School-Partnered Collaborative Care (SPACE) for Pediatric Type 1 Diabetes

项目摘要 尽管在过去的几十年里，现代治疗取得了进步，但大多数患有1型糖尿病(T1D)的年轻人失败了 以达到由血红蛋白A1c测量的血糖控制的推荐目标。作为血糖控制 仍然是预测长期结果的最重要的单一指标，因此需要辅助性干预。一 方法是支持多学科护理提供，这是传统的以医院为基础的管理方法 T1D，通过与支持他们生活的青年和家庭的社区组织合作。这个 学校环境提供了这样一个机会，因为孩子们在工作日几乎有一半的时间是在那里度过的 在学校护士的照顾下，提供一致和受监督的环境。尽管他们的能力有限 设计方面，先前对以学校为中心的T1D干预措施的研究表明，这有助于加强学校- 提供商协作以进行管理。然而，这种关系仍然不是最优的。我们之前的工作已经确定 学校护士觉得他们为T1D做出了有价值的贡献，但往往得不到认可，而提供者 希望从学校卫生工作人员那里得到更多反馈。加强这种伙伴关系可以通过以下方式实现 协作式护理模式，以前研究初级保健和学校的精神健康状况。适应 这种针对T1D的模式可以提供一种基于系统的方法来支持学校护士、患有T1D的青少年以及他们的 家人。这项有指导的K23奖项的总体目标是开发和试点由学校合作的 T1D的协作性护理(空间)干预。马奇博士将发现影响 采用混合方法实施校本协作照护(目标1)，设计T1D空间 通过迭代的、社区合作的进程(次级目标A)进行干预，选择有效措施以 与T1D儿童的父母一起评估空间(子目标2B)，并测试T1D干预空间 试点整群随机对照试验，初步结果为可行性(目标3)。次要结果 将解决其他以实现为重点的措施(例如，可接受性、可用性等)，以及探索性 目标将是描述性地评估未来全功率试验的候选结果。结对培训活动 与每个研究目标保持一致，并包括促进对应用实现科学的理解 原则，培养以用户为中心的设计技能，培养临床试验能力。这些研究将 提供初步数据以支持未来研究影响T1D实施的因素的R-Level研究 在全国范围内对学校进行干预，并在全功率、随机、 混合实施--有效性试验。此外，跨学科的指导和职业发展 这些活动将促进马奇向独立筹资机制的过渡。通过完成这项K23，Dr。 三月将拥有成为一名独立医生所需的培训、经验和初步数据- 科学家领导的研究与NIDDK推进利益相关者参与研究的战略使命保持一致 它在社区环境中传播和实施循证治疗。

Project Summary Despite modern treatment advances over the last several decades, most youth with type 1 diabetes (T1D) fail to meet recommended targets for glycemic control as measured by hemoglobin A1c. As glycemic control remains the single most important predictor for long term outcomes, adjunctive interventions are needed. One approach is to bolster multidisciplinary care delivery, the traditionally hospital-based management approach for T1D, through partnering with community organizations that support youth and families where they live. The school setting provides such an opportunity, as children spend nearly half their weekday waking hours there under the care of school nurses, providing a consistent and supervised environment. Though limited in their design, prior studies of T1D school-centered interventions have suggested a benefit to enhancing school- provider collaboration for management. Yet, this relationship remains sub-optimal. Our prior work has identified that school nurses feel they make valuable contributions for T1D which are often unrecognized, and providers desire more feedback from school health staff. Enhancing this partnership may be accomplished through a Collaborative Care Model, previously studied for mental health conditions in primary care and school. Adapting this model for T1D may offer a systems-based approach to support school nurses, youth with T1D, and their families. The overall objective of this mentored K23 award is to develop and pilot test a School-PArtnered Collaborative carE (SPACE) intervention for T1D. Dr. March will discover the contextual factors affecting implementation of school-based collaborative care using mixed methods (Aim 1), design the SPACE for T1D intervention through an iterative, community-partnered process (sub-Aim 2A), select valid measures to evaluate SPACE with parents of children with T1D (sub-Aim 2B), and test the SPACE for T1D intervention in a pilot cluster-randomized controlled trial with the primary outcome of feasibility (Aim 3). Secondary outcomes will address other implementation-focused measures (e.g., acceptability, usability, etc.), and an exploratory goal will be to descriptively assess candidate outcomes for a future fully powered trial. Paired training activities are cohesive with each research Aim and include to advance understanding in applied implementation science principles, develop skills in user-centered design, and cultivate competences in clinical trials. These studies will provide preliminary data to support future R-level studies examining factors affecting implementation of T1D interventions in schools nationally and testing the SPACE intervention in a fully powered, cluster-randomized, hybrid implementation-effectiveness trial. In addition, cross-disciplinary mentorship and career development activities will foster Dr. March’s transition to independent funding mechanisms. By completing this K23, Dr. March will have the training, experience, and preliminary data needed to become an independent physician- scientist leading studies aligned with NIDDK’s strategic mission to advance stakeholder-engaged research which disseminates and implements evidence-based treatments in community settings.