A Team Approach to Improve the Quality of Diabetes Care for Patients with Schizop

提高精神分裂症患者糖尿病护理质量的团队方法

• 批准号: 8654334
• 负责人: Lydia Ann Chwastiak
• 金额: $ 23.18万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-04-20 至 2015-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8654334
• 关键词: Achievement; Address; Adherence; Adult; Antipsychotic Agents; Cardiovascular Diseases; Cardiovascular system; Caring; Cessation of life; Collaborations; Communities; Community Mental Health Centers; Complex; Development; Diabetes Mellitus; Foundations; General Population; Health Food; Health Personnel; Intervention; Knowledge; Lead; Life Style; Lipids; Medical; Mental Depression; Mental Health; Metabolic; Modeling; Morbidity - disease rate; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Outcome Measure; Outpatients; Patient Care; Patients; Persons; Pharmaceutical Preparations; Pilot Projects; Population; Primary Health Care; Provider; Psychiatric therapeutic procedure; Randomized; Randomized Controlled Trials; Sample Size; Schizophrenia; Services; System; Tobacco Dependence; Universities; University Hospitals; Vulnerable Populations; Washington; Weight Gain; base; blood pressure regulation; cardiovascular risk factor; collaborative care; community setting; data management; depressive symptoms; diabetes risk; effective intervention; efficacy trial; glycemic control; high risk; improved; innovation; mental health center; mortality; multidisciplinary; nutrition; pilot trial; premature; primary outcome; programs; psychotic symptoms; public health relevance; secondary outcome; sedentary; severe mental illness

DESCRIPTION (provided by applicant): Patients treated in community mental health settings die, on average, 25 years earlier than the general population, and the vast majority of these premature deaths are due to cardiovascular disease. There is an urgent need to develop effective interventions to decrease this excess cardiovascular morbidity and mortality. Such interventions need to address patient-level, provider-level and system-level factors. Patient-level factors include limited knowledge about nutrition, lack of access to healthy foods, sedentary lifestyle, tobacco dependence, and poor adherence to medications and medical treatment. The weight gain and other adverse metabolic effects of antipsychotic medication treatment and the poor quality of diabetes medical care received by patients with schizophrenia (specifically the lack of appropriate intensification of medications for cardiovascular risk factors) represent provider-level factors that contribute to poor diabetes outcomes among persons with schizophrenia treated in community settings. System-level factors that need to be addressed include limited access to medical care and the fragmentation of care. We propose a model of diabetes care that is a unique collaboration between community mental health centers and a university hospital-based diabetes center. The MHC Diabetes Team model will be an adaptation of the TEAMcare approach to management of primary care patients with depression and poorly controlled type 2 diabetes. TEAMcare is a care management intervention that integrates a treat-to-target program for cardiovascular disease with collaborative care for depression. Given the unique needs and vulnerabilities of patients with schizophrenia, the adaptation of TEAMcare for this population will essentially require the development of a new intervention. The purpose of this pilot study is to evaluate the feasibility and preliminary efficacy of an innovative approach o diabetes care for a complex population at very high risk of poor diabetes outcomes. We aim to demonstrate that 1) a team approach to diabetes care is feasible to implement in urban community mental health centers; 2) that it is acceptable to multiple stakeholders (patients, primary care providers, MHC and Diabetes Center providers); and 3) that treatment by MHC TEAMcare will result in significant improvement of diabetes and cardiovascular risk factor outcomes among community mental health center outpatients with schizophrenia and co-occurring type 2 diabetes, compared to usual psychiatric care and primary care of diabetes. The achievement of these aims will lead to the development of a full scale RCT (R01) to evaluate the efficacy of this innovative model of diabetes care.

描述（由申请人提供）：在社区心理健康环境中接受治疗的患者平均死亡，比普通人群早25年，而这些早期死亡的绝大多数是由于心血管疾病。迫切需要采取有效的干预措施，以降低这种过多的心血管发病率和死亡率。这种干预措施需要解决患者级，提供者级别和系统级别的因素。患者级 因素包括有限的知识，缺乏健康食品，久坐的生活方式，烟草依赖以及对药物和医疗的依从性不佳。抗精神病药物治疗的体重增加和其他不良代谢作用以及精神分裂症患者接受的糖尿病医疗质量（特别是缺乏适当的心血管风险危险因素药物的适当强化）代表提供者水平的因素，这些因素会导致糖尿病在社区设置中有助于糖尿病患者的不良糖尿病。需要解决的系统级因素包括有限的医疗服务和护理分裂。 我们提出了一种糖尿病护理模型，这是社区心理健康中心和基于大学医院的糖尿病中心之间的独特合作。 MHC糖尿病团队模型将适应抑郁症和控制不良的2型糖尿病患者的团队保健方法。 TeamCare是一项护理管理干预措施，将心血管疾病的治疗对象计划与抑郁症的协作护理相结合。鉴于精神分裂症患者的独特需求和脆弱性，对该人群的团队护理的适应基本上将需要开发新的干预措施。这项试点研究的目的是评估创新方法的可行性和初步疗效O糖尿病护理对糖尿病结果不良风险非常高的复杂人群的护理。我们的目的是证明1）在城市社区心理健康中心实施糖尿病护理的团队方法是可行的； 2）对于多个利益相关者（患者，初级保健提供者，MHC和糖尿病中心提供者）是可以接受的； 3）与通常的精神分裂症和2型糖尿病相比，MHC TeamCare的治疗将导致社区心理健康中心门诊病人之间的糖尿病和心血管危险因素的结果显着改善。这些目标的实现将导致发展全尺度RCT（R01），以评估这种糖尿病护理创新模型的功效。