A Patient-Centered Strategy to Reduce Diabetes Disparities in Chinese Americans

描述（由申请人提供）：从1991年到2001年，美国诊断为糖尿病的成年人数量增加了61%，到2050年将翻一番。糖尿病是第六大最常见的死亡原因，导致心血管和肾脏疾病，失明和下肢截肢。改善疾病管理可以降低糖尿病的发病率和死亡率。不幸的是，糖尿病患者，特别是移民和少数民族，往往得不到建议的护理水平，这表明迫切需要制定文化上适当和有效的战略，可以纳入现有的医疗实践。糖尿病已成为美国的一种新流行病，亚裔美国人和太平洋岛民的糖尿病发病率增长速度超过任何其他种族/民族。特别是，中国人在美国的糖尿病发病率高于本土国家，而且已经证明，随着文化适应，糖尿病发病率会增加。大约15%的中国人被诊断患有糖尿病，是美国普通人群（5.9%）的2.5倍。此外，华裔美国人的糖尿病发病率比他们的祖国高5至7倍。然而，在收集中国糖尿病数据方面，国家、社区和学术界的努力仍然缺乏支持。这可能与华裔美国人相对缺乏政治影响力和模范少数族裔神话有关。该拟议项目是亚洲卫生服务机构（AHS）、亚太社区卫生组织协会和加州大学伯克利分校之间的社区学术合作，其中包括一个由中国糖尿病患者、家庭成员组成的美籍华人社区咨询委员会成员、服务提供者和参与该项目各个阶段的倡导者。它将评估多层次的试点团队护理干预，结合文化和语言熟练的临床护理，家庭教育和社区推广，是否可行，有效，并负担得起，以改善糖尿病护理和结果相比，通常的护理模式在服务不足的美国华人在AHS。在AHS，74%的患者是中国人，67%的患者处于或低于100%的联邦贫困水平，86%的患者最好用英语以外的语言提供服务。将使用定性和定量技术分析数据。该项目的一个特别优势是，它将建立在现有的合作基础上，即糖尿病护理倡议，该倡议是由加州阿拉米达县的一个联邦合格的健康中心AHS的中国患者和提供者发起的。这项以社区为基础的合作旨在增加以患者为中心的护理，并促进中国糖尿病患者的健康饮食和体育活动行为。最终，它的目标是促进中国糖尿病患者，他们的家庭成员和整个社区的健康行为，以防止不良的糖尿病后果，并防止阿拉米达县及其他地区的新糖尿病病例。公共卫生相关性：这个项目是由中国糖尿病患者和诊所的医生发起的，因为糖尿病已经成为中国人的一个大问题。诊所的病人、他们的家人和医生将与当地研究人员合作，寻找改善诊所糖尿病护理的方法，并帮助教育病人及其家人。

DESCRIPTION (provided by applicant): The number of adults with diagnosed diabetes in the US increased 61 percent from 1991 to 2001 and will double by 2050. Diabetes is the sixth most common cause of death, causing cardiovascular and kidney disease, blindness, and lower limb amputations. Improved disease management can reduce morbidity and mortality from diabetes. Unfortunately, diabetes patients, especially immigrants and minorities, often do not receive recommended levels of care, indicating a critical need for developing culturally-appropriate and effective strategies that can be incorporated into existing medical practices. Diabetes has emerged as a new epidemic across the US and diabetes rates are growing faster among Asian Americans and Pacific Islanders than in any other racial/ethnic group. In particular, diabetes rates for Chinese are higher in the US than in native countries, and rates have been demonstrated to increase with acculturation. Approximately 15 percent of Chinese are diagnosed with diabetes, ~ 2.5 times higher than in the general U.S. population (5.9 percent). Also, Chinese American diabetes rates are 5 to 7 times higher than in their native countries. However, there continues to be a lack of support for national, community and academic efforts to collect Chinese diabetes data. This may be related to the relative lack of political influence and the model minority myth among Chinese Americans. This proposed project is a community-academic collaboration between Asian Health Services (AHS), the Association of Asian Pacific Community Health Organizations, and the University of California, Berkeley that includes a Chinese American community advisory board consisting of Chinese diabetics, family members, providers, and advocates that are engaged in all phases of the project. It will assess whether a multi-level pilot team care intervention, incorporating culturally and linguistically-proficient clinical care, family education, and community promotion, is feasible, effective, and affordable for improving diabetes care and outcomes compared with usual care model among underserved Chinese Americans at AHS. 74 percent of patients at AHS are Chinese, 67 percent of patients are at or below 100 percent federal poverty level and 86 percent are best served in a language other than English. Data will be analyzed using qualitative and quantitative techniques. A particular strength of this project is that it will build on an existing collaborative, the Diabetes Care Initiative, that was started by Chinese patients and providers at AHS, a safety net federally qualified health center, in Alameda County, California. This community-based collaborative seeks to increase patient-centered care and to promote healthy dietary and physical activity behaviors in Chinese diabetics. Ultimately, it aims to promote healthy behaviors among Chinese diabetics, their family members, and the community at-large to prevent adverse diabetes outcomes and prevent new diabetes cases in Alameda County and beyond. PUBLIC HEALTH RELEVANCE: This project was started up by Chinese diabetes patients and doctors at a clinic, because diabetes has become a big issue for Chinese people. The clinic's patients, their families, and doctors will work with local researchers to find ways to improve diabetes care in the clinic and to help educate patients and their families.