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病护理模式已作为补充框架出现，以实现医学研究所高质量预防性和慢性病护理的目标，并帮助控制医疗保健成本。这些模型强调以患者为中心的护理，包括自我管理支持（SMS）、群体管理、协调护理团队、改进的信息系统和主动质量改进。这些模型在 2 型糖尿病 (T2DM) 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、延迟或随着时间的推移减少 T2DM 和心血管疾病的并发症。很少有工具可以帮助初级保健临床医生识别、监测和干预 T2DM 患者不健康的生活方式和有问题的社会心理因素。交互式行为改变技术可以促进在 T2DM 患者和相关健康风险行为的初级保健中采用关键的 SMS 干预措施。为了发挥作用，该技术必须很好地融入实践系统，具有成本效益和时间效益，并增强和补充（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 SMS 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 SMS 计划，利用初级保健临床医生和 T2DM 患者之间的有针对性的对话来帮助改善临床上重要的糖尿病相关健康结果并解决自我管理问题。由于实践无法将项目组成部分适应和实施到其文化、患者流程和工作流程中，初级保健中 CTH 等项目的采用和维护受到了限制。事实证明，实践辅导可以有效地帮助实践做出最佳计划实施所需的改变。拟议的研究旨在通过结合两个有前途的研究方向，促进 SMS 转化为 T2DM 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 T2DM 患者的有效性，以及 (b) 评估实践辅导的影响，以增强干预措施的采用和维持。 公共卫生相关性：自我管理支持涉及向人们提供照顾其健康所需的帮助和资源。这对于糖尿病患者尤其重要，但医生和实践通常很难做到这一点。该项目将测试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的不同方法。

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.