Translating Research Into Action for Diabetes (TRIAD) Legacy Study

项目描述：凯撒永久北加州(KPNC)的S研究部建议通过其遗留的FOA继续参与三合会研究。三合会已经证明了许多关于系统和患者因素如何影响卫生系统中糖尿病护理的质量和结果的新见解。已经提出了许多“第二代”问题，三合会数据集允许对其中一些问题进行研究。KPNC团队(Selby、Karter、Ferrara和Schmittdiel博士)都希望在三合会期间继续参与 每个人都为所包括的六个文件提案做出了贡献。这些建议直接侧重于促进我们对这些参保人群中健康差距的理解。他们考察了系统因素和患者因素作为差异的潜在决定因素。两项提案考察了系统级干预措施(邮购药房(#3)和鼓励使用邮购药房(#1))对患者行为和结果的潜在影响，并特别关注种族/民族和社会经济地位的差异。两项提案(#‘S 4和6)着眼于患者因素(即体重增加)，以及糖尿病患者和妊娠期糖尿病患者的不同体重增加如何影响心血管危险因素水平的差异模式。 提案(#5)着眼于医生因素，即初级保健医生对药物不依从性的认识。最后一项建议(#2)是对健康差距的机制进行方法论调查。KPNC三合会调查员团队首先撰写了16篇三合会的论文，并向来自其他三合会的同事提供了其他三合会特定项目(例如，邮购药房项目、联邦医疗保险D部分项目、胰岛素启动项目)的额外KPNC数据，从而证明了他们与三合会的合作。小组希望以三合会已建立的相同协作方式，继续推行我们的文件建议和其他三合会区域议会的建议，继续参与(并在被要求时继续担任主席) 督导委员会。它还致力于保存和实行以前收集的三合会数据的安全数据共享，并通过出版物和演示将研究结果传回提供数据的卫生系统以及科学界。

DESCRIPTION OF THE PROJECT: The Kaiser Permanente Northern California (KPNC)'s Division of Research proposes to continue participation in the TRIAD Study through its Legacy FOA. TRIAD has proven many new insights into how both system and patient factors influence the quality and outcomes of diabetes care in health systems. Many "second generation" questions have been raised and the TRIAD datasets allow for study of some of these questions. The KPNC team (Drs. Selby, Karter, Ferrara, and Schmittdiel) all hope to remain involved during TRIAD and have each contributed to the six paper proposals included. These proposals focus squarely on advancing our understanding of health disparities in these insured populations. They examine both system and patient factors as potential determinants of disparities. Two proposals examine the potential effects of system-level interventions (mail order pharmacy (#3) and incentives to use mail order pharmacy (#1)) on patient behaviors and outcomes, with specific attention to differences by race/ethnicity and socioeconomic status. Two proposals (#'s 4 and 6) look at patient factors (i.e., weight gain) and how differential weight gain in persons with diabetes and women with gestational diabetes affects patterns of disparities in CVD risk factor levels. One proposal (#5) looks at a physician factor, the awareness of medication non-adherence, by primary care physicians. The final proposal (#2) is a methodologic inquiry into the mechanisms of health disparities. The KPNC TRIAD investigator team has proven its engagement with TRIAD by first-authoring 16 of TRIAD's 64 papers, and by making additional KPNC data available to colleagues from other TRCs for site specific projects (e.g., Mail Order Pharmacy Project, Medicare Part D Project, Insulin Starts Project). The team hopes to pursue our paper proposals and those proposed from other TRIAD TRCs in the same collaborative fashion that TRIAD has established, to continue participating on (and continuing to chair, if requested) the Steering Committee. It is also committed to preserving and practicing secure data sharing of the previously collected TRIAD data and to disseminating study findings back to the health systems that provided the data as well as to the scientific community through publications and presentations.