Added Value of Primary Care-Senior Center Linkages for Health and Functioning

初级保健-老年中心联系对健康和功能的附加值

• 批准号: 8571881
• 负责人: POLLY H. NOEL
• 金额: $ 19.23万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8571881
• 关键词: Address; Administrator; Advisory Committees; Aerobic Exercise; Body mass index; Caring; Cessation of life; Characteristics; Chronic Disease; Chronically Ill; Church; Clinic; Clinical; Collaborations; Communities; Computerized Medical Record; Consent; Data; Diabetes Mellitus; Elderly; Enrollment; Exercise; Feedback; Frequencies; Glycosylated hemoglobin A; Grant; Health; Health Professional; Health Promotion; Healthcare; Hispanics; Indium; Individual; Inpatients; Institutes; Intervention; Interview; Life; Link; Low income; Maintenance; Measures; Metric; Minority; Modeling; Neighborhoods; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Participant; Patient Self-Report; Patients; Peer Review; Performance; Pharmaceutical Preparations; Play; Population Heterogeneity; Prevalence; Preventive screening; Primary Health Care; Provider; Qualitative Methods; Quality of Care; Recruitment Activity; Reporting; Research; Research Personnel; Resources; Review Literature; Role; Schools; Self Care; Self Management; Services; Solutions; Time; Visit; Vulnerable Populations; Wellness Program; Workplace; aging population; base; cardiovascular risk factor; chronic care model; clinically relevant; combat; community organizations; cost effective; diabetes control; disability; efficacy trial; evidence base; fitness; follow-up; improved functioning; informant; innovation; member; public health relevance; public-private partnership; strength training; tool; trend

DESCRIPTION (provided by applicant): The prevalence of diabetes and its complications has increased among older adults, and new models of care are needed to combat this trend among vulnerable populations. According to the Chronic Care Model (CCM), optimal chronic illness care requires linkages with community-based resources. Research based upon the CCM suggests that self-management support for older adults with diabetes may be bolstered by linkages between primary care providers and senior centers, but studies of such linkages are rare. This proposal describes an exploratory grant to demonstrate the added value of primary care's linkage with multipurpose senior centers in maintaining the health and functioning of older adults with diabetes, as well as to identify facilitators and barriers to creating and maintaining linkages between primary care clinics and community-based multipurpose senior centers. Our initial inquiry will capitalize on a unique, existing public-private partnership that has linked an innovative primary care network to two community-based, multipurpose Senior Centers that serve over 9,000 vulnerable seniors living in majority Hispanic, low-income neighborhoods in San Antonio, TX. In collaboration with these partners, an interdisciplinary team of researchers proposes to accomplish the following specific aims for the R21: 1) Among newly registered members of multipurpose senior centers who have type 2 diabetes, determine if being a patient of primary clinics with established linkages to the Senior Centers is associated with frequency and type of services used and clinically relevant improvements over a 9-month follow-up period. 2) Using qualitative methods, identify: a) Senior Center services that primary care providers, administrators, and staff are aware of and value most; b) specific ways, formal and informal, in which members' primary care clinics are linked to the senior centers; and c) barriers and facilitators (e.g., tools, resources, and interactions) to creating and maintaining primary care-senior center linkages. To address Aim 1, we propose to recruit and consent 360 older adults ¿ 65 years with type 2 diabetes as they become new members of the two multipurpose Senior Centers over a 9-month enrollment period. At baseline (i.e., time of registration as a new senior center member) and 9-months follow-up, we will assess patient activation and functioning using self-report and performance-based measures. At 9-months follow-up, we will ascertain frequency of visits and type of services used from Senior Center activity logs. We will also obtain electronic medical record data for those Senior Center members who are patients of the primary care clinics with established links to the senior centers. To address Aim 2, we will use key informant interviews to identify: a) Senior Center services that primary care providers, administrators, and staff are aware of and value most; b) specific ways, formal and informal, in which members' primary care clinics are linked to the Senior Centers; and c) barriers and facilitators (e.g., tools, resources, and interactions) to creating and maintaining primary care-senior center linkages.

描述（由申请人提供）：糖尿病及其并发症的患病率在老年人中有所增加，需要新的护理模式来应对弱势人群中的这一趋势。根据慢性病护理模式（CCM），最佳的慢性病护理需要与社区资源相联系。基于CCM的研究表明，对老年糖尿病患者的自我管理支持可能会受到初级保健提供者和老年中心之间联系的支持，但这种联系的研究很少。该提案描述了一项探索性补助金，以证明初级保健与多功能老年中心在维持糖尿病老年人的健康和功能方面的联系的附加值，并确定促进者和障碍，以建立和维持初级保健诊所与社区多功能老年中心之间的联系。我们的初步调查将利用一个独特的，现有的公私合作伙伴关系， 创新的初级保健网络，以两个社区为基础的，多功能的老年人中心，为9,000多名弱势老年人生活在大多数西班牙裔，低收入社区在圣安东尼奥，得克萨斯州。在与这些合作伙伴的合作中，一个跨学科的研究小组提出了实现R21的以下具体目标：1）在患有2型糖尿病的多功能老年中心的新注册成员中，确定是否是与老年中心建立联系的初级诊所的患者与9个月随访期间使用的服务频率和类型以及临床相关改善相关-上时期。2)使用定性方法，确定：a）初级保健提供者、管理人员和工作人员最了解和最重视的老年中心服务; B）会员初级保健诊所与老年中心联系的正式和非正式的具体方式;以及c）障碍和促进因素（例如，工具，资源和互动），以创建和维护初级保健，高级中心的联系。为了解决目标1，我们建议招募并同意360名65岁的2型糖尿病老年人，因为他们在9个月的招募期内成为两个多功能老年中心的新成员。在基线（即，注册为新的高级中心成员的时间）和9个月的随访，我们将使用自我报告和基于性能的测量来评估患者的激活和功能。在9个月随访时，我们将根据老年中心活动日志确定访视频率和使用的服务类型。我们还将获取老年中心成员的电子病历数据，这些成员是与老年中心建立联系的初级保健诊所的患者。为了实现目标2，我们将使用关键的知情人访谈来确定：a）初级保健提供者、管理人员和工作人员最了解和最重视的老年中心服务; B）会员的初级保健诊所与老年中心联系的正式和非正式的具体方式;以及c）障碍和促进因素（例如，工具，资源和互动），以创建和维护初级保健，高级中心的联系。