Improving Diabetes Care and Outcomes on the South Side of Chicago

描述（由申请人提供）：种族/民族和社会经济差异在糖尿病患者的护理质量和结果方面已经被广泛记录，但相对而言，我们对如何减少这些差异知之甚少。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，并考虑到城市卫生环境的文化、种族、组织和经济现实。在此之前，研究人员系统地发现了文献中关于有效干预以减少糖尿病差异的空白。该提案旨在以一种创新的、可持续的方式解决这些知识差距，这种方式可以在该国的其他地区复制。主要目的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主要生活在低收入非裔美国人社区的糖尿病患者的护理质量和预后。具体目标是：1)测试在芝加哥南部六家诊所实施的合作模式项目在糖尿病护理质量和结果方面的有效性。这种多因素干预措施包括根据患者的文化特点进行患者激活、对临床医生进行文化能力和沟通培训、与患者倡导者一起重新设计诊所、质量改进协作、护理管理和加强社区伙伴关系。干预措施还寻求通过患者倡导者和与社区组织的合作，增加服务不足人群中获得安全网健康中心综合护理的糖尿病患者人数。2)从门诊诊所的商业案例角度和从社会角度确定实施干预的成本。3)确定成功实施这一区域干预的主要障碍和解决方案。研究团队在结果研究、文化定制行为改变、文化能力培训、区域质量改进协作、种族研究、经济分析、组织理论和社区参与性研究方面具有专业知识。

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.