Technology to improve the health of resource-poor Hispanics with diabetes

1A.摘要 我是德克萨斯州休斯顿贝勒医学院的内科医生。我的职业目标是成为一名 独立的临床研究者和专家，通过以下方式改善资源匮乏个体的糖尿病护理 加强社区卫生工作者（CHW）的支持。在社区接受培训和指导 实验研究（CBPR）（学习目标[LG] 1），实施研究（LG 2）和研究设计 随机对照试验（RCT）（LG 3）的实施对我来说是必要的， 作为一名独立的调查员。为了实现这些目标，我组织了一个详细的职业发展计划， 多样化的课程和科学指导团队，包括约翰·福雷，博士（主要导师，主任 DeBakey心脏中心的行为医学研究中心进行NIDDK支持的RCT 糖尿病）和3名共同导师，Aanand Naik，MD（实施研究领域的专家），大卫 海曼，医学博士，公共卫生硕士（CBPR的内科医生/研究员，在低收入环境中进行RCT）和苏珊 Samson，MD，PhD（一位以患者为导向的糖尿病研究成果的内分泌学家）。此外，查尔斯 Minard（Baylor的生物统计学家研究员），Sanjeev Arora，MD（国际 认可的组织[Project ECHO]使用模式[即，CHW，远程医疗]以增加获得服务的机会 护理），和得克萨斯大学CHW培训计划将在我的整个培训合作者。 在美国，被诊断患有糖尿病的西班牙裔人数正在上升， 患病率和并发症发生率高于其他种族。CHW是一个成熟的和文化敏感的 这意味着弥合糖尿病患者护理方面的差距。然而，CHW通常不受支持， 患者面临不合格护理或伤害的风险。远程医疗是一个用来描述一系列技术的术语， 通过与患者或医疗保健提供团队成员的通信来支持医疗保健提供。 虽然远程医疗已经应用于糖尿病项目多年，但数据缺乏 展示了远程医疗在CHW培训和支持中的应用。在一项试点研究中，我发起了一项CHW领导的糖尿病 为资源贫乏的西班牙裔人提供的计划，并为CHW提供亲自支持。拟议的研究利用调查结果 从试点研究，以评估使用远程医疗支持的CHW谁领导糖尿病项目， 资源贫乏的西班牙裔具体来说，我将在4个队列中进行一项随机对照试验，其中176名成年人被诊断为 2型糖尿病本研究将比较临床结局（具体目标1）和治疗满意度 （具体目标2）接受CHW领导的糖尿病教育计划（包括远程医疗）的受试者 支持（T-CDEP）（干预，n=88）接受常规治疗的受试者（等待列表控制，n=88）。另外我 将分析远程医疗用于CHW的可接受性（探索性目标1）。拟议研究 作为扩展到其他种族和环境的多中心纵向研究的基础（例如， R 01提交的5年K奖期结束之前。

1A. ABSTRACT I am an internist at Baylor College of Medicine in Houston, Texas. My career goal is to become an independent clinical investigator and expert in improving diabetes care for resource-poor individuals by increasing Community Health Worker (CHW) support. Receiving training and mentorship in Community-Based Participatory Research (CBPR) (Learning goal [LG] 1), Implementation Research (LG2), and study design and implementation of randomized controlled trials (RCTs) (LG3) are necessities for me to achieve independence as an investigator. To achieve these goals, I organized a detailed career development plan with diverse coursework and a scientific mentoring team that includes John Foreyt, PhD (primary mentor, Director of the DeBakey Heart Center's Behavioral Medicine Research Center which conducts NIDDK-supported RCTs in diabetes) and 3 co-mentors, Aanand Naik, MD (an expert in the field of Implementation Research), David Hyman, MD, MPH (an internist/researcher in CBPR who conducts RCTs in low-income settings), and Susan Samson, MD, PhD (an endocrinologist in patient-oriented outcomes diabetes research). In addition, Charles Minard (a biostatistician researcher at Baylor), Sanjeev Arora, MD (Founder/Director of an internationally recognized organization [Project ECHO] that uses modalities [i.e., CHWs, telemedicine] to increase access to care), and the University of Texas CHW training program will be collaborators throughout my training. The number of Hispanics diagnosed with diabetes is escalating in the US with disproportionately higher prevalence and complication rates than other ethnicities. CHWs are a well-established and culturally sensitive means to bridge gaps in care to individuals with diabetes. However CHWs are often left unsupported, placing patients at risk of substandard care or harm. Telemedicine is a term used to describe a range of technologies to support healthcare delivery via communication with the patient or a member of the healthcare delivery team. Though telemedicine has been implemented into diabetes programs for many years, there is a paucity of data showing the use of telemedicine for CHW training and support. In a pilot study, I initiated a CHW-led diabetes program for resource-poor Hispanics with in-person support for CHWs. The proposed research utilizes findings from the pilot study to evaluate the use of telemedicine support for CHWs who lead diabetes programs for resource-poor Hispanics. Specifically, I will conduct a RCT in 4 cohort waves with 176 adults diagnosed with type 2 diabetes. The study will compare clinical outcomes (Specific Aim 1) and treatment satisfaction (Specific Aim 2) of subjects who receive a CHW-led diabetes education program incorporating telemedicine support (T-CDEP) (intervention, n=88) to subjects who receive usual care (wait list control, n=88). In addition, I will analyze the acceptability of telemedicine use for CHWs (Exploratory Aim 1). The proposed research serves as the foundation for a multicenter, longitudinal study expanded to other ethnicities and settings (e.g., rural) for R01 submission prior to the completion of the 5-year K Award period.