The Flint Neuropathy Study: assessing diagnostic and management gaps in a Black, low-income population

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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.