Management and Education for Diabetes in New York City (MED-NYC)

纽约市糖尿病管理和教育 (MED-NYC)

• 批准号: 8510467
• 负责人: JEANINE B ALBU
• 金额: $ 45.98万
• 依托单位: ST. LUKE'S-ROOSEVELT INST FOR HLTH SCIS
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-30 至 2015-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8510467
• 关键词: Management; Education; Diabetes; New; York

DESCRIPTION (provided by applicant): Similar to trends both globally and in the United States, the burden of obesity and diabetes in New York City (NYC) is projected to increase - possibly to overwhelming proportions. Our large primary care health system on the West Side of Manhattan (St. Luke's Roosevelt Hospital Center) has been delivering primary care to a large population, a large proportion of which are minorities at high risk for type 2 diabetes. We have assembled a strong research team including diabetes and obesity clinical research leaders, clinicians with strong community service record and lead public health epidemiologists in New York City. A uniform electronic medical records system (EMR) is being implemented in the next 2 years, in phases, into our primary care practices. The same EMR has been implemented in adjacent health systems on the West Side, federally- funded community health centers (Ryan Clinics) New York City Department of Health Primary Care Initiative - sponsored private practices. This presents the opportunity to form a clinical network where well worked out changes in health policy and care design could easily be implemented and tested. We are completing development of a standard diabetes management system (SDMS) that is in accordance with current practice for diabetes prevention and care, and can be added to the EMR. This will contain the use of a screening questionnaire for detecting individuals at risk to develop type 2 diabetes and a prompt to order an A1C test in those identified to be at risk. We are also working on development of an enhanced management and education for diabetes system (EMEDS) that incorporates all components of the Chronic Care Model and the latest evidence based recommendation for care with regard to diabetes prevention and management. We will be able to implement EMEDS in our practices, one site at a time. We will take advantage of the delayed implementation schedule to evaluate the effectiveness of our systems in a modified "natural experiment" design. We will conduct retrospective analysis on data collected throughout the natural experiment. The Primary Aim is to examine whether implementation of EMEDS across a network of primary care practices will result in greater reductions in A1C than the standard care, over a 12 month follow-up period of patients with "pre-diabetes" (A1C 5.7-6.4%) or new diabetes (A1C >6.5%) diagnosed through our screening system. We hypothesize that the average A1C level of patients exposed to sites/providers that implement EMEDS will be lower than that of patients exposed to SDMS at 12 months. Data will be collected from the EMR which would have been set up at all practices before the study started. This experiment will occur at multiple levels in our health system and will involve a change in the health policy for the entire system and a change in the entire health system as the entire population will be asked to undergo screening at the point-of-care. Moreover this experiment will generate methods and tools that will be easily leveraged to other health care systems.

描述（由申请人提供）：与全球和美国的趋势相似，预计纽约市（NYC）的肥胖和糖尿病负担将增加-可能达到压倒性的比例。我们在曼哈顿西区（圣卢克罗斯福医院中心）的大型初级保健系统一直在为大量人口提供初级保健，其中很大一部分是2型糖尿病高危少数群体。我们已经组建了一个强大的研究团队，包括糖尿病和肥胖症临床研究领导者，具有良好社区服务记录的临床医生和纽约市领先的公共卫生流行病学家。在未来两年，我们将分阶段在基层医疗实践中实施统一的电子医疗记录系统。同样的电子病历已在邻近的卫生系统实施的西区，联邦资助的社区卫生中心（瑞安诊所）纽约市卫生部初级保健倡议赞助的私人执业。这提供了形成临床网络的机会，在该网络中，可以很容易地实施和测试卫生政策和护理设计方面的精心设计的变化。我们正在完成标准糖尿病管理系统（SDMS）的开发，该系统符合当前糖尿病预防和护理的实践，并可添加到EMR中。这将包括使用筛查问卷来检测有患2型糖尿病风险的个体，并提示那些被确定为有风险的人进行A1 C测试。我们还致力于开发一个增强型糖尿病管理和教育系统（EMEDS），该系统包含慢性病护理模式的所有组成部分以及糖尿病预防和管理方面最新的循证护理建议。我们将能够在我们的实践中实施EMEDS，一次一个站点。我们将利用延迟的实施时间表来评估我们的系统在修改后的“自然实验”设计的有效性。我们将对整个自然实验过程中收集的数据进行回顾性分析。主要目的是检查在初级保健实践网络中实施EMEDS是否会导致A1 C比标准护理更大的降低，对通过我们的筛查系统诊断的“糖尿病前期”（A1 C 5.7-6.4%）或新发糖尿病（A1 C>6.5%）患者进行12个月的随访。我们假设，在12个月时，暴露于实施EMEDS的研究中心/提供者的患者的平均A1 C水平将低于暴露于SDMS的患者。将从EMR中收集数据，EMR将在研究开始前在所有实践中建立。这项实验将在我们的卫生系统的多个层面进行，并将涉及整个系统的卫生政策的变化，以及整个卫生系统的变化，因为整个人口将被要求在护理点进行筛查。此外，这项实验将产生的方法和工具，将很容易利用到其他卫生保健系统。