Translating Research Into Action for Diabetes (TRIAD) Legacy Study

项目描述：北方加州凯撒医疗机构（KPNC）的研究部门建议通过其遗留FOA继续参与TRIAD研究。TRIAD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质量和结果的新见解。许多“第二代”问题已经提出，TRIAD数据集允许研究其中一些问题。KPNC团队（Selby、Karter、费拉拉和Schmittdiel博士）都希望在TRIAD期间继续参与 并各自为所包含的六份文件提案做出了贡献。这些提案的重点是促进我们对这些投保人群健康差异的理解。他们研究了系统和患者因素作为差异的潜在决定因素。两项提案研究了系统级干预措施（邮购药房（#3）和使用邮购药房的激励措施（#1））对患者行为和结局的潜在影响，特别关注种族/民族和社会经济地位的差异。两个提案（#的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妇女的体重增加差异如何影响CVD危险因素水平的差异模式。一 建议（#5）着眼于医生因素，即初级保健医生对药物非依从性的认识。最后一个建议（#2）是对健康差异机制的方法学调查。KPNC TRIAD调查员团队已经证明了其与TRIAD的合作，他们首先撰写了TRIAD 64篇论文中的16篇，并向其他TRC的同事提供了额外的KPNC数据，用于现场特定项目（例如，邮购药房项目，医疗保险D部分项目，胰岛素启动项目）。该小组希望以与TRIAD建立的相同的合作方式，继续推进我们的文件提案和其他TRIAD TRCs提出的提案，继续参与（并继续主持，如果要求的话） 指导委员会。它还致力于保存和实践先前收集的TRIAD数据的安全数据共享，并通过出版物和演示文稿将研究结果传播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.