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Public-Private Partnership Addressing Literacy-Numeracy to Improve Diabetes Care

公私合作解决读写算术问题以改善糖尿病护理

基本信息

批准号：
8301008
负责人：
RUSSELL L. ROTHMAN
金额：
$ 64.79万
依托单位：
VANDERBILT UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-07-15 至 2015-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8301008
关键词：
Academic Medical Centers Accident and Emergency department Address Adult Affect American Attention Award Beech Behavior Behavior Therapy Blood Glucose Blood Pressure Carbohydrates Caring Cholesterol Chronic Disease Clinic Clinical Clinical Services Communication Communities Control Groups Cost Effectiveness Analysis Diabetes Mellitus Disease Disease Management Education Educational Intervention Educational Materials Educational process of instructing Effectiveness of Interventions Enrollment Evaluation Funding Future Health Health Communication Health Personnel Health behavior High Prevalence Hospitalization Intake Internet Intervention Knowledge Latino Learning Lipids Medically Underserved Area Modeling National Institute of Diabetes and Digestive and Kidney Diseases Nature Non-Insulin-Dependent Diabetes Mellitus Nurse Practitioners Outcome Participant Patient Care Patients Pharmaceutical Preparations Physicians Population Primary Health Care Provider Randomized Randomized Controlled Trials Registered nurse Reporting Research Research Personnel Research Proposals Research Training Risk Factors Role Sampling Self Efficacy Self Management Services Site Surveys Tennessee Training Uninsured Universities Visit Vulnerable Populations Weight Work active control arm cholesterol control cohort cost cost effective cost effectiveness diabetes control diabetes education diabetes educator diabetes management follow-up glucose monitor glycemic control group intervention health literacy high risk improved innovation intervention effect literacy modifiable risk multidisciplinary neighborhood safety novel primary care setting primary outcome programs public-private partnership randomized trial safety net satisfaction skills skills training sugar

项目摘要

DESCRIPTION (provided by applicant): Despite strong evidence about the optimal treatment of diabetes, care often remains suboptimal. One recent examination of a national sample of diabetes patients found that less than 10% of patients surveyed were in optimal blood sugar, blood pressure and cholesterol control. One recently discovered barrier to optimal diabetes care is poor health literacy. Poor health literacy affects over 90 million Americans. Our research group was one of the first to demonstrate that low health literacy was independently associated with worse diabetes knowledge, self-management, and glycemic control (A1C). Numeracy (math skills) is an understudied component of literacy that is essential for many tasks in diabetes including glucose monitoring, assessing carbohydrate intake, and medication adjustment. Recently, our group demonstrated that poor numeracy is common in adults with diabetes and significantly associated with worse diabetes self-management, self- efficacy, and A1C. Addressing literacy and numeracy represent an exciting opportunity to improve diabetes care, because these are potentially modifiable risk factors. We recently performed four trials at academic medical centers that suggest that addressing literacy and numeracy can improve diabetes control. The aim of the proposed study is to perform a cluster-randomized trial to assess the efficacy of a low- literacy/numeracy-oriented intervention to improve diabetes care in under-resourced communities in Tennessee. The state of Tennessee now has a higher prevalence of diabetes then any other state in the nation. The study will occur in Tennessee Department of Health "safety net" primary care clinics in middle Tennessee. These primary care clinics provide diabetes care for a predominantly uninsured population at high risk for poor diabetes related health. The study represents a novel partnership between the Tennessee Department of Health and the Vanderbilt Diabetes Research and Training Center to improve care for a vulnerable population of diabetes patients. Ten State Health Department Clinics located in medically underserved areas will be randomized, and a total of 400 diabetes patients will be enrolled. Health Care Providers at the 5 control sites will receive standard diabetes education and the use of educational materials from the National Diabetes Education Program. Health Care Providers at intervention sites will receive training in clear health communication skills, and a Diabetes literacy and numeracy sensitive Educational Toolkit to use in partnership with their diabetes patients. Primary outcomes will include A1C, Blood Pressure, Cholesterol, Weight, Self-Management, and Self-Efficacy at 1 year. Patients will be followed for 2 years to assess sustainability. A cost-effectiveness analysis will be performed. The products of this study (health communication skills training modules and educational materials) will be disseminated via public access on the Internet. If successful, the proposed model will be disseminated across the State and will be a model for other Health Departments and clinics across the nation. PUBLIC HEALTH RELEVANCE: Over 90 million Americans have poor literacy or numeracy skills. Diabetes patients with poor literacy or numeracy skills can have poorer understanding of their disease, worse self-management, and worse blood sugar control. This study will be a novel partnership with the Tennessee Department of Health to improve care for vulnerable English and Spanish speaking patients with diabetes by improving health care providers' health communication skills, and providing a novel diabetes education toolkit that is sensitive to literacy and numeracy issues.

描述（由申请人提供）：尽管有强有力的证据表明糖尿病的最佳治疗方法，但护理往往仍然不是最佳的。最近一项针对全国糖尿病患者样本的调查发现，接受调查的患者中，血糖、血压和胆固醇控制在最佳水平的不到10%。最近发现的最佳糖尿病护理的一个障碍是糟糕的健康素养。健康知识贫乏影响着9000多万美国人。我们的研究小组是第一个证明低健康素养与较差的糖尿病知识、自我管理和血糖控制（A1C）独立相关的研究小组之一。计算能力（数学技能）是识字的一个未被充分研究的组成部分，它对于糖尿病的许多任务至关重要，包括血糖监测、评估碳水化合物摄入量和药物调整。最近，我们的研究小组发现，计算能力差在成人糖尿病患者中很常见，并且与糖尿病自我管理、自我效能和糖化血红蛋白水平较差显著相关。解决识字和算术问题是改善糖尿病护理的一个令人兴奋的机会，因为这些是潜在的可改变的风险因素。我们最近在学术医疗中心进行了四项试验，表明提高读写能力和计算能力可以改善糖尿病的控制。该研究的目的是进行一项集群随机试验，以评估在田纳西州资源不足的社区中，以低读写能力/计算能力为导向的干预措施改善糖尿病护理的效果。田纳西州现在的糖尿病患病率比全国其他任何一个州都高。这项研究将在田纳西州中部的田纳西州卫生部“安全网”初级保健诊所进行。这些初级保健诊所为糖尿病相关健康状况较差的主要无保险人群提供糖尿病护理。这项研究代表了田纳西州卫生部和范德比尔特糖尿病研究和培训中心之间的一项新的合作伙伴关系，以改善对糖尿病患者弱势群体的护理。设在医疗服务不足地区的10个州卫生部门诊所将被随机选取，总共将有400名糖尿病患者入选。5个控制点的卫生保健提供者将接受标准的糖尿病教育，并使用国家糖尿病教育计划的教育材料。干预点的卫生保健提供者将接受明确的卫生沟通技巧方面的培训，以及与糖尿病患者合作使用的糖尿病扫盲和算术敏感教育工具包。主要结局包括1年后的糖化血红蛋白、血压、胆固醇、体重、自我管理和自我效能。患者将被随访2年以评估可持续性。将进行成本效益分析。这项研究的产品（卫生传播技能培训模块和教育材料）将通过互联网上的公众通道传播。如果成功，提议的模式将在全州推广，并将成为全国其他卫生部门和诊所的样板。