Maximizing the Scalability of the Chronic Disease Self-Management Program (CDSMP) Among Older Adults in State Correctional Settings

项目摘要/摘要 被监禁的人患慢性病的比率比普通人群更高， 随着监狱人口继续老龄化，负担可能会增加。尽管如此，监狱里的医疗服务 主要关注传染病、精神疾病和药物滥用，基本上忽视了慢性生理疾病 健康状况。慢性病自我管理计划(CDSMP)是一个基于证据的计划 为支持慢性病患者的自我管理而开发。至少进行了10项随机试验 在非矫正环境中，将CDSMP与疾病相关的改善和医疗保健减少联系起来 支出。CDSMP已通过三种方式在国家惩教系统中使用：1)引入社区 机构CDSMP领导进入惩教环境领导计划，2)将惩教人员作为计划进行培训 领导人，以及3)培训被监禁的个人担任同行领导人。然而，到目前为止，几乎没有 加强国家惩戒系统内干预的高效有效战略研究 使用这些方法中的任何一种。纵向扩展(即刻意增加成功测试的影响 健康创新以造福更多的人并促进可持续发展)是#年一个研究不足的概念 实施科学，现有的经验研究很少明确地侧重于扩大规模的过程。 然而，评估可扩展性对于确保资源内复杂干预措施的可持续性至关重要。 糟糕的设置。此K01的研究目标是评估和最大化CDSMP的可扩展性 州惩教系统中的老年人。在纵向扩展管理框架的指导下，我们将使用 询问社区机构领导人、工作人员和被监禁个人的混合方法研究方法 如何在国家惩教机构内最大限度地提高CDSMP的可扩展性，并开发和完善CDSMP 针对这些设置的扩展策略。我们的目标是开发扩展战略，以便在后续的 随机实施试验。K01的培训目标将增加实施科学方面的专业知识 对我现有的疾病、社会心理和社会模型方面的知识基础进行公正研究 老年学、健康差距、定量分析和慢性病管理，以实现我的目标 成为使用实施科学方法改善健康结果的独立研究人员 在涉及正义的人群中。随着监狱人口继续老龄化，慢性病的负担 惩教系统内的惩教费用将继续增加，这将导致惩教费用飙升。 了解如何在惩教系统内扩大循证慢性病计划是至关重要的 用于减少被监禁个人中与疾病有关的发病率和死亡率，并降低费用。这 一系列研究将确定和测试监狱慢性病管理的扩大战略。

PROJECT SUMMARY/ABSTRACT Incarcerated individuals have higher rates of chronic disease than the general population, and disease burden will likely increase as the prison population continues to age. Despite this, health care services in prison primarily focus on infectious diseases, mental illness, and substance abuse, largely neglecting chronic physical health conditions. The Chronic Disease Self-Management Program (CDSMP) is an evidence-based program developed to support self-management for people with chronic illnesses. At least 10 randomized trials conducted in non-correctional settings have linked CDSMP to disease-related improvements and reduced healthcare expenditures. CDSMP has been used in state corrections systems via 3 approaches: 1) bringing community agency CDSMP leaders into the correctional setting to lead the program, 2) training correctional staff as program leaders, and 3) training incarcerated individuals to serve as peer leaders. To date, however, there has been little research into efficient and effective strategies for scaling up the intervention within state corrections systems using any of these approaches. Scale-up (i.e. deliberate efforts to increase the impact of successfully tested health innovations to benefit more people and promote sustainability) is an understudied concept in implementation science, with few existing empirical studies that explicitly focus on the process of scale-up. Assessing scalability, however, is crucial for ensuring sustainability of complex interventions within resource- poor settings. The research objective of this K01 is to evaluate and maximize the scalability of CDSMP among older adults in state correctional systems. Guided by the Scaling up Management Framework, we will use a mixed methods research approach to query community agency leaders, staff, and incarcerated individuals about ways to maximize the scalability of CDSMP within state correctional settings and develop and refine CDSMP scale-up strategies for these settings. Our goal is to develop scale-up strategies to be evaluated in a subsequent randomized implementation trial. The training objectives of this K01 will add expertise in implementation science and justice-involved research to my existing knowledge base in biopsychosocial models of disease, social gerontology, health disparities, quantitative analysis, and chronic disease management, to reach my goal of becoming an independent researcher who uses implementation science approaches to improve health outcomes among justice-involved populations. As the prison population continues to age, the burden of chronic disease within correctional systems will continue to increase, which contributes to skyrocketing correctional costs. Understanding how to expand evidence-based chronic disease programs within correctional systems is crucial for reducing disease-related morbidity and mortality among incarcerated individuals and for reducing costs. This line of research will identify and test scale-up strategies for chronic disease management in prisons.