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Optimizing a scalable intervention to maximize guideline-recommended diabetes testing after GDM

优化可扩展的干预措施，以最大限度地提高 GDM 后指南推荐的糖尿病检测

基本信息

批准号：
10682465
负责人：
Susan Denise Brown
金额：
$ 70.86万
依托单位：
UNIVERSITY OF CALIFORNIA AT DAVIS
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-12 至 2026-07-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10682465
关键词：
Acceleration Address Affect Body Weight California Caring Chronic Clinical Cluster randomized trial Communities Complication Cost Sharing Data Decision Making Diabetes Mellitus Diabetes prevention Diagnosis Early treatment Electronic Health Record Enrollment Face Fostering Fright Future Gestational Diabetes Glycosylated hemoglobin A Goals Guidelines Health Health Professional Health Services Health system Healthcare Hour Infrastructure Intervention Life Style Link Mediator Medical Methods Minority Modeling Motivation Non-Insulin-Dependent Diabetes Mellitus OGTT Outcome Pathway interactions Patient Outcomes Assessments Patients Perinatal Care Phase Population Postpartum Period Pregnancy Pregnancy Complications Prenatal care Prevention Preventive Preventive care Problem Solving Provider Randomized Recommendation Reporting Risk Sampling Screening Result Secure Self Care Self Direction Self Efficacy Services Surveys Testing Time Visit Weight Woman Work acceptability and feasibility clinical risk comparative effectiveness cost design diabetes prevention program diabetes risk discount empowerment ethnic diversity evidence base fasting plasma glucose feasibility testing health assessment high risk innovation interest motivational enhancement therapy multiphase optimization strategy neglect novel online delivery outreach postpartum care pragmatic trial prevent primary outcome programs psychologic racial diversity randomized trial screening secondary outcome theories therapy development uptake

项目摘要

ABSTRACT Gestational diabetes mellitus (GDM) is a common complication that is routinely detected as part of standard prenatal care. After delivery, women with GDM are 7 times more likely to develop type 2 diabetes than those without GDM. National clinical guidelines thus urge completion of a 75-gram, 2-hour oral glucose tolerance test (OGTT), given its superior sensitivity to detect diabetes, by 12 weeks postpartum. Clinical guidelines also advise participation in an evidence-based lifestyle program for diabetes prevention. Yet uptake of this recommended care remains low, and evidence from randomized trials on interventions to increase uptake remains scarce. Here, we propose to test a novel, multi-component outreach intervention that explicitly targets as-yet neglected, patient-level motivational and logistical barriers to engaging in preventive care during the demanding postpartum period. We will leverage the multiphase optimization strategy (MOST) to identify, in a randomized factorial trial, which of four theory-driven components increase actual completion of postpartum screening and enrollment in lifestyle programs for diabetes prevention: 1) a streamlined values affirmation, 2) personalized information about diabetes risk, 3) an interactive motivational interviewing-based module, and 4) an interactive action planning module. Each component is designed to be self-directed and delivered securely online via existing infrastructure in a health system setting, increasing its future potential for large-scale reach. In a racially and ethnically diverse sample of women with GDM within the Kaiser Permanente Northern California (KPNC) health system, our specific aims are as follows. Aim 1: Identify which of four components of the outreach intervention increase completion of a) a 75-gram, 2-hour OGTT within 4-12 weeks postpartum, aligned with national clinical guidelines (primary outcome), and b) any postpartum diabetes screening test (OGTT, fasting plasma glucose, or hemoglobin A1c) by 52 weeks postpartum (secondary outcome). Aim 2: Identify which of four components of the outreach intervention increase enrollment in a health system- or community-based lifestyle program for diabetes prevention by 52 weeks postpartum (secondary outcome). Aim 3: Determine whether each intervention component impacts its target mediator, as predicted by its respective theory. We will efficiently and objectively assess screening outcomes via electronic health records. Results will yield an optimized intervention ready to be tested in a future pragmatic trial to accelerate uptake of guideline- recommended postpartum care for women with GDM, with the long-term goal of preventing diabetes in a diverse and high-risk clinical population.

摘要