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

项目概要/摘要 被监禁者患慢性病的比例高于一般人群，而且疾病 随着监狱人口继续老龄化，负担可能会增加。尽管如此，监狱内的医疗保健服务 主要关注传染病、精神疾病和药物滥用，很大程度上忽视了慢性身体疾病 健康状况。慢性病自我管理计划 (CDSMP) 是一项循证计划 旨在支持慢性病患者的自我管理。至少进行了 10 项随机试验 在非惩教环境中，CDSMP 与疾病相关的改善和减少的医疗保健联系起来 支出。 CDSMP 已通过 3 种方法用于州惩戒系统：1) 引入社区 机构 CDSMP 领导者进入惩教环境领导该计划，2) 培训惩教人员作为计划 领导者，以及 3) 培训被监禁者担任同侪领导者。但迄今为止，还很少有 研究扩大国家惩教系统内干预的高效和有效的战略 使用这些方法中的任何一种。扩大规模（即刻意努力增加成功测试的影响 健康创新以造福更多人并促进可持续发展）是一个未被充分研究的概念 实施科学，现有的实证研究很少明确关注扩大规模的过程。 然而，评估可扩展性对于确保资源范围内复杂干预措施的可持续性至关重要。 糟糕的设置。 K01 的研究目标是评估和最大化 CDSMP 的可扩展性 国家惩教系统中的老年人。在扩展管理框架的指导下，我们将使用 混合方法研究方法，询问社区机构领导、工作人员和被监禁人员的相关信息 在州惩教环境中最大限度地提高 CDSMP 的可扩展性以及开发和完善 CDSMP 的方法 这些设置的扩展策略。我们的目标是制定扩大规模的战略，并在后续的评估中进行评估 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 以及涉及正义的研究，以我现有的疾病生物心理社会模型知识库，社会 老年学、健康差异、定量分析和慢性病管理，以实现我的目标 成为一名独立研究人员，使用实施科学方法来改善健康结果 在参与正义的人群中。随着监狱人口持续老龄化，慢性病的负担 惩教系统内的犯罪率将继续增加，这导致惩教成本飙升。 了解如何在惩教系统内扩大循证慢性病项目至关重要 减少被监禁者中与疾病相关的发病率和死亡率并降低成本。这个 研究方向将确定并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.