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

项目总结 该项目的长期目标是解决糖尿病和糖尿病之间的显著差异。 美洲印第安人和阿拉斯加原住民(AI/ANS)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 迫切需要减少人工智能/ANS的发病率和死亡率，并改善其 总体健康和生活质量。病案管理是加强 为不良后果风险较高的人提供传统的保健服务。它的保持性很好 承诺减轻AI/ANS和其他少数群体沉重的糖尿病和心血管疾病负担 人口。然而，如何在现实世界中有效地实施这种干预 大而多样的社区仍然不清楚。建议的研究将比较评估 糖尿病专项计划健康心脏示范项目实施效果评价 印度人(SDPI-HH)，一个使用密集病例管理的降低心血管风险的项目 (ICM)方法。综合管理办法的效力已经得到了很好的确立，因此，SDPI-HH 被设计为一个没有控制组的翻译项目。这项计划的成效 干预措施已被评估为测试前和测试后的设计，尽管有必要和 信息丰富，仅提供了对该计划管理糖尿病和 它的复杂性。在本提案中，SDPI-HH数据将与2个目标源相结合， 印度卫生服务(IHS)糖尿病护理和结果审计数据和 前瞻试验，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)对患有以下疾病的个人的心血管结局 糖尿病。本项目的具体目标是：(1)利用IHS审计数据，扩大 比较糖尿病护理质量变化趋势了解SDPI-HH的有效性 1998至2013年HH和非HH设施之间的关系；(2)使用前瞻性试验的数据 并采用倾向得分匹配的方法比较SDPI的有效性 在糖尿病患者中采用前瞻性ILI和DSE方法的ICM干预。 我们建议的分析策略有可能减少或消除目前存在的潜在偏见 在一个手臂中，测试前和测试后设计通常是以社区为基础的 转化性干预举措。由此产生的发现不仅将提供批判性的指导 当我们寻求降低患有糖尿病的人工智能/AN的心血管疾病风险时，他们也将展示方法 其中公开的公共卫生监测和/或历史控制数据可以帮助 评估类似的基于社区的干预措施。

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.