖尿病电信疗法与常规疗法的成本效益和满意度，以及3)确定糖尿病电信疗法与常规疗法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卫生中心招募，并根据患者随机化时间表随机进行。糖尿病电信(一种结构化课程)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讲授，并得到其他卫生专业人员的支持，这些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(单身和小组)联系起来。主要结果是代谢控制(A1c、血脂)、血压和远程医疗促进的视网膜筛查能力的使用。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，每个A1c的成本增量减少和糖尿病电信与常规治疗相比的估计终身成本效用将得到确定。远程医疗可能是传统医疗保健提供系统的有效替代方案，从而改善糖尿病的教育和控制。

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.