Bronx A1c: Bring it Down for Health

布朗克斯 A1c：为了健康而降低它

• 批准号: 7245289
• 负责人: ELIZABETH A. WALKER
• 金额: $ 49.39万
• 依托单位: ALBERT EINSTEIN COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-05-01 至 2012-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7245289
• 关键词: Address; Adult; Age; Behavior; Behavioral; Caring; Case Manager; Chronic; Clinical; Clinical Management; Clinical Trials; Collaborations; Communicable Diseases; Computerized Medical Record; Coronary heart disease; Data; Databases; Diabetes Mellitus; Diabetic Angiopathies; Disease; Effectiveness of Interventions; Electronics; Eligibility Determination; Epidemic; Federally Qualified Health Center; Feedback; Follow-Up Studies; Glycosylated Hemoglobin; Glycosylated hemoglobin A; Goals; Health; Health Personnel; Health Policy; Health behavior; Health care facility; Hospitalization; Income; Individual; Informed Consent; Insulin; Insulin-Dependent Diabetes Mellitus; Intervention; Kidney Diseases; Laboratories; Left; Life Style; Link; Literature; Low income; Mails; Maintenance; Measures; Mediating; Medical; Medical Surveillance; Medicine; Mental Depression; Mental Health; Metabolic Control; Neighborhoods; Neuropathy; New York; New York City; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Outcome Study; Patient Education; Patient Self-Report; Patients; Pattern; Perception; Policies; Population; Population Attributable Risks; Population Surveillance; Prevalence; Prevention; Printing; Problem Solving; Process; Provider; Psychosocial Factor; Public Health; Quality of Care; Randomized; Randomized Controlled Trials; Rate; Records; Registries; Reporting; Research Personnel; Research Training; Retinal Diseases; Risk; Risk Reduction; Sampling; Screening procedure; Secondary Prevention; Self Management; Staging; Standards of Weights and Measures; Statistically Significant; System; Telephone; Testing; Translations; Uncertainty; United Kingdom; United States Department of Veterans Affairs; Walkers; Woman; base; cardiovascular disorder risk; college; cost; design; diabetes management; diabetes risk; glycemic control; improved; innovation; medication compliance; men; mortality; patient oriented; programs; prospective; psychosocial; response; sex; therapy design; type I and type II diabetes; urban area

DESCRIPTION (provided by applicant): Metabolic control of diabetes, measured by hemoglobin A1c (HbA1c), reduces the risk of microvascular complications. Health care providers frequently do not meet standards for managing HbA1c and individuals with diabetes are often not aware of their HbA1c values. To address these issues and reduce population- attributable risk due to elevated HbA1c, the New York City Department of Health and Mental Hygiene (DOHMH) developed an innovative HbA1c registry, which requires all major laboratories to report HbA1c results electronically. We propose to utilize this registry to conduct a randomized controlled trial addressing the following specific aims: 1) to evaluate the incremental effect of a tiered and tailored, patient-centered telephone intervention, in English and Spanish, on the mean HbA1c levels beyond that achieved with print materials mailed to patients and providers by the DOHMH registry intervention; 2) determine what patient demographic and psychosocial factors mediate the effect of the interventions; and 3) provide estimates of implementation costs of the tiered, tailored telephone intervention for comparison with the print intervention. The individual is the unit of sampling, assignment and analysis. After eligibility is assessed and informed consent is obtained by telephone, the individual will be randomly assigned to one of the two groups. The patient telephone intervention will focus on collaborative problem solving for resolving barriers to medication adherence, improving lifestyle behaviors, and communicatiing effectively with their providers. The print materials from the DOHMH will communicate HbA1c results to patients and their providers, with strategies to improve them. The study outcome will be change in HbA1c values from the registry records from baseline to one-year post-randomization. A total of 941 individuals with diabetes will be needed to provide 83% power to detect a statistically significant difference (p<0.05) between groups of at least 0.3% in absolute HbA1c. Psychosocial data on depression, health behaviors, and risk perceptions will be collected by telephone. Intervention cost data will be evaluated for translation of findings and scalability. At study end, we will know the extent to which this intervention will improve metabolic control in a low-income, multi-ethnic sample who are part of the DOHMH HbA1c registry in the South Bronx, New York. These findings will inform public health policies and practices in New York City, as well as other urban areas throughout the nation.

描述（由申请人提供）：通过糖化血红蛋白 (HbA1c) 测量的糖尿病代谢控制可降低微血管并发症的风险。医疗保健提供者经常不符合 HbA1c 管理标准，糖尿病患者通常不知道自己的 HbA1c 值。为了解决这些问题并降低因 HbA1c 升高而导致的人群风险，纽约市健康和心理卫生局 (DOHMH) 开发了一种创新的 HbA1c 登记系统，要求所有主要实验室以电子方式报告 HbA1c 结果。我们建议利用该登记系统开展一项随机对照试验，以实现以下具体目标：1) 评估分层、定制、以患者为中心的英语和西班牙语电话干预对平均 HbA1c 水平的增量影响，超出 DOHMH 登记干预措施邮寄给患者和提供者的印刷材料所达到的水平； 2) 确定哪些患者人口统计和心理社会因素介导干预措施的效果； 3) 提供分层、定制的电话干预的实施成本估算，以便与印刷干预进行比较。个体是抽样、分配和分析的单位。在评估资格并通过电话获得知情同意后，个人将被随机分配到两组中的一组。患者电话干预将侧重于协作解决问题，以解决药物依从性的障碍、改善生活方式以及与提供者进行有效沟通。 DOHMH 的印刷材料将向患者及其提供者传达 HbA1c 结果，以及改进策略。研究结果将是登记记录中 HbA1c 值从基线到随机化后一年的变化。总共需要 941 名糖尿病患者才能提供 83% 的功效来检测各组之间绝对 HbA1c 至少 0.3% 的统计显着差异 (p<0.05)。有关抑郁、健康行为和风险认知的心理社会数据将通过电话收集。将评估干预成本数据以转化研究结果和可扩展性。在研究结束时，我们将了解这种干预措施将在多大程度上改善低收入、多种族样本的代谢控制，这些样本是纽约南布朗克斯区 DOHMH HbA1c 登记的一部分。这些发现将为纽约市以及全国其他城市地区的公共卫生政策和实践提供信息。