Comparative Effectiveness Evaluation of a Diabetes Case Management Intervention in AI/AN Communities

项目摘要 该项目的长期目标是解决糖尿病及其并发症的显著差异。 美国印第安人和阿拉斯加原住民（AI/AN）面临的复杂情况。为了实现这一目标， 糖尿病管理和降低心血管疾病（CVD）风险的有效策略 迫切需要降低AI/AN的发病率和死亡率， 整体健康和生活质量。案件管理是提高 传统的卫生保健服务，为人们在高风险的不良后果。它很棒 承诺减轻AI/AN和其他少数群体的沉重糖尿病和CVD负担 人口数量。然而，如何有效地实施这种干预在现实世界的设置， 大而多样的社区仍不清楚。拟议的研究将比较评估 糖尿病特殊计划健康心脏示范项目的有效性， 印度人（SDPI-HH），一项采用强化病例管理的心血管风险降低项目 (ICM)approach. ICM方法的有效性已经得到充分证实，因此，SDPI-HH 是一个没有对照组的转化项目。的有效性 干预已被评估为一个前和后测试的设计，虽然必要和 信息，仅提供了该计划管理糖尿病的能力的部分评估， 其并发症。在本提案中，SDPI-HH数据将与2个目标来源相结合， 印度卫生服务（IHS）糖尿病护理和结局审计数据以及来自 前瞻性试验，一项比较强化生活方式干预影响的随机试验 (ILI)和糖尿病支持教育（DSE）对心血管结局的影响， 糖尿病本项目的具体目标是：（1）利用IHS审计数据，扩大 通过比较糖尿病护理质量的趋势，了解SDPI-HH的有效性 从1998年到2013年，HH和非HH设施之间的差异;（2）使用Look AHEAD试验的数据 并采用倾向得分匹配方法，比较SDPI的有效性 在糖尿病患者中采用Look AHEAD ILI和DSE方法进行ICM干预。 我们提出的分析策略有可能减少或消除潜在的偏见 在一个手臂前和后测试设计，往往是唯一的选择，在社区为基础的 转化干预举措。研究结果不仅将为我们提供重要的指导， 当我们寻求降低患有糖尿病的人工智能/人工神经网络患者的心血管疾病风险时，他们也将展示如何 其中公共卫生监测和/或历史控制数据可有助于 评估类似的社区干预措施。

PROJECT SUMMARY The long-term goal of this project is to address the striking disparities in diabetes and its complications that American Indians and Alaska Natives (AI/ANs) face. To achieve this goal, effective strategies for diabetes management and cardiovascular disease (CVD) risk reduction are urgently needed to decrease morbidity and mortality among AI/ANs and to improve their overall health and quality of life. Case management is an important approach to enhance traditional health care delivery for people at elevated risk of adverse outcomes. It holds great promise for alleviating the heavy diabetes and CVD burden among AI/ANs and other minority populations. However, how to effectively implement this intervention in the real-world settings of large and diverse communities remains unclear. The proposed study will comparatively evaluate the effectiveness of the Healthy Heart demonstration project of Special Diabetes Program for Indians (SDPI-HH), a cardiovascular risk reduction project using an intensive case management (ICM) approach. The efficacy of the ICM approach was already well established, thus, SDPI-HH was designed as a translational project without a control group. The effectiveness of the intervention has been evaluated as a pre- and post-test design which, albeit necessary and informative, provides only a partial assessment of the program's ability to manage diabetes and its complications. In this proposal, the SDPI-HH data will be combined with 2 targeted sources, the Indian Health Service (IHS) Diabetes Care and Outcomes Audit data and the data form the Look AHEAD trial, a randomized trial comparing the impacts of an intensive lifestyle intervention (ILI) and diabetes support education (DSE) on cardiovascular outcomes among individuals with diabetes. The specific aims of this project are: (1) Using IHS Audit data, to broaden the understanding of SDPI-HH effectiveness by comparing the trends of diabetes quality of care between HH and non-HH facilities from 1998 to 2013; (2) Using data from the Look AHEAD trial and employing a propensity score matching approach, to compare the effectiveness of SDPI ICM intervention with the Look AHEAD ILI and DSE approaches among patients with diabetes. Our proposed analytic strategy has the potential to reduce or eliminate potential biases present in one arm pre- and post-test design that are frequently the only option in community-based translational intervention initiatives. Not only will the resulting findings provide critical guidance as we seek to reduce CVD risks among AI/ANs with diabetes, they will also demonstrate ways in which publicly available public health surveillance and/or historical control data may assist in evaluating similar community-based interventions.