The Flint Neuropathy Study: assessing diagnostic and management gaps in a Black, low-income population
弗林特神经病研究:评估黑人低收入人群的诊断和管理差距
基本信息
- 批准号:10642447
- 负责人:
- 金额:$ 21.83万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 财政年份:2023
- 资助国家:美国
- 起止时间:2023-07-01 至 2028-06-30
- 项目状态:未结题
- 来源:
- 关键词:AddressAdoptionAdultAffectAmericanAmputationAnalgesicsAttitudeBlack AmericanBlack raceCaringCharacteristicsClinicClinicalClinical Decision Support SystemsCluster randomized trialComputerized Medical RecordDataDecision MakingDiabetes MellitusDiagnosisDiagnosticDisease ProgressionEvidence based interventionFoundationsFutureGoalsGuidelinesHealthHealth systemHyperglycemiaIndividualInterventionIntervention TrialInterviewKnowledgeLow Income PopulationLow incomeMentorshipMetabolicMetabolic syndromeMethodsMichiganMissionModificationMorbidity - disease rateNeuropathyObesityOutcomePainPain managementPatientsPhysiciansPilot ProjectsPlayPopulationPovertyPractice ManagementPrevalencePrimary Care PhysicianPublic HealthQuality of lifeRandomizedReach, Effectiveness, Adoption, Implementation, and MaintenanceRecommendationResearchResearch DesignRisk FactorsRisk ManagementRoleStructureSurveysSymptomsTestingTheoretical Domains frameworkTrainingUnderserved PopulationUnited States National Institutes of Healthblack patientcareerclinical efficacycomputerizeddisabilityelectronic medical record toolevidence baseevidence based guidelinesfallshealth disparityimplementation scienceimprovedinnovationmodifiable riskpainful neuropathypatient populationpilot testprimary care clinicprimary care providerscreeningskills
项目摘要
ABSTRACT
Neuropathy is a highly prevalent, disabling condition that leads to pain and reduced quality of life, yet little is
known about neuropathy diagnosis and management in Black, low-income populations. Our preliminary data
indicates that 61% of primarily Black, low-income patients >40 years with neuropathy are undiagnosed.
Without appropriate diagnosis, optimal management of modifiable risk factors, such as hyperglycemia and
obesity, and neuropathic pain is unlikely. Computerized clinical decision support systems (CDSSs) improve
primary care physician (PCP) diagnoses and management by delivering evidence-based recommendations
based on patient characteristics. This proposal’s overall objective is to assess neuropathy diagnosis and
management at two Flint, Michigan clinics (54% Black, 40% <US poverty line), then adapt and pilot an
intervention to address determinants of gaps in neuropathy diagnosis and management. We expect that there
is substantial a neuropathy diagnostic and management gap among Black, low-income patients and that an
adapted CDSS will reduce these gaps. These hypotheses will be tested by pursuing three specific aims: 1)
quantify gaps in neuropathy diagnosis and management in a predominantly Black, low-income population, 2)
determine PCP-level predictors of gaps in diagnosis and management, and 3) adapt a CDSS intervention
emphasizing neuropathy screening, risk factor modification, and pain management and evaluate CDSS reach,
adoption, and implementation. The first aim will use a piloted study design to assess neuropathy prevalence
and determine gaps in diagnosis and management. The second aim will utilize the Theoretical Domains
Framework to assess PCP knowledge, attitudes, and clinic level determinants of neuropathy diagnosis,
management of risk factors and neuropathic pain using mixed methods. The final aim involves adapting an
existing CDSS intervention for neuropathic pain to include neuropathy diagnosis and risk factor management.
This intervention will then be piloted at two clinics in different health systems serving predominantly Black and
low-income patients. The proposed research is highly innovative because it examines gaps in neuropathy
diagnosis and management among a population most likely to be affected by neuropathy and their usual
PCPs, which few studies have done. Even fewer have assessed determinants of gaps in neuropathy diagnosis
and management in this patient population. Uncovering determinants of neuropathy diagnosis and
management represents a significant impact as this will form the foundation for an intervention aimed at
improving neuropathy diagnosis and management in this population and other similar, underserved
populations.
摘要
神经病是一种非常普遍的致残性疾病,会导致疼痛和生活质量下降,但很少有
了解黑人低收入人群的神经病诊断和管理。我们的初步数据
表明,61%的主要是黑人,低收入患者>40岁的神经病未被诊断。
如果没有适当的诊断,可改变的风险因素,如高血糖症和
肥胖和神经性疼痛的可能性不大计算机化的临床决策支持系统(CDSS)
初级保健医生(PCP)通过提供循证建议进行诊断和管理
根据患者的特点。该提案的总体目标是评估神经病诊断,
在密歇根州弗林特市的两家诊所(54%为黑人,40%低于美国贫困线)进行管理,然后调整并试点
干预,以解决神经病诊断和管理差距的决定因素。我们预计,
在黑人、低收入患者中,
经过调整的CDSS将缩小这些差距。这些假设将通过追求三个具体目标进行测试:1)
量化以黑人为主的低收入人群中神经病诊断和管理的差距,2)
确定PCP水平的诊断和管理差距的预测因素,以及3)调整CDSS干预措施
强调神经病变筛查、风险因素修正和疼痛管理,并评估CDSS覆盖范围,
通过和实施。第一个目标将使用试点研究设计,以评估神经病变的患病率
并确定诊断和管理方面的差距。第二个目标将利用理论领域
评估PCP知识、态度和神经病诊断的临床水平决定因素的框架,
使用混合方法管理危险因素和神经性疼痛。最后的目标是调整一个
现有的CDSS干预神经性疼痛,包括神经病诊断和风险因素管理。
这项干预措施将在不同卫生系统的两个诊所进行试点,主要为黑人和
低收入患者。这项拟议中的研究是高度创新的,因为它检查了神经病变的差距
在最有可能受神经病变影响的人群中进行诊断和管理,
PCP,很少有研究。甚至更少的人评估了神经病诊断差距的决定因素
和管理。揭示神经病诊断的决定因素,
管理具有重大影响,因为这将构成干预的基础,
改善这一人群和其他类似的、服务不足的人群的神经病诊断和管理
人口。
项目成果
期刊论文数量(1)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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