Tailored, eHealth-based Management for Persistent Poorly-Controlled Diabetes

针对持续性控制不佳的糖尿病的定制化、基于电子健康的管理

• 批准号: 9981441
• 负责人: Matthew J. Crowley
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9981441
• 关键词: Address; Behavioral; Blindness; Caring; Clinic; Clinical; Clinical Data; Clinical Trials; Comorbidity; Competence; Complications of Diabetes Mellitus; Cost of Illness; Data; Databases; Diabetes Mellitus; Education; Endocrinology; Ensure; Funding; Glycosylated hemoglobin A; Goals; Health Services; Health Services Research; Health Services for the Aged; Home environment; Intervention; Interview; K-Series Research Career Programs; Kidney Failure; Knowledge; Maintenance; Medical; Medication Management; Mental disorders; Mentors; Mentorship; Methodology; Modeling; Morbidity - disease rate; Multicenter Trials; Myocardial Infarction; Patients; Population; Primary Health Care; Provider; Psychosocial Factor; Public Health; Qualitative Methods; Qualitative Research; Refractory; Research; Research Personnel; Risk; Risk Factors; Socioeconomic Factors; Stroke; Supervision; System; Technology; Testing; Theoretical model; Training; United States; Veterans; Work; base; care delivery; cohort; cost; design; diabetes control; diabetes management; diabetes risk; eHealth; glycemic control; health belief; high risk; high risk population; implementation research; improved; innovation; limb amputation; mortality; novel; novel strategies; patient oriented; pilot trial; preference; programs; prospective; skills; social; socioeconomics; standard care; telehealth; theories; therapy design; therapy development

DESCRIPTION (provided by applicant): This career development award (CDA) proposal seeks to improve management of Veterans with persistent poorly-controlled diabetes mellitus (PPDM). Diabetes is the leading cause of kidney failure, limb amputation, and blindness among Veterans, and is a major risk factor for heart attack and stroke. Diabetes is also associated with a two-fold increase in mortality among Veterans, and is among the most costly diseases to VA. Because diabetes complications and costs rise exponentially as hemoglobin A1c (HbA1c) increases, maintenance of an HbA1c >9% represents a risk factor that can be modified with improved glycemic control. For this reason, Veterans with PPDM (defined as having HbA1c continuously >9% for >1 year despite VA Primary Care or Endocrinology management), are likely the highest-risk diabetes patients within VA. Given their disproportionate contribution to diabetes complications and costs, novel approaches to managing Veterans with PPDM are urgently needed. However, two evidence gaps currently hinder the development of interventions targeting these Veterans: 1) the optimal diabetes management content to address factors underlying PPDM in Veterans is unclear; and 2) the ideal intervention delivery strategy for Veterans with PPDM is not known. The proposed CDA will address these gaps and generate a novel intervention specifically designed to improve diabetes control among Veterans with PPDM. The central hypothesis for this CDA is that this intervention will be effective if it: 1) delivers content targeting specific barriers to improvemen among Veterans with PPDM; and 2) utilizes a patient-centered delivery strategy that facilitates frequent patient-provider contact in a manner consistent with this group's preferences. The proposed CDA comprises three complementary Specific Aims, and a theoretical framework based on the Health Belief Model will guide this program of research. For Aim 1, existing data will be analyzed to identify patient factors associated with PPDM in Veterans. Per this CDA's theoretical model, these factors will point toward barriers to improvement in PPDM, which in turn will guide the selection of targeted intervention content. Aim 2 will utilize qualitative methodoloy to query stakeholders regarding perceived barriers and facilitators of diabetes control in PPDM, which will further refine intervention content. Additional qualitative work will define the intervention delivery strategy/strategies preferred by Veterans with PPDM for facilitating frequent patient-provider contact; strategies evaluated will include those currently in wide use throughout VA (e.g., MyHealtheVet, Home Telehealth, Group Medical Clinics). Aim 3 will utilize data from Aims 1 and 2 to design and pilot test a novel intervention specifically targeting Veterans with PPDM. Ultimately, by applying a patient- centered intervention to a costly condition in a high-risk population, this CDA aligns with strategic goals for relevant VA organizations (e.g., VA HSR&D, Diabetes QUERI) and has great significance for VA. The PI for this CDA is for Matthew Crowley, MD, a Core Investigator at the Durham VA Center of Innovation (COIN). Dr. Crowley has assembled an expert mentorship team based at the Durham COIN. His primary mentor is David Edelman, a senior Health Services Research (HSR) investigator who has conducted multiple trials of care delivery redesign in diabetes. Dr. Crowley's co-mentor, Hayden Bosworth, has broad expertise in HSR, including using theoretical models to guide intervention design. Karen Steinhauser, a key collaborator, is expert in using qualitative methods to develop and evaluate HSR interventions. Dr. Crowley and his mentors have designed a CDA training plan that will fill key gaps in his current expertise (including behavioral/social theory, qualitative research, implementation research) by systematically addressing core HSR competencies through comprehensive didactic and mentored training. This CDA will enable Dr. Crowley to meet his long-term objectives: following his mentors as an independent VA Health Services Researcher and emerging as a national thought-leader in the management of refractory diabetes.

