Peer-led and Telehealth CER Adoption for Diabetes Prevention and Management

描述（由申请人提供）：已知预防和管理糖尿病的最佳实践，但尚未在临床和社区环境中充分实施。与迈阿密大学合作，南佛罗里达健康基金会，该提案的社区合作伙伴，创建了健康老龄化区域合作（HARC），以应对老年人慢性病预防和管理的挑战。HARC为卫生组织（代表78个合作伙伴的几个牵头机构）提供了防范主要健康威胁所需的工具：缺乏体力活动和无法管理慢性疾病。在联邦机构的支持下，HARC寻求（2008-2013年）改善健康行为，降低医疗费用，并提高约35,000南佛罗里达老年人的生活质量。我们的研究目标是增加采用现有的比较有效性研究（CER）证据，用于预防和管理南佛罗里达超重/肥胖（OW JOB）老年人的糖尿病。我们将实施糖尿病预防计划（DPP）的研究结果，该计划表明接受生活方式干预的前驱糖尿病患者的糖尿病发病时间延迟了4年，以及美国糖尿病协会关于老年人糖尿病管理的指南，其中包括退伍军人事务糖尿病试验（VADT）的数据。DPP和VADT均符合CER联邦协调理事会的定义，并将在迈阿密-戴德县、布劳沃德县和门罗县的公立和私立医疗机构HARC网络中采用。具体而言，拟议的研究将检验以下假设：单独的同伴引导护理（PC）或通过技术激活（TechnAlert-Peer或TAP）上级传统的信息传播方法（社区护理或UC），以采用CER预防和管理糖尿病，从而获得更好的自我效能和临床结局。我们建议在南佛罗里达参与HARC的糖尿病前期或糖尿病老年人中进行一项为期12个月的随机对照试验，主要目的如下：1）比较接受同伴主导护理（有或没有TAP干预）的参与者与接受UC的参与者之间自我效能的变化。2)比较接受同伴护理（有或没有TAP干预）和接受UC的参与者之间体重和血红蛋白A1 C的变化。此外，我们提出了以下关于过程和健康结果的次要目标：a）进行需求评估，以阐明参与HARC的老年人寻求糖尿病预防和管理相关信息的方式。B）评估同行领导者的可用性和技术在增加糖尿病预防和管理CER采用方面的作用。c）评估采用CER预防和管理糖尿病过程中潜在的种族差异。d）比较治疗组（UC、PC和TAP）之间血压、血脂、身体功能和生活质量的变化。e）比较治疗组（UC、PC和TAP）之间的医疗保健利用（医生就诊、急诊和住院天数）的变化。 公共卫生相关性：这项建议，以加快通过比较有效性研究（CER）的证据，糖尿病预防和管理在南佛罗里达老年人将提供实用的知识和资源的新策略，适用于大型，多民族社区。这一合作努力将使CER的进一步翻译能够减轻老年人慢性病的医疗和经济负担，老年人是美国人口增长最快的群体之一。

DESCRIPTION (provided by applicant): Best practices for prevention and management of diabetes are known but not fully implemented in clinical and community settings. Working with the University of Miami, the Health Foundation of South Florida, a community partner in this proposal, created the Healthy Aging Regional Collaborative (HARC) in response to the challenges of chronic disease prevention and management in the elderly. HARC provides health organizations (several lead agencies representing 78 partners) with the tools they need to guard against key health threats: lack of physical activity and inability to manage chronic diseases. With support from federal agencies, HARC seeks (2008-2013) to improve healthy behaviors, reduce healthcare costs, and improve quality of life in approximately 35,000 South Florida older adults. Our study goal is to increase adoption of existing comparative effectiveness research (CER) evidence for prevention and management of diabetes in South Florida overweight/obese (OW JOB) older adults. We will implement findings from the Diabetes Prevention Program (DPP), which demonstrated a 4 year delay over a decade in the onset of diabetes among individuals with prediabetes that received lifestyle intervention, as well as guidelines from the American Diabetes Association for management of diabetes in older adults, which include data from the Veterans Affairs Diabetes Trial (VADT). Both DPP and VADT meet the CER Federal Coordinating Council definition and will be adopted in the HARC network of public and private health care institutions in Miami-Dade, Broward, and Monroe Counties. Specifically, the proposed study will test the hypothesis that Peer-led Care alone (PC), or activated by technology (TechnAlert-Peer or TAP), is superior to traditional methods of information dissemination (Usual Care or UC) for adoption of CER on prevention and management of diabetes, leading to better self-efficacy and clinical outcomes. We propose to conduct a 12-month randomized controlled trial in South Florida older adults with prediabetes or diabetes participating in the HARC with the following primary objectives: 1) Compare changes in self-efficacy between participants receiving peer-led care (with or without TAP intervention) and those receiving UC. 2) Compare changes in weight and hemoglobin A1C between participants receiving peer-led care (with or without TAP intervention) and those receiving UC. In addition, we proposed the following secondary objectives on process and health outcomes: a) Perform a needs assessment to elucidate ways older adults participating in the HARC seek information related to prevention and management of diabetes. b) Assess the availability of peer-leaders and the role of technology to increase adoption of CER for prevention and management of diabetes. c) Evaluate potential racial ethnic disparities in the process of adoption of CER for prevention and management of diabetes. d) Compare changes in blood pressure, lipids, physical function, and quality of life among treatment groups (UC, PC, and TAP). e) Compare changes in health care utilization (physician visits, emergency visits, and days in hospital) among treatment groups (UC, PC, and TAP). PUBLIC HEALTH RELEVANCE: This proposal to accelerate adoption of comparative effectiveness research (CER) evidence for diabetes prevention and management in South Florida older adults will provide practical knowledge and resources on novel strategies for applicability in large, multi-ethnic communities. This collaborative effort will enable further translation of CER to reduce the medical and financial burden of chronic diseases in the elderly, one of the fastest growing segments of the US population.