Bridging Income Generation with Group Integrated Care (BIGPIC)

通过团体综合护理 (BIGPIC) 架起创收桥梁

• 批准号: 9212849
• 负责人: Rajesh Vedanthan
• 金额: $ 64.3万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-04-01 至 2020-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9212849
• 关键词: Address; African; Blood Pressure; Cardiovascular Diseases; Cardiovascular Models; Cardiovascular system; Caring; Cessation of life; Characteristics; Chronic Disease; Clinical; Cluster randomized trial; Communities; Development; Diabetes Mellitus; Economic Burden; Effectiveness; Effectiveness of Interventions; Ensure; Focus Groups; Generations; Goals; Government; Health; Hypertension; Income; Individual; Intervention; Kenya; Knowledge; Mediating; Mediation; Medical; Modeling; Morbidity - disease rate; Outcome; Outcome Measure; Patients; Population; Prediabetes syndrome; Principal Investigator; Qualitative Research; Quality of Care; Research; Research Methodology; Research Personnel; Research Project Grants; Research Technics; Resources; Risk Factors; Risk Reduction; Rural; Rural Health; Savings; Self Efficacy; Social Network; Social support; Testing; Trust; Visit; Vulnerable Populations; Work; arm; blood pressure regulation; cardiovascular disorder risk; cardiovascular risk factor; clinical care; cohesion; contextual factors; cost; cost effective; design; diabetes risk; diabetic; disability-adjusted life years; experience; health care availability; health economics; implementation research; improved; incremental cost-effectiveness; innovation; knowledge base; low and middle-income countries; member; mortality; novel; primary outcome; public health relevance; secondary outcome; trial comparing

 DESCRIPTION (provided by applicant): Bridging Income Generation with Group Integrated Care (BIGPIC) Cardiovascular disease (CVD) is the leading cause of mortality in the world. Diabetes, a major risk factor for CVD, is increasingly prevalent and responsible for substantial cardiovascular morbidity and mortality. Elevated blood pressure (BP) increases CVD risk among individuals with diabetes and pre-diabetes; BP control is therefore a powerful way to reduce CVD risk. Cost-effective, context-specific, and culturally appropriate interventions are critical, and both group medical visits and microfinance have the potential to achieve this. In partnership with the Government of Kenya, the Academic Model Providing Access to Healthcare Partnership has expanded its clinical scope of work in rural western Kenya to include diabetes and hypertension, and has piloted group care and microfinance initiatives with promising early results. However, the effectiveness of these strategies individually, and in combination, on improving CVD risk is not known. Thus, the overall objective of this proposal is to utilize a transdisciplinary implementation research approach to address the challenge of reducing CVD risk in low-resource settings. Specifically, we propose to test the hypothesis that group medical visits integrated into microfinance groups will be effective and cost-effective in reducing CVD risk among individuals with diabetes and at increased risk for diabetes in western Kenya. We further hypothesize that changes in social network characteristics may mediate the impact of these interventions, and that baseline social network characteristics may moderate the impact. Aim 1 is to identify contextual factors, facilitators, and barriers that may impact integration of group medical visits and microfinance groups in this setting, using novel qualitative research techniques. We will then design a contextually and culturally appropriate integrated group medical visit-microfinance model for CVD risk reduction. Aim 2 is to evaluate the effectiveness of group medical visits and microfinance groups for CVD risk reduction among individuals with diabetes or at increased risk of diabetes, by conducting a four-arm cluster randomized trial comparing: 1) usual clinical care; 2) usual clinical care plus microfinance groups only; 3) group medical visits only; and 4) group medical visits integrated into microfinance groups. The primary outcome will be one-year change in systolic BP, and a key secondary outcome will be change in QRISK2 CVD risk score. We will also conduct mediation analysis and moderation analysis to evaluate the influence of social network characteristics on intervention outcomes. Aim 3 is to evaluate the incremental cost-effectiveness of each intervention arm of the trial. The research will be accomplished by an Early Stage Principal Investigator with extensive experience in implementation research in low-resource settings, supported by a transdisciplinary team of investigators with diverse and complementary expertise. Our goal is to add to the existing knowledge base of innovative, scalable, and sustainable strategies to reduce CVD risk in diabetes and other chronic diseases in low-resource settings worldwide.

 描述(由申请者提供)：将收入产生与团体综合护理(BIGPIC)联系起来心血管疾病(CVD)是世界上导致死亡的主要原因。糖尿病是心血管疾病的一个主要危险因素，它日益普遍，并导致大量心血管疾病的发病率和死亡率。血压升高会增加糖尿病和糖尿病前期患者的心血管风险；因此，控制血压是降低心血管风险的有效方法。成本效益高、针对具体情况和文化上适当的干预措施至关重要，团体就诊和小额供资都有潜力实现这一目标。与肯尼亚政府合作，提供获得医疗保健伙伴关系的学术模式扩大了其在肯尼亚西部农村的临床工作范围，将糖尿病和高血压包括在内，并试行了团体护理和小额供资举措，取得了可喜的早期成果。然而，这些策略单独或组合在改善心血管疾病风险方面的有效性尚不清楚。因此，本提案的总体目标是利用跨学科执行研究方法来应对在低资源环境下减少心血管疾病风险的挑战。具体地说，我们建议测试这样一种假设，即将团体医疗访问整合到小额信贷团体将在降低肯尼亚西部糖尿病患者和糖尿病风险增加的个人的心血管疾病风险方面有效且具有成本效益。我们进一步假设，社会网络特征的变化可能会中介这些干预措施的影响，而基线社会网络特征可能会缓和这种影响。目标1是利用新的定性研究技术，确定在这种情况下，可能影响团体就医和小额信贷团体整合的背景因素、促进者和障碍。然后，我们将设计一种适合背景和文化的综合团体医疗访问-小额信贷模式，以降低心血管疾病风险。目的2是通过进行一项四臂整群随机试验，比较以下几种情况：1)常规临床护理；2)常规临床护理加小额信贷组；3)仅团体医疗访视；4)整合到小额信贷组中，以评估团体就诊和小额信贷组在降低糖尿病患者或糖尿病风险增加的个人心血管疾病风险方面的有效性。主要结果将是一年内收缩压的变化，而一个关键的次要结果将是QRISK2心血管危险评分的变化。我们还将进行中介分析和调节分析，以评估社会网络特征对干预结果的影响。目标3是评估试验中每个干预措施的增量成本效益。这项研究将由一名在低资源环境下开展执行研究方面具有丰富经验的早期首席调查员完成，并由一支具有多样化和互补性专门知识的跨学科调查组提供支助。我们的目标是增加现有的创新、可扩展和可持续战略的知识库，以在全球资源匮乏的环境中降低糖尿病和其他慢性疾病的心血管疾病风险。