Clinic to Community Connections: Enhancing Prenatal to Postpartum Care Transitions to Prevent Type 2 Diabetes in Low Income Women with Gestational Diabetes

项目概要/摘要 2型糖尿病是一个日益增长的公共卫生挑战，妊娠糖尿病预示着这种可预防的慢性 早年患病。一半的妊娠期糖尿病妇女会发展为2型糖尿病 没有干预。有明确的机会调解期间和怀孕后，以防止2型 糖尿病;然而，很难在低资源环境和传统环境中实施这些干预措施， 医疗模式。该指导性患者导向研究职业发展奖的目的是 授权候选人开发一个研究计划，使用创新的方法来提供护理， 最大限度地预防弱势群体的糖尿病。为了实现这一目标， 建议提供资金支持：1）社区参与研究、干预方法的额外培训 为孕妇和产后妇女提供培训，为健康知识水平低的妇女提供专门的教育材料， 实施科学、务实的试验设计; 2）以患者为导向，保障时间进行有计划的试验 研究;以及3）收集和公布初步数据，以促进研究的后续步骤 程序.该奖项中的研究计划得到了职业发展计划和跨学科的支持 导师、顾问和合作者团队。拟议的工作旨在1）开发和完善糖尿病 低收入妊娠期妇女自我管理教育和医学营养治疗课程 糖尿病，可以提供由诊所工作人员和社区卫生工作者;和2）进行试点试验， 课程评估范围，初步有效性，采用，实施保真度和维护。的 这项研究的预期成果是高质量的试点数据，这些数据将为R 01的应用提供基础 进行更大规模的实用随机对照试验，以评估有效性、成本效益和 干预的可持续性。我们假设，一个社区参与的干预提供了 社区卫生工作者和诊所工作人员通过产前到产后的过渡护理将减少 糖尿病相关的痛苦，增加糖尿病知识和自我效能，并改善糖尿病的态度， 对妇女患2型糖尿病的风险认识，最终提高产后 筛查和后续护理。如果这是真的，这种护理模式可能会对护理服务产生重大的积极影响。 为资源有限环境中的人口提供服务。本建议书所述的培训和研究活动 补充候选人在临床内分泌学和人口健康方面的背景，并将使她能够 为医疗保健服务体系的变革做出重大贡献。最终，这项工作将带来新的 改善高风险人群糖尿病预防和护理的护理过渡和护理协调的模式 人口。

Project Summary/Abstract Type 2 diabetes is a growing public health challenge and gestational diabetes predicts this preventable chronic disease at an early age. Half of all women with gestational diabetes will go on to develop type 2 diabetes without intervention. There are clear opportunities to intercede during and after pregnancy to prevent type 2 diabetes; however, it is difficult to operationalize these interventions in low resource settings and traditional healthcare models. The purpose of this Mentored Patient-Oriented Research Career Development Award is to empower the candidate to develop a research program that uses innovative approaches to care delivery to maximize diabetes prevention in vulnerable populations. To achieve this goal, mentorship and training in this award are proposed to support: 1) additional training in methods of community-engaged research, intervention development for pregnant and postpartum women, tailoring education materials for low health literacy, implementation science, and pragmatic trial design; 2) protected time to conduct the planned patient-oriented research; and 3) the collection and publication of preliminary data to facilitate the next steps in the research program. The research plan in this award is supported by the career development plan and interdisciplinary team of mentors, advisors and collaborators. The proposed work seeks to 1) develop and refine a diabetes self-management education and medical nutrition therapy curriculum for low-income women with gestational diabetes that can be delivered by clinic staff and community health workers; and 2) conduct a pilot trial of this curriculum to assess reach, preliminary effectiveness, adoption, implementation fidelity, and maintenance. The anticipated outcome of this study is high-quality pilot data that will provide the foundation for an R01 application to conduct a larger pragmatic randomized controlled trial to assess effectiveness, cost-effectiveness, and sustainability of the intervention. We hypothesize that a community-engaged intervention delivered by community health workers and clinic staff through the prenatal to postpartum transition of care will decrease diabetes-related distress, increase diabetes knowledge and self-efficacy, and improve diabetes attitudes and risk perception for the development of type 2 diabetes among women, ultimately enhancing post-partum screening and follow-up care. If true, this care model could have a significant positive impact on care delivery for populations in resource-limited settings. The training and research activities delineated in this proposal complement the candidate’s background in clinical endocrinology and population health and will position her to make substantial contributions to health care delivery systems change. Ultimately, this work will lead to new models to improve care transitions and care coordination for diabetes prevention and care in our highest risk populations.