Medical Assistant Health Coaching for Diabetes in Diverse Primary Care Settings

不同初级保健机构中糖尿病医疗助理健康指导

• 批准号: 9769704
• 负责人: Linda C Gallo
• 金额: $ 50.56万
• 依托单位: SCRIPPS HEALTH
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-01 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9769704
• 关键词: Address; Adopted; Adoption; Adult; Affect; Behavior assessment; Behavioral; Blood Pressure; Caring; Caucasians; Chronic Care; Clinic; Clinical; Cluster randomized trial; Collaborations; Communication; Communities; Complex; Cost efficiency; County; Diabetes Mellitus; Education; Educational Intervention; Effectiveness; Electronic Health Record; Elements; Enrollment; Ensure; Environment; Evaluation; Glycosylated Hemoglobin; Glycosylated hemoglobin A; Goals; Health; Health Care Costs; Health behavior; Health system; Healthcare; Healthcare Systems; Home environment; Human Resources; Income; Individual; Insurance; Intervention; Intervention Studies; LDL Cholesterol Lipoproteins; Lead; Licensing; Lipids; Low income; Low-Density Lipoproteins; Maintenance; Medical; Medical center; Methods; Modeling; Morbidity - disease rate; Neighborhoods; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Participant; Patients; Pharmaceutical Preparations; Population; Population Heterogeneity; Prevalence; Primary Health Care; Privatization; Problem Solving; Process; Program Evaluation; Provider; Public Health; Quality of life; Randomized; Recommendation; Reporting; Research; Sampling; Self Care; Self Management; System; Taxes; Techniques; Telephone; Testing; Time; Training; Training Support; Underserved Population; Uninsured; Visit; Work; aged; base; cardiometabolism; care providers; chronic care model; compare effectiveness; cost effectiveness; ethnic minority population; evidence base; experience; flexibility; follow-up; health care settings; health information technology; healthcare community; improved; improved outcome; innovation; mortality; motivational enhancement therapy; multidisciplinary; patient oriented; pragmatic trial; primary care setting; program costs; programs; psychosocial; public health relevance; racial and ethnic; satisfaction; socioeconomics; standard of care; success; treatment as usual; trend

 DESCRIPTION (provided by applicant): Diabetes affects nearly 26 million individuals in the U.S, and if current trends continue, 1 of 3 adults will have diabetes by 2050. Diabetes self-management education and support (DSME) is a cornerstone of effective care that improves clinical control and health outcomes; however, DSME participation is low, particularly among underserved populations, and ongoing support is often needed to maintain DSME gains. The complex needs of individuals with diabetes cannot be adequately addressed in the typical 15-minute primary care visit. By adopting a "team-based" approach that is informed by the Chronic Care Model, other primary care personnel [e.g., medical assistants (MAs)] can be trained as health coaches to work in tandem with primary care providers to deliver self-management support. Although research is limited, several studies have shown that MA-provided self-management support improves outcomes in diabetes. The proposed cluster-randomized, controlled, pragmatic trial will compare the effectiveness of MA Health Coaching (MAC) with usual care (UC) in improving diabetes clinical control among 600 individuals, aged 18 and older, with type 2 diabetes mellitus (T2DM), and glycosylated hemoglobin (HbA1c) = 8.0%, and/or low-density lipoprotein cholesterol (LDL-C) = 100 mg/dL, and/or systolic blood pressure (SBP) = 140 within the last 60 days The study will take place within primary care clinics of two health systems that serve large, ethnically/racially, and socioeconomically diverse populations in San Diego County: Neighborhood Healthcare (a FQHC) and Scripps (a large, non-profit, private insurance-based health system). One clinic within each system will be randomly allocated to MAC, and one to UC. In addition to usual care, MAC clinics patients will receive brief, targeted self-management support from the MA Health Coach. The MA will be afforded flexibility in their implementation of MAC elements (i.e., health behavior assessment, medication reconciliation, motivational interviewing, agenda- and goal-setting, problem- solving, "closing the loop" techniques to ensure understanding of recommendations), and will tailor their use of these components to patient-specific needs and priorities. As needed, MAs will coordinate brief phone follow- up to review progress and problem-solve around any barriers. Electronic health records will be used to identify eligible patients and to examine change in diabetes clinical outcomes (HbA1c, LDL, SBP) over 12 months. Changes in patient-reported behavioral (diabetes self-care) and psychosocial (quality of life, patient activation) outcomes will be evaluated by phone assessment in a subset (N=300) of MAC and UC participants at baseline, and months 6 and 12. An evaluation guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and an examination of program costs will assess potential for sustainability and scalability. The MAC program offers a potential solution to the burgeoning primary care demand-capacity imbalance that can be applied in diverse healthcare settings to better address the needs of the growing number of individuals with T2DM.



项目成果

Does Diabetes Distress Influence Clinical Response to an mHealth Diabetes Self-Management Education and Support Intervention?

糖尿病的困扰会影响对MHealth糖尿病自我管理教育和支持干预的临床反应吗？

• DOI: 10.1177/0145721720913276
• 发表时间: 2020-06
• 期刊: The Diabetes educator
• 作者: Clark TL;Gallo L;Euyoque JA;Philis-Tsimikas A;Fortmann A
• 通讯作者: Fortmann A

Innovative Diabetes Interventions in the U.S. Hispanic Population.

• DOI: 10.2337/ds19-0006
• 发表时间: 2019-11-01
• 期刊: Diabetes spectrum : a publication of the American Diabetes Association
• 作者: Fortmann, Addie L;Savin, Kimberly L;Gallo, Linda C
• 通讯作者: Gallo, Linda C