Peer Support to Enhance Diabetes Shared Medical Appointments: Examining Comparative Effectiveness in VA Health Systems

加强糖尿病共享医疗预约的同伴支持：检查 VA 卫生系统的比较有效性

• 批准号: 9759679
• 负责人: MARY ELLEN MICHELE HEISLER
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-03-01 至 2020-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9759679
• 关键词: Age; Behavior; Blood Pressure; Caring; Characteristics; Chronic; Client satisfaction; Clinic; Clinical; Complement; Data; Diabetes Mellitus; Distress; Effectiveness; Enrollment; Evaluation; Face; Geography; Goals; Health; Health Services Accessibility; Health system; Healthcare; Home environment; Insulin; Intervention; Life; Light; Literature; Maintenance; Measures; Medical; Methods; Modeling; Nursing Care Management; Outcome; Outcome Measure; Participant; Patient-Focused Outcomes; Patients; Periodicity; Pragmatic clinical trial; Process; Provider; Quality of Care; Quality of life; Randomized; Randomized Controlled Trials; Recommendation; Resources; Self Management; Services; Site; Social support; System; Telephone; Testing; Time; Training; Training Programs; Veterans; base; blood pressure regulation; comparative effectiveness; cost; design; diabetes control; diabetes self-management; efficacy trial; follow-up; formative assessment; glycemic control; implementation research; implementation science; improved; improved outcome; innovation; medical appointment; meetings; multidisciplinary; novel; novel strategies; peer; peer support; pragmatic trial; program costs; programs; satisfaction; service utilization; standard care; success; treatment as usual

 DESCRIPTION (provided by applicant): PROJECT BACKGROUND: Shared Medical Appointments (SMAs)-group sessions of Veterans with the same medical condition led by a multi-disciplinary/multi-expertise team of providers-are now being widely implemented at VA facilities nationwide. Efficacy trials have found that SMAs in VA increase access to care and improve participants' self-management, clinical, and Veteran-centered outcomes during and immediately after completion of the SMAs. Less is known about the extent to which gains achieved through SMAs are maintained over time and, if not, what additional scalable approaches can best maintain improvements in self-management and clinical outcomes. Moreover, factors influencing effective implementation of SMAs and follow-up maintenance programs in diverse settings are poorly understood. One potentially scalable approach is telephone-based peer support in which fellow Veterans provide support to each other. Because peers share similar characteristics, this approach is intrinsically culturally sensitive. Moreover, because most contacts are over the telephone, it is accessible to vulnerable patients who face obstacles to accessing clinic-based care. PROJECT OBJECTIVES: Accordingly, this mixed methods cluster randomized controlled trial will evaluate the comparative effectiveness and implementation of a novel reciprocal peer support program-the Peer to Peer Program (P2P)-in maintaining gains from diabetes SMAs. In a prior VA efficacy randomized controlled trial, P2P improved VA patients' diabetes-specific social support, insulin starts, and glycemic control compared to usual nurse care management. PROJECT METHODS: P2P program components include at-least weekly telephone calls between paired Veterans with poor diabetes control who are participating in the same SMA group and periodic Veteran-directed group sessions. Participants are matched with another patient of similar age and facing similar self-management challenges. These "peer buddies" are encouraged to talk by phone at least weekly to provide mutual support and share their progress setting and meeting their self-management goals. The goal is to enhance and help maintain improvements achieved through short-term diabetes self-management training and clinical programs such as diabetes SMAs. Based on the success of separate efficacy trials of diabetes SMAs and of the P2P program, this project will examine the comparative effectiveness of SMAs alone, SMAs + P2P, and usual care without either of these programs and study the implementation process at seven sites in five diverse VA facilities. Outcomes measured at 6- and 12-months post-enrollment include: 1) changes in participants' glycemic and blood pressure control and statin use; 2) service utilization; 3) satisfaction with VA care; 4) diabetes-specific distress; 5) diabetes socia support; and 5) diabetes self- management behaviors. Constructs from the Consolidated Framework for Implementation (CFIR) have already been used in a completed pre-implementation formative evaluation at the study sites that was used to refine the implementation plan at each site. CFIR constructs will also be used during the post- implementation evaluation process to identify recommendations for facilitating widespread dissemination efforts and to contribute to the implementation science literature. Data will be gathered throughout implementation on staff effort required in order to calculate costs of the program.

 描述(由申请人提供)： 项目背景：共享医疗预约(SMA)是由多学科/多专业提供者团队领导的具有相同医疗条件的退伍军人的小组会议，目前正在全国退伍军人管理局广泛实施。疗效试验发现，退伍军人管理局增加了获得护理的机会，并改善了参与者在完成中小企业管理局期间和之后的自我管理、临床和以退伍军人为中心的结果。关于通过SMA取得的成果在多大程度上随时间保持不变，以及如果不是，哪些额外的可扩展方法可以最好地保持自我管理和临床结果的改善，人们知之甚少。此外，影响在不同环境下有效实施SMA和后续维护方案的因素也缺乏了解。一种潜在的可扩展方法是基于电话的同伴支持，在这种方法中，退伍军人同胞相互支持。由于同龄人有相似的特征，这种方法在本质上具有文化敏感性。此外，由于大多数联系人是通过电话联系的，因此面临获得以诊所为基础的护理的障碍的脆弱患者可以接触到它。项目目的：因此，这项混合方法整群随机对照试验将评估一种新的对等同伴支持计划-对等计划(P2P)-在维持糖尿病SMAS收益方面的比较有效性和实施情况。在先前的VA疗效随机对照试验中，与常规护理管理相比，P2P改善了VA患者的糖尿病特有的社会支持、胰岛素开始使用和血糖控制。项目方法：P2P计划部分包括糖尿病控制较差的配对退伍军人之间至少每周一次的电话通话，他们参加相同的SMA小组和定期的退伍军人指导小组会议。参与者与另一名年龄相似、面临类似自我管理挑战的患者配对。这些“同行伙伴”被鼓励至少每周通过电话交谈，以提供相互支持，并分享他们的进展设置和实现他们的自我管理目标。其目标是加强并帮助保持通过短期糖尿病自我管理培训和临床计划(如糖尿病SMA)所取得的改善。基于糖尿病SMAS和P2P计划的单独疗效试验的成功，该项目将检验单独SMAS、SMAS+P2P和没有这两个计划的常规护理的比较有效性，并研究在五个不同的VA设施的七个地点的实施过程。登记后6个月和12个月的结果包括：1)参与者血糖和血压控制以及他汀类药物使用的变化；2)服务利用；3)对退伍军人管理局护理的满意度；4)糖尿病特有的痛苦；5)糖尿病社会支持；以及5)糖尿病自我管理行为。已在研究地点完成的实施前形成性评价中使用了综合执行框架的结构，以完善每个地点的执行计划。在实施后评价过程中，还将使用CFIR结构，以确定促进广泛传播努力的建议，并为实施科学文献作出贡献。将在整个实施过程中收集有关工作人员所需努力的数据，以便计算该计划的成本。