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相关技术 糖尿病(T1D)继续发展；但大多数青少年糖尿病患者都有糖化血红蛋白 (HbA1c)值高于推荐范围。此外，在提供护理方面出现了不平等现象，包括 提供者的知识/遵守准则的差异，接触提供者的可变性，以及 社会经济不平等。美国糖尿病协会(ADA)2016年改善护理的战略 声明“以病人为中心，包括以病人为中心的沟通方式，其中包括病人 应使用偏好、评估识字和计算能力以及解决护理障碍的方法“。此外， 先进的技术，为患者量身定做及时、循证的治疗决策 推荐患者的喜好、预后和合并症。不幸的是，这些类型的可概括 目前在儿科糖尿病护理中还不存在工具。为了解决这一差距，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 改善健康状况。我们将使用我们开发的CDSS来实施ADA的护理建议 课题组-通过计算机自动化(CHICA)系统改善儿童健康。最伟大的 CHICA的优势包括执行权威机构基于证据的建议的能力 消息来源，如ADA，以一种易于集成到常规护理中的格式，用于筛选和提醒提供者 关于以病人为中心的问题。为了确保我们设计出最有效的CDSS干预措施，我们将 以超出标准期望的方式与青少年、家长和其他利益相关者合作 让这些人参与研究。这一真正创新的方法将提供改进的基于技术的 支持糖尿病管理系统，同时关注以患者为中心的目标 糖尿病自我管理的干预措施。具体来说，本研究的目的是：(1)利用以人为本的 设计方法让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 CDSS内实施的管理计划；(2)扩展和修改CHICA，为患者提供- 为照顾患有T1D的青少年(=12岁)的糖尿病提供者提供集中、自动化的决策支持 纳入目标1的调查结果，并促使根据反兴奋剂机构的建议提供护理； 以及(3)论证CHICA T1D原型的可行性和有效性，以改善a)临床护理 措施(例如，HbA1c)，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，我们将进行三个周期的利益相关者改进，以确保我们 我们设计了最理想的干预措施。到研究结束时，最终确定的CHICA T1D系统应该是 安全、可行、有效、在我们的目标人群中可接受，并准备在更大范围内进行测试， 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.