EMPLOYING DIABETES SELF-MANAGEMENT MODELS TO REDUCE HEALTH DISPARITIES IN TEXAS

尽管联邦和州政府在过去几十年里共同努力缩小健康差距，但 少数群体报告的慢性病发病率方面的差距仍然存在。特别是，非洲裔美国人和 拉美裔美国人患2型糖尿病(T2 DM)和心血管疾病(CVD)的几率比 美国人口的其他部分。这项拟议的研究项目的目标是测试两个 中部一家大型多地点医疗机构的不同糖尿病自我管理(DSM)计划 服务于大量少数民族和农村居民的德克萨斯州，比较结果以评估 它们在缩小健康差距方面的有效性。我们的具体目标是：i)记录其性质和规模 糖尿病治疗过程和结果中现存的健康差距；2)评估不同的需求侧管理 干预方法对行为和临床结果的影响，注意不同患者的不同影响 和环境特征；3)检查这些不同的需求侧管理方法的成本效益 少数民族和农村人口的教育；以及4)探索我们的干预努力的覆盖范围和 DSM教育的更广泛的组织影响，包括对临床医生和组织的反馈循环 接受自我管理的方法。我们的研究将采用四种不同的活动：i)最初的 1300份成人病历的电子病历回顾；2)2×2开放24个月的随机临床试验 对400名21岁及以上的2型糖尿病患者进行基于行为和技术的需求侧管理干预 糖尿病(T2 DM)；3)不同治疗方法的成本-效果分析；以及4)调查 初级保健提供者和卫生保健管理人员。虽然我们的主要成果将是减少 HbAIC，我们的概念模型包括临床、行为、经济和组织 结果。我们还将评估我们的干预措施在多大程度上减少了健康差距，方法是 辨证治疗成功。这项研究的创新之处在于对行为和技术的比较 干预方法不同，其关注的公共卫生影响和成本效益不同 干预方法及其对组织应对干预可持续性的关注。一个 值得注意的是加强临床治疗和社区治疗之间的联系。 在不同的环境和人群中确定成功的治疗策略和方法。

Despite concerted federal and state attempts to reduce health disparities over the past decades substantial disparities in reported rates of chronic disease for minorities still exist. In particular, African Americans and Hispanics experience higher rates of Type 2 diabetes (T2DM), and cardiovascular disease (CVD) than do other segments of the U.S. population. The objectives of this proposed research project are to test two different diabetes self-management (DSM) programs in a large multi-site health care organization in Central Texas that serves large populations of minority and rural residents, comparing outcomes in order to evaluate their efficacy for reducing health disparities. Our specific aims are to: i) document the nature and magnitude of extant health disparities in diabetes treatment processes and outcomes; 2) evaluate different DSM intervention approaches on behavioral and clinical outcomes, with attention to differential effects by patient and environmental characteristics; 3) examine the cost-effectiveness of these different approaches to DSM education in minority and rural populations; and 4) explore the reach of our intervention efforts and the broader organizational impacts of DSM education, including feedback loops to clinicians and organizational receptivity to self-management approaches. Our study will employ four different activities: i) an initial electronic chart review of 1300 records of adults; 2) a 2 by 2 open 24 month randomized clinical trial of behaviorally and technologically based DSM interventions with 400 adults age 21 and older who have type 2 diabetes (T2DM); 3) a cost-effectiveness analysis of the different treatment approaches; and 4) surveys of primary care providers and health care administrators. While our primary outcome will be reductions in hemoglobin Aic (HbAic), our conceptual model includes clinical, behavioral, economic and organizational outcomes. We will also assess the extent to which our interventions reduce health disparities by examining differential treatment success. This study is innovative in its comparison of both behavioral and technological intervention approaches, its attention to the public health impact and cost-effectiveness of different intervention approaches, and its concern with organizational responses to intervention sustainability. A noteworthy significance will be the strengthening of the linkages between clinical and community treatment approaches and the identification of successful treatment strategies in different settings and populations.