Patient-Centered Decision Support to Improve Diabetes Management in Pre-Teens and Adolescents with Type 1 Diabetes

改善1型糖尿病患者血糖控制的管理策略和伴随技术 糖尿病（T1 D）继续发展;但大多数青少年糖尿病患者的糖化血红蛋白 （HbA 1c）值高于推荐范围。此外，在提供护理方面也存在不公平现象， 提供者对指南的了解/遵守情况的差异，提供者访问的可变性，以及 社会经济不平等。美国糖尿病协会（ADA）2016年改善护理的策略 指出“以病人为中心，包括以病人为中心的沟通方式， 应使用”性别、年龄、偏好、评估识字和算术能力以及解决护理障碍“的方法。此外，本发明还 先进的技术，使及时的，基于证据的治疗决定，适合个别病人 偏好、疾病和合并症。不幸的是，这些类型的概括 目前在儿科糖尿病护理中不存在工具。为了弥补这一差距，我们建议研究一种干预措施， 这将为糖尿病提供者提供以患者为中心的自动化决策支持，最终目标是 改善健康成果。我们将使用由我们开发的CDSS实施ADA护理建议， 通过计算机自动化改善儿童健康（CHICA）系统。最伟大的 CHICA的优势包括能够实施权威机构的循证建议， 来源，如ADA，以一种易于融入常规护理的格式，并筛选和提醒提供者 关于以病人为中心的问题为了确保我们设计最有效的CDSS干预措施，我们将 与青少年，父母和其他利益相关者合作，以超越标准期望的方式， 参与这些研究。这种真正创新的方法将提供改进的基于技术的 糖尿病管理支持系统，沿着关注以患者为中心的目标， 糖尿病自我管理的干预措施。具体而言，本研究旨在：（1）利用以人为本的 设计方法，使利益相关者参与改进我们以前开发的以患者为中心的糖尿病 在CDSS内实施的管理计划;（2）扩展和修改CHICA，以提供患者- 为照顾T1 D青少年（>=12岁）的糖尿病提供者提供集中的自动决策支持， 纳入目标1的调查结果，并促进根据《反歧视法》的建议提供护理; 和（3）证明CHICA T1 D原型的可行性和有效性，以改善a）临床护理 措施（例如，HbA 1c），B）护理措施的过程（例如，提供者遵守护理标准），以及c） 以患者为中心的结果。在目标3期间，我们将进行三个利益相关者细化周期，以确保我们 我们设计了最佳的干预措施。研究结束时，最终的CHICA T1 D系统应 安全，可行的实施，有效，可接受的目标人群，并准备在更大的， 随机对照试验。

Management strategies and concomitant technologies for improving glycemic control in patients with type 1 diabetes (T1D) continue to evolve; yet the majority of adolescents with diabetes have glycosylated hemoglobin (HbA1c) values above the recommended range. Moreover, inequities in care delivery occur including differences in providers’ knowledge/adherence to guidelines, variability in access to providers, and socioeconomic inequities. The American Diabetes Association (ADA) Strategies for Improving Care in 2016 states that “patient-centeredness, including a patient-centered communication style that incorporates patient preferences, assesses literacy and numeracy, and addresses barriers to care should be used”. Further, advancing technology to enable timely, evidence-based treatment decisions tailored to individual patient preferences, prognoses, and comorbid conditions is recommended. Unfortunately, these types of generalizable tools currently do not exist in pediatric diabetes care. To address this gap, we propose to study an intervention that will provide patient-centered, automated decision support to diabetes providers with the ultimate goal of improving health outcomes. We will implement ADA recommendations of care using a CDSS developed by our research group – the Child Health Improvement through Computer Automation (CHICA) system. The greatest strengths of CHICA include its ability to implement evidence-based recommendations from authoritative sources, like the ADA, in a format that integrates easily into routine care, and to screen for and alert providers about patient-centered concerns. To ensure that we design the most effective CDSS intervention we will partner with adolescents, parents, and other stakeholders in a way that exceeds standard expectations for the engagement of these parties in research. This truly innovative approach will offer improved technology-based support systems for diabetes management along with attention to patient-centered goals using co-designed interventions for diabetes self-management. Specifically, the study aims are to: (1) Utilize a human-centered design approach to engage stakeholders in refinement of our previously developed patient-centered diabetes management plan for implementation within a CDSS; (2) Expand and modify CHICA to provide patient- centered, automated decision support to diabetes providers caring for youth (>=12 years of age) with T1D that incorporates the findings from Aim 1 and prompts the provision of care according to ADA recommendations; and (3) Demonstrate the feasibility and effectiveness of the CHICA T1D prototype, to improve a) clinical care measures (e.g., HbA1c), b) process of care measures (e.g., provider adherence to standards of care), and c) patient-centered outcomes. During Aim 3 we will conduct three cycles of stakeholder refinement to ensure we that we have designed the most optimal intervention. By study end, the finalized CHICA T1D system should be safe, feasible to implement, effective, acceptable in our target population, and ready to test in a larger, randomized controlled trial.