Integrating Community Health Workers into Primary Care Teams to improve Diabetes Prevention in Underserved Communities

将社区卫生工作者纳入初级保健团队，以改善服务不足社区的糖尿病预防

• 批准号: 9750693
• 负责人: NADIA S ISLAM
• 金额: $ 68.67万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-07-01 至 2021-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9750693
• 关键词: Address; Adult; Affect; American; Asses; Behavioral; Body Weight decreased; Cardiovascular Diseases; Caring; Cause of Death; Child; Chronic; Chronic Disease; Cities; Clinic Visits; Clinical; Cluster randomized trial; Communities; Community Health Aides; Competence; Cost Savings; Counseling; Diabetes Mellitus; Diabetes prevention; Diet; Education; Elements; Exercise; General Population; Goals; Health; Health Care Costs; Health behavior; Health system; Healthcare Systems; Heart Diseases; Home environment; Hospitals; Human Resources; Incidence; Institution; Intervention; Life Style; Measures; Medical center; Modeling; Monitor; Morbidity - disease rate; Motivation; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Outpatients; Patient Care; Patient-Centered Care; Patients; Physical activity; Population; Prediabetes syndrome; Prevention; Prevention strategy; Preventive service; Primary Health Care; Quality of life; Risk; Social support; Stroke; Structure; Target Populations; Techniques; Testing; Time; Training; Translating; Underserved Population; Veterans; Visit; Vulnerable Populations; Work; base; behavior change; blood pressure regulation; care systems; cost; design; diabetes risk; diabetic patient; experience; follow-up; healthy lifestyle; high risk; improved; motivational enhancement therapy; outreach; patient oriented; patient population; peer; peer coaching; prevent; programs; randomized trial; recruit; safety net; skills; tool

Abstract Type 2 Diabetes Mellitus (DM) is a preventable chronic disease that affects 9.3% of US adults and children. It is estimated that 86 million American adults are prediabetic (37%), and thus at risk of DM and cardiovascular disease. DM is a leading cause of death, one of the major causes of heart disease and stroke, and severely threatens quality of life. DM more than doubles the health care costs compared to the general population. Safety-net institutions like Bellevue Hospital Center (BH) and the VA NY Harbor Healthcare System (VA) care for populations with a disproportionate burden of DM and DM risk. Nearly 25% of the 8.7 million US veterans have DM and the rate among Bellevue’s 30,000 primary care adult patients is more than 15%. Despite the potential for reduced morbidity and cost-savings, primary care systems must overcome several barriers to systematically deliver these proven, preventive strategies to patients at highest risk of DM. Employing community health worker (CHW) coaches to conduct behavioral counseling, follow-up referral to programs, and education is a promising approach that could extend the capacity of health systems to better prevent and manage chronic conditions. Despite the potential for peer-led intervention to enhance DM prevention efforts within the patient-centered medical home (PCMH) model, there is need for high quality, randomized trials to asses specific models for CHW support; to aid with implementation of such model, including identification of effective strategies for recruitment, training, monitoring and retention of lay personnel; and to successfully integrate these personnel within the PCMH. The goal of this proposal study is to develop and test a model of CHW health coaching, designed to prevent the onset of Type 2 DM in a large population of underserved patients at risk. CHWs will be recruited from the target populations and trained in core competencies to serve as peer health coaches. Our central premise is that CHWs are uniquely suited to engage fellow patients by encouraging lifestyle change through shared experiences and social support to extend the reach of primary care (PC) beyond the clinic visit. This study will test a scalable model of peer health coaching to address the millions of patients at risk for DM, using low cost, culturally congruent personnel to promote prevention of DM in PCMH practice.

摘要 2型糖尿病(DM)是一种可预防的慢性疾病，影响着9.3%的美国成年人和儿童。它是 据估计，8600万美国成年人患有糖尿病前期(37%)，因此有患糖尿病和心血管疾病的风险 疾病。糖尿病是主要的死亡原因，是心脏病和中风的主要原因之一，严重 威胁到生活质量。与普通人群相比，糖尿病患者的医疗保健费用增加了一倍以上。 贝尔维尤医院中心(BH)和弗吉尼亚州纽约港医疗保健系统(VA)等安全网机构 适用于糖尿病和糖尿病风险负担不成比例的人群。在870万美国退伍军人中，近25% 在贝尔维尤的30,000名初级保健成人患者中，糖尿病的发病率超过15%。 尽管有可能降低发病率和节约成本，但初级保健系统必须克服 系统地向糖尿病风险最高的患者提供这些经过验证的预防策略存在障碍。 聘请社区卫生工作者(CHW)教练进行行为咨询、后续转介 方案和教育是一种很有希望的方法，可以扩大卫生系统的能力，以更好地 预防和管理慢性病。尽管同龄人主导的干预有可能促进糖尿病 在以患者为中心的医疗之家(PCMH)模式下的预防工作中，需要高质量、 评估CHW支持的特定模型的随机试验；为了帮助这种模型的实施， 包括确定招聘、培训、监测和保留业馀人员的有效战略 并成功地将这些人员整合到PCMH。 这项提案研究的目标是开发和测试CHW健康指导模式，旨在预防 在大量未得到充分服务的高危患者中，2型糖尿病的发病。卫生福利署将会从 以目标人群为目标，并接受核心能力培训，担任同行健康教练。我们的中心前提是 CHW特别适合通过共享的方式来鼓励改变生活方式，从而吸引其他患者 经验和社会支持，将初级保健(PC)的覆盖范围扩大到诊所以外。这项研究将 测试可扩展的同伴健康指导模式，以解决数百万面临糖尿病风险的患者的问题， 文化契合的人员，在PCMH实践中促进糖尿病的预防。