糖尿病差异：发短信延长治疗 (DD-TXT)-猫眼课题宝

糖尿病差异：发短信延长治疗 (DD-TXT)

批准号：

9833680

负责人：

Stephanie Leah Shimada

金额：

$0.0万

依托单位：

EDITH NOURSE ROGERS MEMORIAL VETERANS HOSPITAL

依托单位国家：

美国

项目类别：

财政年份：

2020

资助国家：

美国

项目状态：

已结题

起止时间：

2020-05-01 至 2024-10-31

来源：

https://reporter.nih.gov/project-details/9833680

关键词：

Address Address Adherence Adherence Affect Affect African American African American Appointment Appointment Area Area Behavior Behavior Blood Glucose Blood Glucose Blood Pressure Monitors Blood Pressure Monitors Caring Cellular Phone Cellular Phone Chicago Chicago Chronic Disease Chronic Disease Complex Complex Custom Custom Data Data Development Development Diabetes Mellitus Diabetes Mellitus Diagnosis Diagnosis Disease Disease Distress Education Education Effectiveness Effectiveness Emotional Emotional Evaluation Evaluation Expenditure Expenditure Feedback Feedback Foxes Foxes Future Future General Population General Population Glycosylated hemoglobin A Glycosylated hemoglobin A Goals Goals Guidelines Guidelines Health Health Health Care Costs Health Care Costs Health Services Accessibility Health Services Accessibility Healthcare Healthcare Heart Heart Heterogeneity Heterogeneity Hybrids Hybrids Improve Access Improve Access Informatics Informatics Intervention Intervention Lead Lead Libraries Libraries Logic Logic Low income Low income Low-Density Lipoproteins Low-Density Lipoproteins Medical Medical Medication Management Medication Management Medicine Medicine Mental Health Mental Health Methodology Methodology Minority Minority Modality Modality Monitor Monitor Morbidity - disease rate Morbidity - disease rate Motivation Motivation Names Names Non-Insulin-Dependent Diabetes Mellitus Non-Insulin-Dependent Diabetes Mellitus Nurses Nurses Outcome Outcome Ownership Ownership Participant Participant Patient Preferences Patient Preferences Patient Self-Report Patient Self-Report Patient-Centered Care Patient-Centered Care Patients Patients Pharmaceutical Preparations Pharmaceutical Preparations Physical activity Physical activity Physiological Physiological Practice Management Practice Management Preventive care Preventive care Primary Health Care Primary Health Care Problem Solving Problem Solving Process Process Protocols documentation Protocols documentation Provider Provider Randomized Randomized Recommendation Recommendation Research Priority Research Priority Resources Resources Risk Factors Risk Factors Rural Rural Safety Safety Self Care Self Efficacy Self Efficacy Self Management Self Management Subgroup Subgroup System System Technology Technology Testing Testing Text Text Text Messaging Text Messaging Time Time Treatment Protocols Treatment Protocols Veterans Veterans Weight maintenance regimen Weight maintenance regimen Woman Woman Women&apos s Health Women&apos s Health Work Work base base blood pressure regulation blood pressure regulation comorbidity comorbidity comparative effectiveness comparative effectiveness comparative effectiveness trial complex chronic conditions complex chronic conditions connected care coping coping cost cost design design diabetes control diabetes control diabetes distress diabetes self-management diabetic diabetic digital digital effectiveness evaluation effectiveness trial empowered empowered experience experience field study field study health care availability health care availability health equity health equity implementation strategy implementation strategy implementation trial implementation trial improved improved individual patient individual patient innovation innovation literacy literacy medical complication medical complication medication compliance medication compliance member member mortality mortality multidisciplinary multidisciplinary nutrition nutrition population health population health preference preference primary outcome primary outcome protocol development protocol development secondary outcome secondary outcome self-management program self-management program skills skills social health determinants social health determinants sociodemographics sociodemographics success success text messaging intervention treatment as usual treatment as usual treatment comparison treatment effect treatment effect virtual virtual virtual healthcare

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中文摘要

翻译

背景：2型糖尿病是一种常见的复杂疾病，有很高的合并症，影响了24%的退伍军人。

英文摘要

Background: Type 2 Diabetes, a common, complex condition with high comorbidity, affects 24% of Veterans. Vulnerable Veterans (e.g., African-American, rural, comorbid mental health diagnosis, low-income) are less likely to have controlled diabetes, and have higher mortality and morbidity compared to other Veterans. Significance/Impact: Health Care Informatics interventions to support chronic disease self-management through technology can improve access, health equity, and health outcomes for vulnerable Veterans. Customizable, interactive self-management support through Annie addresses the VA's priority of improving access, including via virtual modalities, and providing a tailored experience that incorporates Veteran needs and preferences (VA Strategic Imperative 2). Research priority areas of access to care, women's health, mental health, primary care practice, informatics, virtual care, health equity, and patient-centered care are all addressed. Innovation: By incorporating the needs and preferences of vulnerable Veterans with diabetes in a self- management texting intervention and testing its effectiveness against a more traditional education-only intervention, lessons learned can improve the development of text-based support for other complex chronic conditions. It can also improve future implementation of Annie-based self-management support throughout VA. Specific Aims: AIM 1: Refine and beta test components of an interactive, tailored self-management texting protocol (DD-TXT) using a participatory design process incorporating vulnerable Veterans' preferences, VA clinician input, and evidence on effective texting-enabled self-management programs. The DD-TXT protocol will consist of: Core Messaging: Customizable core modules on medication management, blood sugar and blood pressure monitoring, preventive care, problem solving, appointment reminders, administrative messages; and Optional Messaging: A library of patient-selected modules (e.g. nutrition, physical activity, weight management, emotional coping, goal setting) designed to motivate and educate. AIM 2: Conduct a randomized controlled comparative effectiveness trial with 400 Veterans whose diabetes was uncontrolled (defined as HbA1c over 8.0% for at least 50% of the most recent 6 months) in 2018 in Gainesville, FL or Chicago, IL. The primary aim will be to assess the comparative effectiveness of DD-TXT compared to DSE, a diabetes skills education-only texting protocol based on a skills workbook that is currently given to VA patients with diabetes. The primary outcome will be HbA1c percent time in control. Secondary outcomes include self-reported adherence to diabetes self-care recommendations (SCI-R), diabetes self- efficacy, diabetes distress, LDL, and blood pressure control. We hypothesize that DD-TXT will result in better proximal health outcomes and diabetes self-management behaviors vs an education-only protocol (DSE). AIM 3: Obtain information to guide future implementation of diabetes self-management support through texting by (a) gathering and analyzing qualitative feedback from patients engaged in the comparative effectiveness trial, overall and by subgroup (b) collecting qualitative feedback from providers and key stakeholders on the barriers/facilitators of future RCT evaluation and implementation of DD-TXT vs DSE, (c) conducting a cost- identification analysis and safety analysis to identify resources required for larger-scale implementation. Methodology: We will refine the DD-TXT protocol through a participatory design process, conduct a randomized controlled comparative effectiveness trial with 400 Veterans with uncontrolled diabetes, and collect qualitative feedback from patients, providers, and other stakeholders and conduct a cost-identification analysis to guide future implementation. Next Steps/Implementation: This project will inform future processes for incorporating Veteran input into Annie protocol development and lead to a future Type 2 hybrid implementation trial of DD-TXT or DSE (based on our findings) to determine best implementation strategies for Annie-based self-management support.

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