Improving Diabetes Risk Assessment and Screening in Minority-Predominant Community Health Center Patients

项目摘要 2型糖尿病对美国种族/少数民族的影响不成比例，这一点从更高的 这种疾病及其并发症在拉美裔、黑人、亚裔美国人、太平洋岛民、 印第安人和白人的对比。2015年10月，美国预防服务工作组 (USPSTF)发布了一项新的建议，筛查40-70岁和 糖尿病和糖尿病前期的超重/肥胖(统称为血糖异常)。这些筛选标准是 可能在经历了以下情况的种族/族裔少数群体中按比例确定较少的血糖异常病例 与白人相比，年轻时风险更高，体重更轻。相比之下，美国的糖尿病患者 美国糖尿病协会(ADA)建议对至少有两种糖尿病风险因素的成年人进行筛查，其中包括非白人 种族/民族。筛查标准是基于使用风险因素预测疾病发展的模型 血糖紊乱。然而，现有的风险模型在实践中的应用有限，因为它们包括以下数据 这些数据并不是常规收集的，也不能准确地预测少数族裔的血糖紊乱。vbl.使用 来自全国社区卫生中心网络的数据，这些中心的患者主要是种族/民族 这项及时的研究将调查糖尿病风险的评估和治疗的有效性 替代筛查标准。芝加哥社区卫生服务联盟(Alliance)是一项全国性的数据 200多个社区健康中心的仓库，将社会人口、实验室和医疗保健联系起来 来自超过800,000名患者的电子健康记录(EHR)的利用数据。使用纵向联盟 从2006年到2015年的数据，我们将比较三种不同预测方法的性能 基于：1)USPSTF标准；2)ADA标准；以及3)来自新风险预测模型的标准 我们将使用相同的EHR数据进行开发。在第二个目标中，我们将估计和比较成本和成本- 基于相同标准集的筛查的术语成本效益。这一经济分析对于 促进在实践中采用最佳糖尿病筛查方法。这项研究的发现可以用来 改进糖尿病筛查建议，以更好地识别高危人群，特别是种族/民族 少数族裔。因此，这项研究可能有助于通过早期检测血糖异常来减少种族/民族差异。 这些群体，以便能够启动预防和治疗战略。此外，这项研究将导致 未来的研究将测试用于筛查、诊断和治疗血糖异常的新干预措施，以及 审查筛查方法的长期成本效益。我们的多学科团队拥有广泛的 成功执行拟议的二级数据所需的内容领域和方法方面的专业知识 分析，然后调查研究成果在实践中的应用。这项研究适时地发表在其 检查新的糖尿病筛查标准；新奇的是它纳入了一个以少数族裔为主的大个子患者 样本；以及在最大限度地提高人群健康和糖尿病健康公平方面的潜力。

Project Summary Type 2 diabetes disproportionately affects U.S. racial/ethnic minorities, as evidenced by a higher prevalence of the condition and its complications among Hispanics, blacks, Asian Americans, Pacific Islanders, and Native Americans compared to whites. In October 2015, the U.S. Preventive Services Task Force (USPSTF) released a new recommendation to screen asymptomatic adults who are 40-70 years old and overweight/obese for diabetes and prediabetes (collectively called dysglycemia). These screening criteria are likely to identify proportionately fewer cases of dysglycemia among racial/ethnic minorities, who experience higher risk at younger ages and lower body weights compared to whites. By contrast, the American Diabetes Association (ADA) recommends screening in adults with at least two diabetes risk factors, including non-white race/ethnicity. Screening criteria are based on models that use risk factors to predict the development of dysglycemia. However, existing risk models have limited application in practice because they include data that are not routinely collected, and they do not accurately predict dysglycemia in racial/ethnic minorities. Using data from a national network of community health centers whose patients are predominantly racial/ethnic minorities, this timely research will investigate the assessment of diabetes risk and the effectiveness of alternate screening criteria. The Alliance of Chicago Community Health Services (Alliance) is a national data warehouse for over 200 community health centers, which links sociodemographic, laboratory, and healthcare utilization data from the electronic health records (EHR) of over 800,000 patients. Using longitudinal Alliance data from 2006 to 2015, we will compare the performance of three different approaches for predicting dysglycemia, based on: 1) USPSTF criteria; 2) ADA criteria; and 3) criteria from a novel risk prediction model we will develop using the same EHR data. In a second aim, we will estimate and compare the costs and short- term cost-effectiveness of screening based on the same sets of criteria. This economic analysis is essential to promote the uptake of optimal diabetes screening approaches in practice. Findings from this study can be used to improve diabetes screening recommendations to better identify high-risk individuals, especially racial/ethnic minorities. This study may therefore help reduce racial/ethnic disparities by detecting dysglycemia earlier in these groups, so that prevention and treatment strategies can be initiated. In addition, this study will lead to future research that tests novel interventions for screening, diagnosing, and treating dysglycemia, and examines the long-term cost effectiveness of screening approaches. Our multidisciplinary team has extensive expertise in the content areas and methods needed to successfully conduct the proposed secondary data analysis, and then investigate the application of study findings in practice. This study is timely in its examination of new diabetes screening criteria; novel in its inclusion of a large, minority-predominant patient sample; and significant in its potential to maximize both population health and health equity in diabetes.