Translating Home-Based Interventions for Adolescents with Poorly Controlled T1D

对 T1D 控制不佳的青少年进行家庭干预

• 批准号: 8692342
• 负责人: DEBORAH A. ELLIS
• 金额: $ 21.2万
• 依托单位: WAYNE STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-04-01 至 2016-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8692342
• 关键词: Adherence; Admission activity; Adolescent; Adult; African American; Aftercare; American; Behavior Therapy; Caring; Centers for Disease Control and Prevention (U.S.); Child; Chronic; Collaborations; Communities; Community Health; Complications of Diabetes Mellitus; Cost Savings; Deterioration; Development; Diabetes Mellitus; Diabetic Ketoacidosis; Diagnostic; Effectiveness; Evidence based intervention; Family; Funding; Future; Glycosylated hemoglobin A; Grant; Health; Health Professional; Healthcare; Home environment; Hospitals; Individual; Insulin-Dependent Diabetes Mellitus; Intervention; Latino; Low income; Measures; Medical; Mental Health; Metabolic Control; Methodology; Minority; Monitor; Obesity; Outcome; Outcome Measure; Pilot Projects; Positioning Attribute; Preparation; Primary Health Care; Procedures; Psychotherapy; Quality of life; Randomized Controlled Trials; Regimen; Research; Research Project Grants; Resources; Self Management; Social Work; Societies; Specific qualifier value; Target Populations; Testing; Time; Training; Translating; Translational Research; Translations; United States National Institutes of Health; Visit; Vulnerable Populations; Work; Youth; base; clinically relevant; cost; cost effectiveness; cost efficient; diabetes management; dissemination trial; effectiveness trial; experience; glycemic control; high risk; improved; intervention effect; prevent; public health relevance; quality assurance; therapy development

DESCRIPTION (provided by applicant): The deterioration in regimen adherence and metabolic control associated with the adolescent developmental period is well known. However, a subset of high-risk adolescents with type 1 diabetes (T1D) demonstrate much more serious adherence problems, as evidenced by chronically poor metabolic control (CPMC). Adolescents with CPMC represent a group at high risk for short and long-term diabetes complications and are therefore heavy users of both medical resources and health care dollars. Minorities are also over-represented among adolescents with CPMC. Despite the high costs of CPMC to the individual adolescent and to society, few randomized controlled trials to date have targeted this population. The few behavioral interventions which have shown efficacy for improving adherence and metabolic control among youth with CPMC have also been characterized by very low recruitment rates, have not been tested in effectiveness trials, and have not been disseminated to community treatment settings. We have used Multisystemic Therapy (MST), an intensive, home-based psychotherapy, to treat urban, primarily minority youth with type 1 diabetes and CPMC. Despite MST's high retention rates and effectiveness for improving adherence and metabolic control and reducing admissions for diabetic ketoacidosis, costs to deliver MST to youth with CPMC are high. Costs of interventions can be a barrier to the translation of evidence-based interventions to real-world settings, especially in the context of scarce health care funding. The proposed study is a planning grant in which MST will be adapted for delivery by community health workers and will be conducted in collaboration with CHASS, a community agency providing health care to underserved residents of Detroit with diabetes. The new intervention, Fit Families (FF), will be tested in a pilot randomized controlled trial in order to evaluate FF feasibility, finalize outcome measures, estimate intervention effect sizes on health outcomes (i.e., youth adherence, glycemic control, quality of life) and determine potential cost savings associated with reduced hospital admissions. These steps will allow for finalization of intervention content and other trial parameters in preparation for a larger R18 dissemination trial. If successful, FF has the potential to improve health outcomes in a vulnerable population at high risk for diabetes complications and reduced quality of life, while still having high transportability to real-world treatment settings.

描述（由申请人提供）：与青春期发育相关的治疗方案依从性和代谢控制的恶化是众所周知的。然而，一组高风险的1型糖尿病青少年（T1D）表现出更严重的依从性问题，慢性代谢控制不良（CPMC）就是证据。患有CPMC的青少年是短期和长期糖尿病并发症的高风险群体，因此是医疗资源和医疗保健费用的大量使用者。少数民族在青少年中也有过度的代表性。尽管CPMC对青少年个人和社会的成本很高，但迄今为止很少有针对这一人群的随机对照试验。少数行为干预在改善青少年CPMC患者的依从性和代谢控制方面显示出效果，但其特点是招募率非常低，没有在有效性试验中进行测试，也没有推广到社区治疗环境。我们使用了多系统治疗（MST），一种强化的家庭心理治疗，来治疗城市中主要是少数民族的1型糖尿病和CPMC青年。尽管MST的保留率很高，而且在改善依从性和代谢控制以及减少糖尿病酮症酸中毒的入院率方面也很有效，但向患有CPMC的年轻人提供MST的成本很高。干预措施的费用可能成为将循证干预措施转化为现实环境的障碍，特别是在卫生保健资金匮乏的情况下。拟议的研究是一项计划拨款，其中MST将由社区卫生工作者进行调整，并将与CHASS合作进行，CHASS是一家向底特律糖尿病患者提供医疗服务不足的社区机构。新的干预，Fit Families (FF)，将在一项随机对照试验中进行试验，以评估FF的可行性，确定结果措施，估计干预对健康结果（即青年依从性，血糖控制，生活质量）的影响大小，并确定与减少住院率相关的潜在成本节约。这些步骤将允许最终确定干预内容和其他试验参数，为更大规模的R18传播试验做准备。如果成功，FF有可能改善糖尿病并发症高风险和生活质量下降的弱势人群的健康结果，同时仍然具有很高的可移植性到现实世界的治疗环境。