Improving Diabetes Care and Outcomes on the South Side of Chicago

描述（由申请人提供）：糖尿病患者的护理质量和结局存在种族/民族和社会经济差异，这已被广泛记录，但对如何减少这些差异知之甚少。特别是，迫切需要创新的，可持续的模式，以改善区域糖尿病护理，考虑到城市卫生环境的文化，种族，组织和经济现实。此前，研究人员已经系统地确定了文献中关于有效干预以减少糖尿病差异的差距。这项建议旨在以一种创新的、可持续的方式解决这些知识差距，这种方式可以在该国其他地区推广。主要目标是通过社区卫生中心、学术医疗中心和社区组织之间的合作，测试多因素干预是否可以改善生活在主要是低收入非洲裔美国人社区的糖尿病患者的护理质量和结局。具体目标是：1）测试在芝加哥南部六家诊所内实施的合作模式项目对糖尿病护理质量和结果的有效性。这种多因素干预结合了文化定制的患者激活，临床医生的文化能力和沟通培训，以及与患者倡导者，质量改进协作，护理管理和增强社区伙伴关系的诊所重新设计。该干预措施还寻求通过患者倡导者和与社区组织的伙伴关系，增加来自服务不足人群的糖尿病患者人数，他们在安全网卫生中心获得全面护理。2)从门诊诊所的商业案例角度和社会角度确定实施干预措施的成本。3)确定成功实施这一区域干预措施的主要障碍和解决办法。该研究小组在成果研究，文化定制的行为变化，文化能力培训，区域质量改进协作，种族研究，经济分析，组织理论和基于社区的参与性研究方面具有专业知识。 公共卫生相关性：迫切需要创新的、可持续的模式来改善区域糖尿病护理，这些模式要考虑到城市卫生环境的文化、种族、组织和经济现实。这项建议旨在以一种创新的、可持续的方式解决公认的差距，这种方式可以在该国其他地区推广。主要目标是通过社区卫生中心、学术医疗中心和社区组织之间的合作，测试多因素干预是否可以改善生活在主要是低收入非洲裔美国人社区的糖尿病患者的护理质量和结局。

DESCRIPTION (provided by applicant): Racial/ethnic and socioeconomic disparities in the quality of care and outcomes of patients with diabetes have been widely documented, yet relatively little is known about how to reduce these differences. In particular, innovative, sustainable models to improve regional diabetes care are desperately needed that take into account the cultural, racial, organizational, and economic realities of the urban health setting. Previously the investigators have systematically identified gaps in the literature regarding effective interventions to reduce diabetes disparities. This proposal seeks to address these knowledge gaps in an innovative, sustainable way that can be replicated in other areas of the country. The primary goal is to test whether a multi-factorial intervention can improve the quality of care and outcomes of diabetes patients living in predominantly low- income African-American communities, through collaboration between community health centers, an academic medical center, and community-based organizations. The Specific Aims are: 1) To test the effectiveness of a collaborative model program implemented within six clinics on the South Side of Chicago on the quality of diabetes care and outcomes. This multi-factorial intervention incorporates culturally tailored patient activation, cultural competency and communication training for clinicians, and clinic redesign with patient advocates, a quality improvement collaborative, care management, and enhanced community partnerships. The intervention also seeks to increase the number of persons with diabetes from underserved populations who access comprehensive care in safety net health centers through patient advocates and partnerships with community- based organizations. 2) To identify the costs of intervention implementation from the business case perspective of the outpatient clinics and from a societal perspective. 3) To determine the major barriers and solutions to successfully implementing this regional intervention. The study team has expertise in outcomes research, culturally tailored behavioral change, cultural competency training, regional quality improvement collaboratives, race studies, economic analyses, organizational theory, and community-based participatory research. PUBLIC HEALTH RELEVANCE: Innovative, sustainable models to improve regional diabetes care are desperately needed that take into account the cultural, racial, organizational, and economic realities of the urban health setting. This proposal seeks to address acknowledged gaps in an innovative, sustainable way that can be replicated in other areas of the country. The primary goal is to test whether a multi-factorial intervention can improve the quality of care and outcomes of diabetes patients living in predominantly low-income African-American communities, through collaboration between community health centers, an academic medical center, and community-based organizations.