Comparing Strategies for Translating Self-management Support into Primary Care

将自我管理支持转化为初级保健的策略比较

• 批准号: 8368015
• 负责人: Walter Perry Dickinson
• 金额: $ 68.19万
• 依托单位: UNIVERSITY OF COLORADO DENVER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-15 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8368015
• 关键词: Accounting; Adoption; Alcohols; Area; Behavior; Behavioral; Blood Pressure; Cardiovascular Diseases; Cardiovascular system; Caring; Characteristics; Chronic Disease; Clinical; Complement; Complications of Diabetes Mellitus; Diabetes Mellitus; Diet; Effectiveness; Ensure; Glycosylated hemoglobin A; Goals; Health; Health Care Costs; Health behavior; Healthcare; Home environment; Information Systems; Institute of Medicine (U.S.); Intervention; LDL Cholesterol Lipoproteins; Life Style; Maintenance; Medical; Modeling; Monitor; National Institute of Diabetes and Digestive and Kidney Diseases; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Occupations; Outcome; Patient-Centered Care; Patients; Physical activity; Physicians; Population; Prevention; Preventive; Primary Health Care; Process; Program Effectiveness; Psychosocial Factor; Relative (related person); Research; Resources; Risk; Risk Behaviors; Self Management; System; Technology; Testing; Time; Tobacco Use Cessation; Translating; Translational Research; Translations; Work; base; behavior change; chronic care model; cost; design; diabetes control; evidence base; experience; glycemic control; improved; innovation; interest; medication compliance; meetings; operation; patient oriented; prevent; programs; randomized trial; response; social; theories; tool; uptake

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.

描述（由申请人提供）：以患者为中心的医疗之家和慢性病护理模式已成为互补框架，以实现医学研究所的高质量预防和慢性病护理目标，并帮助控制医疗费用。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，改进信息系统和积极的质量改进。这些模型在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SMS的关键领域。SMS计划很重要，因为它们可以预防，延迟或减少T2 DM和心血管疾病的并发症。很少有工具可用于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。交互式行为改变技术可以促进在T2 DM患者和相关健康风险行为的初级保健中采用关键的SMS干预。为了有效，该技术必须很好地融入实践系统，具有成本和时间效益，并加强和补充-而不是取代-患者和初级保健团队之间的互动。为了满足有效的SMS干预需求，我们开发并测试了连接到健康（CTH），这是一个全面的，基于证据的SMS计划，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，以帮助改善临床重要的糖尿病相关健康结果并解决自我管理问题。在初级保健中，CTH等项目的采用和维护受到了实践无法适应和实施项目组件到其文化、患者流程和工作流程中的限制。实践指导已被证明是有效的，在帮助实践，使最佳的程序执行所需的变化。拟议的研究旨在通过结合两条有前途的研究路线，促进SMS转化为T2 DM患者的初级保健实践，具体来说，（a）在不同的初级保健实践中测试CTH对T2 DM患者的有效性，和（b）评估实践指导对增强干预措施的吸收和维持的影响。B）。 公共卫生相关性：自我管理支持涉及为人们提供照顾自己健康所需的帮助和资源。这对糖尿病患者尤其重要，但医生和实践往往很难做到这一点。该项目将测试不同的方法来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。