Application of the Telemedicine for Reach, Education, Access, and Treatment delivery model to engage emerging adults in Diabetes Self-Management Education and Support (TREAT-ED)

摘要 糖尿病自我管理教育和支持（DSMES）被认为是护理的基石， 帮助人们进行自我管理决策和活动。尽管有证据表明DSMES是一个关键的 作为糖尿病护理的一部分，参与率仍然很低。成年期（EA）被描述为 18至25岁是青少年努力实现自主和探索生活的独特时期 走向成年的可能性。次优的自我管理已被确定为一个主要问题 在患有1型糖尿病（T1 D）的EAs中，一个特别脆弱的群体， 结果。目前形式的DSMES被认为不能满足企业的需要，而企业 对通过同行支持、技术和应用学习驱动的方法提供DSMES表示了兴趣。 为了应对这些挑战，我们将从文献和主要利益相关者中获得的信息应用于我们的 建立了远程医疗覆盖、教育、获取和治疗（TREAT）提供模式， 专注于DSMES EAS-ED（自我管理教育）的设计将专门让EA参与 DSMES通过整合DSMES目标来支持知情决策、自我护理和准备， 转移到成人护理，以改善结果。糖尿病护理和教育专家（DCES）将领导治疗- 艾德与一群EA合作，并将1）帮助组织和促进通过远程医疗提供的小组会议 以及2）使用连续血糖监测（CGM）报告作为个性化示例来驱动建立的 DSMES内容。通过以用户为中心的设计技术，我们将评估实现的决定因素， 开发、构建和测试EPD-ED模型。模型对EA患者影响的可行性评估 参与DSMES的沿着临床、心理和行为结果将被检查。我们 假设模型依赖于当前策略，以使EA处于糖尿病相关高风险， 有效的自我管理技能将改善DSMES的参与和成果。如果被证明是 有效，这种模式是一个可以适应谁已经转移到成人糖尿病护理和其他EA 美国各地的患者。

Abstract Diabetes self-management education and support (DSMES) is considered a cornerstone of care and essential in helping people navigate self-management decisions and activities. Despite evidence that DSMES is a critical component of diabetes care, participation remains low. Emerging adulthood (EA) has been described as the distinct period between 18 and 25 years when adolescents work to achieve autonomy and explore life possibilities in moving toward adulthood. Suboptimal self-management has been identified as a major problem in EAs with type 1 diabetes (T1D), a particularly vulnerable group with an increased risk for poor diabetes-related outcomes. In its current form DSMES has been cited for not meeting the needs of EAs, when EAs have expressed interest in DSMES delivered with peer-supported, technological and applied learning-driven methods. To address these challenges, we are applying information gained from the literature and key stakeholders to our established Telemedicine for Reach, Education, Access and Treatment (TREAT) delivery model with a specific focus on DSMES. TREAT-ED (for self-management EDucation) will be designed to specifically engage EAs in DSMES by integrating DSMES objectives to support informed decision making, self-care, and preparation for transfer to adult care, to improve outcomes. Diabetes care and education specialists (DCESs) will lead TREAT- ED with a cohort of EAs and will 1) help to organize and facilitate group sessions delivered through telehealth and 2) use continuous blood glucose monitoring (CGM) reports as personalized examples to drive established DSMES content. With user-centered design techniques, we will evaluate implementation determinants and then develop, build, and test the TREAT-ED model. Feasibility assessment of the impact of the model on EA patient participation in DSMES along with clinical, psychosocial and behavioral outcomes will be examined. We hypothesize that models that rely on current day strategies to engage EAs at high risk for diabetes-related problems with effective self-management skills will improve DSMES engagement and outcomes. If proven to be effective, this model is one that could be adapted for EAs who have transferred to adult diabetes care and other patient populations throughout the US.