Scaling Telehealth Models to Improve Co-morbid Diabetes and Hypertension in Immigrant Populations

扩大远程医疗模式以改善移民人群的糖尿病和高血压共病

• 批准号: 10680980
• 负责人: NADIA S ISLAM
• 金额: $ 71.04万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-07 至 2028-02-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10680980
• 关键词: Address; Adoption; Adult; Area; Asian Americans; Asian population; Attention; Bangladesh; Blood Pressure; COVID-19 pandemic; Cardiovascular Diseases; Caring; Chronic Disease; Cities; Clinic; Clinical; Collaborations; Communities; Community Health; Community Health Aides; Community Services; Consolidated Framework for Implementation Research; County; Diabetes Mellitus; Diffusion; Disease Outcome; Disparity; Effectiveness; Ethnic Origin; Evidence based intervention; Fostering; Geographic Locations; Glycosylated hemoglobin A; Goals; Growth; Health Sciences; Health Services; Health education; Hypertension; Immigrant; Immigrant community; Immigration; India; Individual; Institution; Intervention; Limited English Proficiency; Linguistics; Long Island; Maintenance; Minority Groups; Modeling; Morbidity - disease rate; Multilingualism; New England; New York City; Non-Insulin-Dependent Diabetes Mellitus; Not Hispanic or Latino; Pakistan; Patients; Pattern; Persons; Population; Poverty; Public Health; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Research; Research Personnel; Resources; Risk Factors; Science; Self Efficacy; Site; Social Work; South Asian; Southeastern United States; Testing; Training; United States; United States National Institutes of Health; Vulnerable Populations; Weight; Work; acceptability and feasibility; blood pressure control; blood pressure reduction; cardiovascular disorder risk; community living; community organizations; community setting; comorbidity; comparison intervention; contextual factors; diabetes management; disease disparity; effectiveness evaluation; effectiveness testing; ethnic minority population; evidence base; experience; health care availability; health care settings; high risk population; hybrid type 1 trial; hypertension control; implementation evaluation; implementation framework; implementation outcomes; implementation process; implementation science; improved; innovation; medical schools; mortality; primary care practice; primary care setting; primary outcome; programs; racial minority population; secondary outcome; social; stroke risk; suburb; telehealth; therapy design; treatment arm; treatment as usual; trial design; urban area

Project Summary/Abstract A cornerstone of Type 2 diabetes (DMII) care is the control of co-morbid cardiovascular disease (CVD) risk factors, including hypertension (HTN), to reduce morbidity and mortality. Yet only half of adults with diabetes achieve recommended blood pressure targets. These disparities are more pronounced in immigrant and minoritized groups that experience a disproportionate burden of CVD. South Asians (persons with ancestry from India, Bangladesh, Pakistan or other parts of the South Asian continent) represent one of the fastest -growing immigrant populations in the US and many of them experience high rates of poverty, limited English proficiency (LEP) and barriers to accessing healthcare that may contributeto their disproportionateburdenof DMII and HTN. Our work in NYC and Atlanta has demonstrated the efficacy and feasibility of linguistically and culturally tailored community health worker (CHW)-led telehealth programs to improve diabetes and co-morbid HTN management among South Asians with DMII. Our model offers opportunities to specifically inform diffusion of a telehealth intervention to the South Asian immigrant community, which has experienced growth in both large urban areas that may contain a wealth of culturally tailored resources, as well as in mid-sized/small cities and suburban areas where ethnic-specific resources may be sparse, creating the ideal context to evaluate the delivery of telehealth education centralized in urban hubs. The proposedproject will build on a well-established collaboration between researchers at the NYU School of Medicine, Emory School of Medicine, community-based primary care practices, and community partners across the northeastern and southeastern US to promote comorbid DMII and HTN management among South Asians. The overall goal of our type 1 hybrid trial is to test the effectiveness and implementation process of a culturally and contextually tailored telehealth -based CHW-led coaching intervention for HTN control among 450 South Asian patients with co-morbid DMII and HTN. The Specific Aims are to: 1. Using a randomized controlled trial design, test the effectiveness of a CHW-led telehealth intervention compared to usual care among individuals with DMII and uncontrolled HTN. The primary outcome is blood pressure control, defined as <130/80 mmHg. We hypothesize that 20% more patients in the intervention arm (relative to control) will achieve blood pressure control at 6 months. Secondary outcomes will include reduction in HbA1c and weight at 6 and 12 months, BP control at 12 months, enhanced use of community services, and increased self-efficacy; and 2. Using RE-AIM and CFIR frameworks, examine the reach, adoption, fidelity, and maintenance of the intervention within clinical and community settings, and delineate contextual factors influencing implementation outcomes. This study addresses the urgent need to test telehealth and CHW-led interventions to address CVD disparities in immigrant communities living outside of urban hubs. Our model offers a paradigm shift by addressing co-morbid HTN and DMII, and will foster dissemination of evidence-based interventions in settings that engage vulnerable populations with a high burden of chronic disease.

项目总结/摘要 2型糖尿病（DMII）护理的基石是控制共病心血管疾病（CVD）风险 包括高血压（HTN）在内的各种因素，以降低发病率和死亡率。然而，只有一半的成年糖尿病患者 达到推荐的血压目标。这些差异在移民和 少数群体经历不成比例的CVD负担。南亚人（祖先来自 印度、孟加拉国、巴基斯坦或南亚大陆其他地区）是增长最快的国家之一 美国的移民人口，其中许多人的贫困率很高，英语水平有限， (LEP)和获得医疗保健的障碍，这可能会导致他们的DMII和HTN的负担。 我们在纽约和亚特兰大的工作证明了语言和文化定制的有效性和可行性 社区卫生工作者（CHW）领导的远程医疗计划，以改善糖尿病和合并症HTN管理 南亚人中的DMII。我们的模型提供了机会，具体通知远程医疗的扩散 南亚移民社区在两个大城市地区都经历了增长， 可能包含丰富的文化定制资源，以及中小城市和郊区 在特定民族资源可能稀少的地方，为评估远程医疗的提供创造了理想的环境 教育集中在城市中心。拟议的项目将建立在一个良好的合作， 纽约大学医学院、埃默里医学院的研究人员， 实践，以及美国东北部和东南部的社区合作伙伴，以促进共病DMII， 南亚人的HTN管理。我们的1型混合试验的总体目标是测试有效性 和实施过程的文化和情境定制的远程保健为基础的CHW主导的辅导 对450名患有DMII和HTN共病南亚患者进行HTN控制干预。具体目标 1.使用随机对照试验设计，测试CHW领导的远程医疗干预的有效性 与DMII和不受控制的HTN患者的常规治疗相比。主要结果是血液 压力控制，定义为<130/80 mmHg。我们假设干预组中有20%的患者 （相对于对照）将在6个月时实现血压控制。次要结局将包括减少 6个月和12个月时的HbA 1c和体重，12个月时的BP控制，加强社区服务的使用，以及 提高自我效能; 2。使用RE-AIM和CFIR框架，检查覆盖范围、采用率、保真度和 在临床和社区环境中维持干预，并描述背景因素 影响执行结果。这项研究解决了迫切需要测试远程医疗和CHW领导的 采取干预措施，以解决居住在城市中心以外的移民社区的心血管疾病差异。我们的模型提供 通过解决共病HTN和DMII的范式转变，并将促进基于证据的 在涉及慢性病负担沉重的弱势群体的环境中采取干预措施。