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

1A.摘要 我是德克萨斯州休斯敦贝勒医学院的内科医生。我的职业目标是成为一名 独立的临床研究员和专家，致力于改善资源匮乏的个人的糖尿病护理 增加社区卫生工作者(CHW)的支持。以社区为基础接受培训和指导 参与性研究(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)是我实现以下目标的必要条件 作为一名调查员的独立性。为了实现这些目标，我组织了一份详细的职业发展计划 多样化的课程和包括John Foreyt博士(主要导师、主任)在内的科学指导团队 DeBakey心脏中心的行为医学研究中心进行了NIDDK支持的RCT 糖尿病)和3位共同导师，Aanand Nak医学博士(实施研究领域的专家)，David 海曼，医学博士，公共卫生硕士(CBPR的内科医生/研究员，在低收入环境下进行随机对照试验)，以及苏珊 Samson，医学博士，博士(以病人为导向的糖尿病研究的内分泌学家)。另外，查尔斯 Minard(贝勒生物统计学家研究员)，Sanjeev Arora，MD(International 公认的组织[项目回声]，使用模式[即，CHWS、远程医疗]来增加对 CARE)和德克萨斯大学CHW培训项目将是我整个培训过程中的合作者。 在美国，被诊断为糖尿病的拉美裔美国人的数量正在上升，不成比例地更高 患病率和并发症发生率高于其他种族。CHW是一种历史悠久、文化敏感的 弥合糖尿病患者在护理方面的差距。然而，CHW通常没有得到支持，放置在 处于不合格护理或伤害风险中的患者。远程医疗是一个用来描述一系列技术的术语 通过与患者或医疗服务团队成员的沟通来支持医疗服务的提供。 虽然远程医疗已经在糖尿病项目中实施了很多年，但数据还很少。 展示远程医疗在CHW培训和支持中的使用。在一项初步研究中，我发起了一种以CHW为主导的糖尿病 为资源贫乏的拉美裔美国人提供身临其境的社区卫生服务支持的计划。这项拟议的研究利用了研究结果 来自评估远程医疗支持对领导糖尿病项目的CHW的使用的试点研究 资源匮乏的拉美裔美国人。具体地说，我将对176名被诊断为 2型糖尿病。这项研究将比较临床结果(特定目标1)和治疗满意度 (具体目标2)接受CHW主导的包含远程医疗的糖尿病教育计划的受试者 支持(T-CDEP)(干预，n=88)接受常规护理的受试者(等待名单对照，n=88)。此外，我 将分析CHWS远程医疗使用的可接受性(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奖励期结束前提交的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.