Comparing Strategies for Translating Self-management Support into Primary Care

描述(由申请人提供)：以患者为中心的医疗之家和慢性护理模式作为补充框架出现，以实现医学研究所的高质量预防和慢性病护理目标，并帮助控制医疗成本。这些模式强调以患者为中心的护理，包括自我管理支持(SMS)、人口管理、协调护理团队、改进的信息系统和积极的质量改进。这些模式在2型糖尿病(T2 DM)患者的初级保健中的有效应用仍然是一个挑战，特别是在短信的关键领域。短信计划很重要，因为随着时间的推移，它们可以预防、推迟或减少T2 DM和心血管疾病的并发症。随着时间的推移，很少有工具可以帮助初级保健临床医生识别、监测和干预T2 DM患者的不健康生活方式行为和有问题的心理社会因素。互动行为改变技术可以促进在T2 DM和相关健康危险行为患者的初级保健中采用关键的短信干预措施。为了有效，该技术必须很好地整合到实践系统中，具有成本和时间效益，并加强和补充--但不是取代--患者和初级保健团队之间的互动。为了满足对有效的短信干预的需求，我们开发并测试了Connection to Health(CTH)，这是一个全面的、基于证据的短信计划，它使用初级保健临床医生和T2 DM患者之间的有针对性的对话来帮助改善与临床重要的糖尿病相关的健康结果，并解决自我管理问题。初级保健中的CTH等计划的采用和维持一直受到实践的限制，因为实践无法将计划组成部分适应和实施到其文化、患者流程和工作流程中。实践指导已被证明在帮助实践做出最佳计划实施所需的改变方面是有效的。这项拟议的研究旨在通过结合两个有希望的研究路线，促进将SMS转化为T2 DM患者的初级保健实践，具体而言，(A)测试CTH对T2 DM患者在各种初级保健实践中的有效性，以及(B)评估实践指导对加强对干预措施的理解和维持的影响。 公共卫生相关性：自我管理支持涉及为人们提供照顾其健康所需的帮助和资源。这对糖尿病患者尤其重要，但医生和医生往往很难做到这一点。该项目将测试不同的方法，以帮助初级保健实践更好地为糖尿病患者提供自我管理支持。

DESCRIPTION (provided by applicant): The Patient-Centered Medical Home and the Chronic Care Model have emerged as complementary frameworks to achieve the Institute of Medicine's goals for high-quality preventive and chronic disease care and to help contain healthcare costs. These models emphasize patient-centered care, including self-management support (SMS), population management, coordinated care teams, improved information systems, and active quality improvement. The effective application of these models in primary care for patients with type 2 diabetes (T2DM) remains a challenge, especially in the key area of SMS. SMS programs are important because they prevent, delay, or reduce over time the complications of T2DM and cardiovascular diseases. Few tools are available to help primary-care clinicians identify, monitor, and intervene on unhealthful lifestyle behaviors and problematic psychosocial factors over time for patients with T2DM. Interactive behavior-change technology can facilitate the adoption of crucial SMS interventions in primary care for patients with T2DM and related health risk behaviors. To be effective, the technology must be well-integrated into the practice system, be cost- and time-efficient, and enhance and complement - but not replace - interactions between patients and primary-care teams. To meet the need for effective SMS intervention, we have developed and tested Connection to Health (CTH), a comprehensive, evidence-based SMS program that uses targeted conversations between primary-care clinicians and patients with T2DM to help improve clinically important diabetes-related health outcomes and resolve self-management problems. Uptake and maintenance of programs such as CTH in primary care have been limited by the inability of practices to adapt and implement program components into their culture, patient flow, and work processes. Practice coaching has been shown to be effective in helping practices make the changes required for optimal program implementation. The proposed research is designed to promote the translation of SMS into primary-care practices for patients with T2DM by combining two promising lines of research, specifically, (a) testing the effectiveness of CTH for patients with T2DM in diverse primary-care practices, and (b) evaluating the impact of practice coaching to enhance uptake and maintenance of the intervention. PUBLIC HEALTH RELEVANCE: Self-management support involves providing people with the help and resources that they need to take care of their health. This is especially important for patients with diabetes, but it is often hard for physicians and practices to do this well. This project would test different ways of helping primary care practices to do a better job of self-management support for their patients with diabetes.