Reducing Diabetes Disparities Using Community Coaches

描述(由申请人提供)：尽管在过去十年中，改善糖尿病护理质量的努力有所增加，但质量仍然不佳，特别是对少数族裔患者。我们建议在社区门诊诊所的墨西哥裔美国人、越南裔美国人和非西班牙裔白人患者中，测试一项旨在增加患者对糖尿病质量、特别是HbA1c值的治疗决策的干预措施的有效性。这种干预措施现在被称为“指导护理”，已经在多个随机对照试验中得到了很好的测试，这些试验针对的是不那么多样化的患者群体，包括糖尿病、高血压、乳腺癌和类风湿性关节炎患者。与自我管理或更传统的患者教育不同，这种干预措施侧重于：1)根据糖尿病管理算法和患者的病历为患者提供个性化的治疗信息；2)使用这些信息谈判更符合患者偏好和生活方式的治疗方案的技能；3)为就诊前的患者做好准备，以便在护理中发挥更积极的作用。为了使这一干预措施适应墨西哥和越南裔美国患者的独特需求，我们建议从患有糖尿病的患者社区中挑选志愿者“教练”。这些教练将在就诊前为患者做好准备，以参与治疗决策和有效参与的身份障碍。教练将在办公室访问期间加强谈判技能。它们还将帮助患者和医生通过有效的治疗实施和疾病管理来识别和解决特定于文化的冲突。在一项大型随机对照试验中，我们将测试干预对三个患者组的临床结果和人际交往质量的影响。我们将根据观察到的糖尿病护理质量的任何变化来衡量干预的成本，以评估广泛实施干预的可行性。如果干预是有效和可行的，它可以作为在资源有限的情况下改善少数群体社区慢性病护理的典范。

DESCRIPTION (provided by applicant): Although efforts to improve the quality of diabetes care have increased over the past decade, quality remains suboptimal, especially for minority patients. We propose to test the effectiveness of an intervention designed to increase patient participation in treatment decisions on diabetes quality, particularly HbA1c values, among Mexican American, Vietnamese American, and non-Hispanic white patients in community-based outpatient clinics. This intervention, now called "Coached Care," has been well tested in multiple randomized controlled trials among less diverse patient groups, including those with diabetes, hypertension, breast cancer, and rheumatoid arthritis. Different from self-management or more traditional patient education, this intervention focuses on: 1) providing patients with individualized treatment information based on an algorithm for diabetes management coupled with a patients' medical records; 2) skills for using the information to negotiate a treatment regimen more consistent with the patients' preferences and lifestyle; and 3) preparation of patients immediately preceding the office visit for a more active role in care. In order to adapt this intervention to the unique needs of Mexican and Vietnamese American patients, we propose to have volunteer "coaches," drawn from the patient's community who themselves have diabetes. These coaches will prepare patients prior to office visits to participate in treatment decisions and identity barriers to effective participation. The coaches will reinforce negotiation skills between office visits. They will also help patients and physicians to identify and resolve culture-specific conflicts with effective treatment implementation and disease management. In a large randomized controlled trial, we will test the impact of the intervention on clinical outcomes and on the quality of interpersonal for each of the three patient groups. We will measure the costs of the intervention relative to any observed changes in the quality of diabetes care to assess the feasibility of widespread implementation of the intervention. If the intervention is effective and feasible, it could serve as model for improving chronic disease care in minority communities in settings with limited resources.