IADAPT

IADAPT

• 批准号: 8359899
• 负责人: Robert Mayberry
• 金额: $ 4.16万
• 依托单位: MOREHOUSE SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-01 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8359899
• 关键词: Adherence; Adult; African American; Appointment; Awareness; Caring; Clinical Research; Communication; Community Health; Community Health Centers; Computerized Medical Record; Diabetes Mellitus; Documentation; Education; Feedback; Funding; Grant; Healthcare; Insulin; Intervention; Knowledge; Learning; Low income; Medical center; Modeling; Motivation; National Center for Research Resources; Non-Insulin-Dependent Diabetes Mellitus; Online Systems; Oral; Participant; Patients; Pharmaceutical Preparations; Population; Principal Investigator; Provider; Quality of Care; Readiness; Relative (related person); Research; Research Infrastructure; Resources; Schedule; Self Care; Self Management; Source; Staging; System; Testing; Training; Translational Research; United States National Institutes of Health; Visit; Work; analog; comparative effectiveness; cost; diabetes education; dissemination research; effectiveness research; evidence base; follow-up; improved; innovation; medication compliance; motivational enhancement therapy; pill; programs; reinforced behavior; social

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. Primary support for the subproject and the subproject's principal investigator may have been provided by other sources, including other NIH sources. The Total Cost listed for the subproject likely represents the estimated amount of Center infrastructure utilized by the subproject, not direct funding provided by the NCRR grant to the subproject or subproject staff. The proposed adaptation and dissemination project builds on previous research aimed at improving diabetes care quality at a local federally-quality community health center, providing care to this predominately low income, urban African American population. Our intent in this proposed project is to adapt and customize Comparative Effectiveness Research Summary Guides (CERSGs) for Consumers and Clinicians: Consumer Guides "Pills for Type 2 Diabetes" and "Premix Insulin for Type 2 Diabetes" and Clinician Guides "Comparing Oral Medications for Adults with Type 2 Diabetes" and "Premixed Insulin Analogues." The CERSGs will be adapted within the socio-cultural context of routine provision of care within this healthcare organization (West End Medical Centers (WEMC)) and in doing so impact overall diabetes care quality. The project objective is to incorporate evidence-based medication use into patient self-care, the WEMC Diabetes Self-Management Education (DSME) Program, and the decision support functions of the electronic medical record (EMR) system. The primary aims are to 1) improve the rate of scheduled diabetes care follow-up visits, to enhance the opportunity for anti-diabetes treatment and treatment intensification, 2) increase medication knowledge and awareness, 3) improve patient communication with the provider regarding medication use and 4) improve adherence to CERSGs prescribed medications. The secondary aims are to 1) increase participation and completion rates of WEMC DSME classes where medication adherence behaviors are reinforced and 2) to improve prescription documentation of CERSGs oral and insulin medications in the EMR systems for periodic review and assessment of evidence-based prescribing practice. We propose a community health work (CHW) model with the innovation of motivational interviewing (MI) to deliver the content of CERSGs to adults with type 2 diabetes. The CHW intervention will be delivered according to the psycho-social needs and stage of readiness of the project participants and for the purpose of facilitating motivation for adherence to prescribed anti-diabetes medications. Despite current efforts at WEMC, diabetes care quality remained suboptimal, the missed appointment rate is high and medication adherence is at 20%. Participation in and completion of DSME classes are poor, and care quality and prescribed medications are poorly documented in the EMR system. The CHW intervention is expected to improve the rate of diabetes care follow-up visits, knowledge and aware of evidence-based medication use, patient communication, medication adherence, and participation in DSME classes where medication adherence will be reinforced. Adaptation CERSGs is expected to be further enhanced by incorporating CERSGs for providers into the EMR system, provide web-base training for clinicians, and audit medications problems, and conduct feedback discussion of medication adherence and patient-provider communication issues, e.g., during "Lunch and Learn" (Figure 1). Two major hypotheses will be tested in this proposed research and dissemination project: 1) the CHW intervention model will increase medication knowledge and awareness, increase patient communication with the provider, reduce medication problems, and improve medication adherence and 2) intrinsic motivation will be actualized among patients assigned to the CHW-MI group, which will results in better medication adherence relative to the patients receiving general diabetes education by the CHW.

这个子项目是利用资源的许多研究子项目之一。 由NIH/NCRR资助的中心拨款提供。对子项目的主要支持 子项目的首席调查员可能是由其他来源提供的， 包括美国国立卫生研究院的其他来源。为子项目列出的总成本可能 表示该子项目使用的中心基础设施的估计数量， 不是由NCRR赠款提供给次级项目或次级项目工作人员的直接资金。 拟议的适应和传播项目建立在之前的研究基础上，旨在提高当地联邦质量的社区卫生中心的糖尿病护理质量，为以低收入为主的城市非裔美国人人口提供护理。我们在这个拟议项目中的目的是为消费者和临床医生调整和定制比较有效性研究摘要指南(CERSGs)：消费者指南“用于2型糖尿病的药丸”和“用于2型糖尿病的预混胰岛素”，以及临床医生指南“比较成人和2型糖尿病的口服药物”和“预混胰岛素类似物”。CERSGs将在该医疗保健组织(West End Medical Center(WEMC))内提供常规护理的社会文化背景下进行调整，并在这样做时影响整体糖尿病护理质量。该项目的目标是将循证用药纳入患者自我护理、WEMC糖尿病自我管理教育(DSME)计划以及电子病历(EMR)系统的决策支持功能。其主要目的是：1)提高定期糖尿病护理随访的比率，增加抗糖尿病治疗和强化治疗的机会；2)增加用药知识和意识；3)改善患者与提供者之间有关用药的沟通；4)提高对CERSGs处方药的遵从性。次要目标是1)提高WEMC DSME课程的参与率和完成率，其中药物依从性行为得到加强；2)改进EMR系统中CERSGs口服和胰岛素药物的处方记录，以定期审查和评估循证处方实践。我们提出了一种社区卫生工作(CHW)模式，并创新了动机访谈(MI)，将CERSGs的内容传递给成年2型糖尿病患者。CHW干预将根据项目参与者的心理社会需求和准备阶段进行，目的是促进坚持服用处方抗糖尿病药物的动力。尽管WEMC目前做出了努力，但糖尿病护理质量仍然不是最优的，错失率很高，服药依从性为20%。参加和完成DSME课程的情况很差，EMR系统中记录的护理质量和处方药物也很少。CHW干预预计将提高糖尿病护理随访的比率、对循证用药的知识和意识、患者沟通、用药依从性以及参加DSME课程，在DSME课程中用药依从性将得到加强。通过将提供者CERSGs纳入EMR系统，为临床医生提供网络培训，审核药物问题，以及对药物依从性和患者-提供者沟通问题进行反馈讨论，例如在“午餐和学习”期间(图1)，适应性CERSGs有望得到进一步加强。这项拟议的研究和传播项目将检验两个主要假设：1)CHW干预模式将增加用药知识和意识，增加患者与提供者的沟通，减少用药问题，并提高用药依从性；2)CHW-MI组患者将实现内在动机，这将导致比CHW接受一般糖尿病教育的患者更好的用药依从性。