描述（由申请人提供）： 该职业发展奖 (CDA) 提案旨在改善对患有持续性糖尿病控制不佳 (PPDM) 的退伍军人的管理。糖尿病是退伍军人肾衰竭、截肢和失明的主要原因，也是心脏病和中风的主要危险因素。糖尿病还与退伍军人死亡率增加两倍有关，并且是退伍军人管理局代价最高的疾病之一。由于随着糖化血红蛋白 (HbA1c) 的增加，糖尿病并发症和费用呈指数级上升，因此维持 HbA1c > 9% 是一个危险因素，可以通过改善血糖控制来改变这一风险因素。因此，患有 PPDM 的退伍军人（定义为尽管有 VA 初级保健或内分泌管理，但 HbA1c 持续 > 9% 超过 1 年）可能是 VA 内风险最高的糖尿病患者。 鉴于退伍军人对糖尿病并发症和费用的影响不成比例，迫切需要新的方法来管理患有 PPDM 的退伍军人。然而，目前有两个证据差距阻碍了针对这些退伍军人的干预措施的制定：1）解决退伍军人 PPDM 潜在因素的最佳糖尿病管理内容尚不清楚； 2) 对于患有 PPDM 的退伍军人来说，理想的干预实施策略尚不清楚。拟议的 CDA 将解决这些差距，并产生一种新的干预措施，专门用于改善 PPDM 退伍军人的糖尿病控制。该 CDA 的中心假设是，如果满足以下条件，这种干预措施将是有效的：1）提供针对特定障碍的内容，以改善患有 PPDM 的退伍军人； 2) 采用以患者为中心的交付策略，以符合该群体偏好的方式促进患者与提供者的频繁接触。 拟议的 CDA 包括三个互补的具体目标，基于健康信念模型的理论框架将指导该研究计划。对于目标 1，将对现有数据进行分析，以确定与退伍军人 PPDM 相关的患者因素。根据该CDA的理论模型，这些因素将指向PPDM改善的障碍，进而指导有针对性的干预内容的选择。目标 2 将利用定性方法向利益相关者询问 PPDM 中糖尿病控制的感知障碍和促进因素，这将进一步细化干预内容。其他定性工作将确定 PPDM 退伍军人首选的干预实施策略，以促进频繁的患者与提供者接触；评估的策略将包括目前在整个 VA 广泛使用的策略（例如 MyHealtheVet、家庭远程医疗、团体医疗诊所）。目标 3 将利用目标 1 和 2 的数据来设计和试点测试一种专门针对 PPDM 退伍军人的新型干预措施。最终，通过对高危人群中昂贵的疾病应用以患者为中心的干预措施，该 CDA 与相关 VA 组织（例如 VA HSR&D、糖尿病 QUERI）的战略目标相一致，对 VA 具有重要意义。 此 CDA 的 PI 是达勒姆弗吉尼亚州创新中心 (COIN) 的核心研究员 Matthew Crowley 博士。克劳利博士在达勒姆 COIN 组建了一支专家指导团队。他的主要导师是大卫·埃德尔曼 (David Edelman)，他是一名高级健康服务研究 (HSR) 研究员，曾进行过多项糖尿病护理服务重新设计试验。 Crowley 博士的合作导师 Hayden Bosworth 在 HSR 方面拥有广泛的专业知识，包括使用理论模型来指导干预设计。关键合作者 Karen Steinhauser 擅长使用定性方法来开发和评估 HSR 干预措施。克劳利博士和他的导师设计了一个 CDA 培训计划，该计划将通过全面的教学和指导培训系统地解决 HSR 核心能力问题，从而填补他当前专业知识（包括行为/社会理论、定性研究、实施研究）的关键空白。该 CDA 将使 Crowley 博士能够实现他的长期目标：跟随他的导师，成为一名独立的 VA 健康服务研究员，并成为难治性糖尿病管理领域的全国思想领袖。