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

针对儿童 1 型糖尿病的学校合作协作护理 (SPACE)

• 批准号: 10640614
• 负责人: Christine March
• 金额: $ 18.97万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2027-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10640614
• 关键词: Address; Administrator; Affect; Area; Attention; Behavior; Caregivers; Caring; Case Study; Child; Child Support; Childhood; Chronic; Clinical Trials; Clinical Trials Design; Collaborations; Communities; Competence; Control Groups; Data; Data Collection; Diabetes Mellitus; Effectiveness; Ensure; Environment; Evaluation; Evidence based practice; Evidence based treatment; Family; Family health status; Feedback; Focus Groups; Fostering; Foundations; Funding Mechanisms; Future; Glycosylated hemoglobin A; Goals; Health; Health Services Accessibility; Hospitals; Hour; Individual; Insulin-Dependent Diabetes Mellitus; Intervention; Interview; Lead; Leadership; Letters; Measures; Medical; Medical center; Mental Health; Mental Health Services; Mentored Patient-Oriented Research Career Development Award; Mentors; Mentorship; Methods; Mission; Modeling; Modernization; National Institute of Diabetes and Digestive and Kidney Diseases; Nursing Faculty; Outcome; Outcome Measure; Parents; Patient Outcomes Assessments; Patient-Focused Outcomes; Physicians; Policies; Preparation; Primary Care; Primary Schools; Process; Provider; Quality of Care; Randomized; Randomized, Controlled Trials; Recommendation; Reporting; Research; Research Design; Risk; Role; Sampling; School Nursing; Schools; Scientist; Social Workers; Specialist; Surveys; System; Testing; Time; Training; Training Activity; Visit; Work; Youth; aged; arm; behavioral health; care delivery; career development; collaborative care; community organizations; community setting; contextual factors; cost; data integration; design; diabetes management; diabetes self-management; effectiveness/implementation study; effectiveness/implementation trial; experience; feasibility testing; glycemic control; health care delivery; implementation determinants; implementation measures; implementation research; implementation science; improved; interdisciplinary approach; multidisciplinary; nutrition; pilot test; primary outcome; programs; prototype; provider communication; recruit; school district; school health; secondary outcome; skills; success; therapy design; treatment arm; usability; user centered design

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.

项目摘要 尽管现代治疗在过去几十年中取得了进展，但大多数1型糖尿病（T1 D）青年 以达到推荐的血糖控制目标（通过血红蛋白A1 c测量）。作为血糖控制 仍然是长期结果的唯一最重要的预测因素，因此需要进行干预。一 方法是支持多学科护理服务，传统的以医院为基础的管理方法， T1 D，通过与社区组织合作，支持他们生活的青年和家庭。的 学校环境提供了这样一个机会，因为孩子们在那里度过了近一半的工作日醒着的时间 在学校护士的照顾下，提供一致和监督的环境。虽然他们的能力有限， 设计，以前的研究T1 D学校为中心的干预措施表明，加强学校的好处， 供应商协作管理。然而，这种关系仍然是次优的。我们之前的工作已经确定了 学校护士认为他们为T1 D做出了宝贵的贡献，而这些贡献往往没有得到承认， 希望得到学校卫生人员的更多反馈。加强这种伙伴关系可以通过 协作护理模式，以前研究的心理健康状况在初级保健和学校。适应 这种T1 D模型可以提供一种基于系统的方法，以支持学校护士、T1 D青年及其 家庭这个指导K23奖的总体目标是开发和试点测试一个学校Partnered T1 D的协作护理（SPACE）干预。马奇博士会发现影响 实施以学校为基础的合作照顾使用混合方法（目标1），设计空间为T1 D 通过迭代的社区合作过程（子目标2A）进行干预，选择有效的措施， 与T1 D儿童的父母一起评估SPACE（子目标2B），并在一个 初步随机分组对照试验，主要结局为可行性（目标3）。次要结局 将处理其他以实施为重点的措施（例如，可接受性、可用性等），一个探索性的 我们的目标将是为未来的充分把握度试验连续评估候选结果。配对培训活动 与每个研究目标相结合，并包括促进应用实施科学的理解 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，以支持未来的R级研究，审查影响T1 D实施的因素 在全国学校进行干预，并在一个完全有效的、集群随机的、 混合执行----有效性试验。此外，跨学科导师和职业发展 这些活动将促进马奇博士向独立供资机制过渡。通过完成这个K23，博士。 马奇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的战略使命保持一致，以推进企业主参与的研究 在社区环境中传播和实施循证治疗。