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Identifying Risk Factors for Poor Glycemic Control among Emergency Department Patients and Improving Linkage to Outpatient Care

确定急诊科患者血糖控制不佳的风险因素并改善与门诊护理的联系

基本信息

批准号：
10734304
负责人：
David C Lee
金额：
$ 73.06万
依托单位：
NEW YORK UNIVERSITY SCHOOL OF MEDICINE
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：
2023-08-25 至 2028-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10734304
关键词：
Accident and Emergency department Address Age Algorithms Ambulatory Care American Asian Belief Black race Blood Blood Pressure Blood Tests Caring Cessation of life Characteristics Chronic Disease Clinical Communities Complications of Diabetes Mellitus Country Data Diabetes Mellitus Diagnosis Disease Disparity in diagnosis Economic Burden Electronic Health Record Emergency Care Emergency Department patient Emergency department screening Emergency department visit Face Frequencies Glycosylated hemoglobin A Health Health Personnel Health Services Accessibility Healthcare Systems High Prevalence Hispanic Income Individual Insurance Insurance Coverage Intervention Interview Latino Link Minority Modeling Neighborhoods Newly Diagnosed Outcome Outpatients Patient Care Patient-Focused Outcomes Patients Persons Phenotype Poverty Predisposing Factor Prevalence Preventive care Primary Care Radiology Specialty Randomized, Controlled Trials Recommendation Recording of previous events Research Research Methodology Risk Factors Sampling Shapes Social support Sorting Structure Subgroup Symptoms System Telemedicine Testing Time United States Visit Work barrier to care care seeking comorbidity data registry diabetes risk disparity reduction electronic health data ethnic minority follow-up glycemic control health care availability health care disparity health disparity high risk improved machine learning method male pandemic disease poor health outcome primary care clinic primary care provider primary care visit racial minority screening socioeconomics statistics telehealth

项目摘要

PROJECT SUMMARY Of the millions of Americans who visit an emergency department (ED) each year, there are substantially higher rates of ED use among racial and ethnic minorities and patients with significant socioeconomic barriers. However, EDs rarely provide any sort of preventive care, and the care they provide is often not well coordinated with critically important outpatient care. The consequences are higher rates of undiagnosed diseases like diabetes among ED patients, which then go untreated, exacerbating health disparities, poor glycemic control, diabetic complications, and early diabetes-related death. Given the high volume of ED patients, especially those who are high-risk and have poor access to care, ED-based diabetes screening can help identify undiagnosed cases and presents an important opportunity to link newly diagnosed patients to appropriate outpatient care. Nearly 1 in 5 Americans visit an ED in any given year and more than 50% of ED patients receive some type of blood test. NYU Langone Health has recently launched a system-wide initiative to screen ED patients already receiving blood work using HbA1c tests. Our preliminary data demonstrate that this screening approach can help identify ED patients with previously undiagnosed diabetes, especially among minorities and those without a regular primary care provider. The most critical practical consideration that has emerged from this initiative is how to improve follow-up with outpatient care. Only 23% of these newly diagnosed patients had a follow-up outpatient visit within our healthcare system. While these patients may have had visits elsewhere, this statistic is consistent the low rates of follow-up after ED visits. Therefore, this proposal seeks to address the following questions: (1) which patients are least likely to follow-up after a new diagnosis of diabetes, (2) what are the primary reasons why these patients do not follow-up as outpatients, and (3) whether targeted interventions can help bridge these gaps in care. Therefore, this study will develop clinical algorithms using data from electronic health records to identify which patients are least likely to follow-up for patient care after being newly diagnosed with diabetes. It will also perform detailed qualitative interviews among these newly diagnosed ED patients who fail to follow-up to obtain a comprehensive understanding of their barriers to care. We will also perform a randomized controlled trial of telemedicine to link ED patients identified as having newly diagnosed diabetes to appropriate outpatient care. This study will help improve diabetes surveillance by testing a scalable model to transform EDs into a clinical setting that can effectively screen and refer the millions of high-risk patients that visit EDs in the United States each year, thereby reducing disparities in diagnoses, the frequency of diabetic complications, and early diabetes-related death.

项目总结