EMPLOYING DIABETES SELF-MANAGEMENT MODELS TO REDUCE HEALTH DISPARITIES IN TEXAS

尽管联邦和州政府在过去几十年里一致努力减少健康差距， 报告的少数群体慢性病发病率方面的差异仍然存在。特别是非洲裔美国人和 西班牙裔的2型糖尿病（T2 DM）和心血管疾病（CVD）的发病率高于 美国人口的其他部分。本研究项目的目标是测试两个 不同的糖尿病自我管理（DSM）计划，在一个大型多地点的卫生保健组织在中环 德克萨斯州，为大量少数民族和农村居民提供服务，比较结果，以评估 减少健康差距的功效。我们的具体目标是：i）记录 糖尿病治疗过程和结果中现存的健康差异; 2）评估不同的DSM 行为和临床结果的干预方法，注意患者的不同影响 和环境特征; 3）研究这些不同的DSM方法的成本效益 少数民族和农村人口的教育;以及4）探索我们干预努力的范围和 DSM教育的更广泛的组织影响，包括对临床医生和组织的反馈循环 对自我管理方法的接受性。我们的研究将采用四种不同的活动： 1300例成人记录的电子病历审查; 2）2 × 2开放式24个月随机临床试验， 行为和技术为基础的DSM干预与400名成年人年龄21岁及以上的2型 糖尿病（T2 DM）; 3）不同治疗方法的成本效益分析;以及4） 初级保健提供者和卫生保健管理人员。虽然我们的主要成果将是减少 血红蛋白Aic（HbAic），我们的概念模型包括临床，行为，经济和组织 结果。我们还将评估我们的干预措施在多大程度上减少了健康差距， 差异化治疗成功。本研究在行为和技术两方面的比较上具有创新性 干预方式、其对公共卫生的关注程度和成本效益不同 干预方法，并关注组织对干预可持续性的反应。一 值得注意的是，加强临床治疗和社区治疗之间的联系 在不同的环境和人群中确定成功的治疗策略。

Despite concerted federal and state attempts to reduce health disparities over the past decades substantial disparities in reported rates of chronic disease for minorities still exist. In particular, African Americans and Hispanics experience higher rates of Type 2 diabetes (T2DM), and cardiovascular disease (CVD) than do other segments of the U.S. population. The objectives of this proposed research project are to test two different diabetes self-management (DSM) programs in a large multi-site health care organization in Central Texas that serves large populations of minority and rural residents, comparing outcomes in order to evaluate their efficacy for reducing health disparities. Our specific aims are to: i) document the nature and magnitude of extant health disparities in diabetes treatment processes and outcomes; 2) evaluate different DSM intervention approaches on behavioral and clinical outcomes, with attention to differential effects by patient and environmental characteristics; 3) examine the cost-effectiveness of these different approaches to DSM education in minority and rural populations; and 4) explore the reach of our intervention efforts and the broader organizational impacts of DSM education, including feedback loops to clinicians and organizational receptivity to self-management approaches. Our study will employ four different activities: i) an initial electronic chart review of 1300 records of adults; 2) a 2 by 2 open 24 month randomized clinical trial of behaviorally and technologically based DSM interventions with 400 adults age 21 and older who have type 2 diabetes (T2DM); 3) a cost-effectiveness analysis of the different treatment approaches; and 4) surveys of primary care providers and health care administrators. While our primary outcome will be reductions in hemoglobin Aic (HbAic), our conceptual model includes clinical, behavioral, economic and organizational outcomes. We will also assess the extent to which our interventions reduce health disparities by examining differential treatment success. This study is innovative in its comparison of both behavioral and technological intervention approaches, its attention to the public health impact and cost-effectiveness of different intervention approaches, and its concern with organizational responses to intervention sustainability. A noteworthy significance will be the strengthening of the linkages between clinical and community treatment approaches and the identification of successful treatment strategies in different settings and populations.