Improving Diabetes Care and Outcomes on the South Side of Chicago

描述(由申请人提供)：糖尿病患者在护理质量和结果方面的种族/民族和社会经济差异已被广泛记录在案，但对于如何缩小这些差异知之甚少。特别是，迫切需要创新的、可持续的模式来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，研究人员系统地找出了有关减少糖尿病差异的有效干预措施的文献中的空白。这项提议寻求以创新的、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复制。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以低收入非裔美国人为主的社区的糖尿病患者的护理质量和结果。具体目标是：1)测试在芝加哥南区六家诊所内实施的关于糖尿病护理质量和结果的合作模式计划的有效性。这一多因素干预包括文化定制的患者激活、临床医生的文化能力和沟通培训、与患者倡导者的诊所重新设计、质量改进协作、护理管理和增强的社区合作伙伴关系。这项干预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)从门诊的业务案例角度和社会角度确定实施干预的成本。3)确定成功实施区域干预的主要障碍和解决方案。研究团队在成果研究、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拥有专业知识。 公共卫生相关性：迫切需要考虑到城市卫生环境的文化、种族、组织和经济现实的创新、可持续的模式来改善区域糖尿病护理。这项提议寻求以创新、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复制。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以低收入非裔美国人为主的社区的糖尿病患者的护理质量和结果。

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.