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 独立临床研究者和专家，致力于改善资源匮乏人群的糖尿病护理 增加社区卫生工作者 (CHW) 支持。接受社区培训和指导 参与式研究 (CBPR)（学习目标 [LG]1）、实施研究 (LG2) 和研究设计 和实施随机对照试验（RCT）（LG3）是我实现目标的必要条件 作为调查员的独立性。为了实现这些目标，我与 多样化的课程和科学指导团队，其中包括 John Foreyt 博士（主要导师、主任） DeBakey 心脏中心行为医学研究中心负责开展 NIDDK 支持的随机对照试验 糖尿病领域的专家）和 3 位共同导师，医学博士 Aanand Naik（实施研究领域的专家）、David Hyman，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随机对照试验）和 Susan Samson，医学博士、哲学博士（以患者为导向的糖尿病研究领域的内分泌学家）。此外，查尔斯 Minard（贝勒大学生物统计学家研究员）、Sanjeev Arora，医学博士（国际组织的创始人/主任） 公认的组织 [ECHO 项目]，使用各种方式 [即社区卫生工作者、远程医疗] 来增加获得医疗服务的机会 护理），德克萨斯大学 CHW 培训计划将是我整个培训过程中的合作者。 在美国，被诊断患有糖尿病的西班牙裔人数正在不断增加，其中不成比例地增加了 患病率和并发症发生率高于其他种族。社区卫生工作者是一个成熟且具有文化敏感性的组织 旨在弥补糖尿病患者护理方面的差距。然而，社区卫生工作者常常得不到支持， 面临护理不合格或伤害风险的患者。远程医疗是一个用于描述一系列技术的术语 通过与患者或医疗保健服务团队成员的沟通来支持医疗保健服务。 尽管远程医疗已在糖尿病项目中实施多年，但数据匮乏 显示远程医疗在社区卫生工作者培训和支持中的应用。在一项试点研究中，我发起了一项由社区卫生工作者主导的糖尿病研究 为资源匮乏的西班牙裔提供计划，为社区卫生工作者提供面对面的支持。拟议的研究利用了研究结果 来自试点研究，旨在评估远程医疗支持对领导糖尿病项目的社区卫生工作者的使用情况 资源匮乏的西班牙裔。具体来说，我将分 4 波队列对 176 名被诊断患有以下疾病的成年人进行随机对照试验 2型糖尿病。该研究将比较临床结果（具体目标 1）和治疗满意度 （具体目标 2）接受社区卫生工作者主导的包含远程医疗的糖尿病教育计划的受试者 向接受常规护理的受试者（候补名单对照，n=88）提供支持（T-CDEP）（干预，n=88）。另外，我 将分析社区卫生工作者使用远程医疗的可接受性（探索性目标 1）。拟议的研究 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， 农村），用于在 5 年 K 奖期结束之前提交 R01。

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.