Integrated Population Program for Diabetic Kidney Disease

糖尿病肾病综合人口计划

• 批准号: 8707890
• 负责人: Hayden B Bosworth
• 金额: $ 35.36万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8707890
• 关键词: Accounting; Address; Adherence; Adoption; Adult; Affect; Area; Aspirin; Awareness; Back; Behavior; Behavior Therapy; Blood Glucose; Blood Pressure; Cardiovascular system; Case Management; Case Manager; Cessation of life; Communication; Control Groups; County; Data; Development; Diabetes Mellitus; Diabetic Nephropathy; Diet; Disease Outcome; Disease Progression; Education; Effectiveness; Effectiveness of Interventions; Electronic Health Record; Electronics; End stage renal failure; Enrollment; Epidemic; Event; Expenditure; Future; Glomerular Filtration Rate; Glucose; Grant; Health Status; Health behavior; Health system; Healthcare Systems; Hypertension; Impact evaluation; Individual; Intervention; Kidney Diseases; Kidney Failure; Lipids; Lipoproteins; Mails; Maintenance; Medical; Medication Management; Modeling; Monitor; Online Systems; Outcome; Patients; Pharmaceutical Preparations; Physical activity; Population; Population Intervention; Population Programs; Quality-Adjusted Life Years; Renal function; Risk; Risk Factors; Self Efficacy; Self Management; Solutions; Stable Disease; System; Technology; Telephone; Testing; Text; Translating; Translations; United States; Visit; Voice; Vulnerable Populations; Weight; Weight maintenance regimen; Work; adverse outcome; base; behavior influence; blood pressure regulation; burden of illness; cardiovascular risk factor; cost; cost effective; diabetic; diet and exercise; economic evaluation; evidence base; experience; high risk; hypertension control; improved; innovation; medication compliance; primary outcome; programs; public health relevance; randomized trial; response; scale up; secondary outcome; smoking cessation; success; telehealth; therapy design

DESCRIPTION (provided by applicant): Diabetic kidney disease (DKD) is the major cause of end-stage renal disease (ESRD) in the US. Although many people with diabetes develop DKD, approximately one in five has DKD with uncontrolled hypertension that increases their risk of ESRD, cardiovascular events, and death. These risks are reduced by simultaneously improving control of multiple risk factors. However, prior interventions have largely: ignored low awareness of kidney disease limiting treatment; been conducted using costly face-to-face visits limiting widespread application; and included populations with limited generalizability. In addition, most studies have included those with early or late DKD but have not targeted moderate DKD and uncontrolled hypertension which would potentially optimize efficiency and impact by excluding those with stable disease and reducing the risks of ESRD, cardiovascular events and death before developing advanced DKD. For this planning grant, we propose to develop The STOP-DKD Automated Population Program (APP), a population management program that will: identify patients with moderate DKD and uncontrolled hypertension from an integrated data warehouse for a multi-state diabetes study in four underserved Southeastern counties; monitor adherence and self-management behaviors, providing e-reminders/messages to improve DKD medication adherence and health behaviors via patient-selected technology (mobile/web-based applications, text messaging, interactive voice response, or e-mail); and monitor outcomes with activation of engagement by a case manager through our existing telehealth platform for suboptimal control of blood pressure or health status. Our APP builds upon our prior work to deliver a tailored, multi-factorial intervention to address medication management and modify multiple risk factors simultaneously through a combination of patient self-monitoring, behavioral therapies and education that optimize adherence and self-efficacy. Intervention effectiveness will be evaluated among 320 individuals with moderate DKD in a six-month randomized trial to improve blood pressure control (primary outcome) and health behaviors that influence other cardiovascular risk factors (secondary outcome). To assess the feasibility of future large-scale implementation and dissemination, we will also conduct impact (using the RE-AIM framework) and economic evaluations (using the Archimedes model). For sustained adoption, this study will establish critical experience necessary for successful scale up in future effectiveness studies within this pre-identified dissemination channel and other health systems. To mitigate the growing burden of DKD in the US, this study is expected to fill a void in scalable treatment options by establishing the feasibility and efficacy of our evidence-based APP to identify and manage DKD in underserved high-risk patients.

描述（由申请人提供）：糖尿病肾病（DKD）是美国终末期肾脏疾病（ESRD）的主要原因。尽管许多糖尿病患者发展为DKD，但大约五分之一的DKD患有不受控制的高血压，增加了ESRD，心血管事件和死亡的风险。通过同时改善对多个风险因素的控制，可以降低这些风险。但是，先前的干预措施很大程度上是：忽略了对肾脏疾病限制治疗的低认识；使用昂贵的面对面访问限制了广泛应用；并包括有限的普遍性人群。此外，大多数研究包括患有早期或晚期DKD的研究，但没有针对中等的DKD和不受控制的高血压，这将通过排除稳定疾病的患者并降低ESRD，心血管事件和死亡的风险来优化效率和影响，并在发展高级DKD之前。对于这项计划赠款，我们建议开发一项人口管理计划的Stop-DKD自动化人群计划（APP），该计划将：确定中等DKD的患者，并从四个不足服务的东南县的多状态糖尿病研究中的综合数据仓库中从综合数据仓库中进行不受控制的高血压；监视通过患者选择的技术（基于移动/Web的应用程序，文本消息传递，交互式语音响应或电子邮件）来监视E-Reminders/Messages以改善DKD药物依从性和健康行为的行为；并通过我们现有的远程医疗平台激活案例经理的参与度，以对血压或健康状况进行次优控制。我们的应用程序基于我们先前的工作，以提供量身定制的多项式干预措施，以解决药物管理，并通过患者自我监测，行为疗法和教育的结合来同时修改多个风险因素，从而优化依从性和自我效能感。在为期六个月的随机试验中，将评估320名中度DKD患者之间的干预效果，以改善血压控制（主要结果）和影响其他心血管危险因素（次要结果）的健康行为。为了评估未来大规模实施和传播的可行性，我们还将进行影响（使用RE-AIM框架）和经济评估（使用Archimedes模型）。为了持续采用，这项研究将在此预识别的传播渠道和其他卫生系统中成功扩大未来有效性研究所必需的重要经验。为了减轻美国DKD的日益增长的负担，预计这项研究将通过确定基于证据的应用程序的可行性和功效来识别和管理不受欢迎的高危患者的DKD，以填补可扩展治疗方案的空隙。