VIDA: Virtual Diabetes Group Visits Across Health Systems

项目摘要 在美国的3000万糖尿病成年人中，97%至少有一种合并症（例如， 高血压、心脏病、肾病）。DM和DM相关并发症不成比例地影响人们 颜色。西班牙裔美国人（12.5%）和非洲裔美国人（11.7%）的糖尿病患病率高于 非西班牙裔白人（7.5%）;西班牙裔和非洲裔美国人有更高的糖尿病相关 并发症，包括截肢和慢性肾病。小组访视（GV）可以为患者提供全面的 照顾他们的多重慢性病。糖尿病GVs-共享预约，患者接受自我- 在小组环境中的管理教育和个人医疗访问-可以改善血糖控制， 降低医疗保健利用率，并提供社会支持和同伴之间的共同学习。而虚拟 在COVID-19大流行期间，预约已成为临床护理的常规部分，通过虚拟 平台仍然不常见，研究不足。在模型被广泛采用之前，重要的问题是 关于虚拟糖尿病GV模型的有效性和实施需要解决。我们提出 建立在一个既定的计划，在人的糖尿病GV和虚拟糖尿病GV试点的大学 芝加哥和中西部临床医生网络的我们的目标是实现虚拟GV模型（维达：虚拟糖尿病 在芝加哥地区的两个不同的卫生系统：访问和 奥罗拉健康倡导者（AAH）。ACCESS是美国最大的联邦合格健康中心（WHEHC）之一。 美国在芝加哥大都市区设有35个站点，为175，000名医疗服务不足的人提供护理， 低收入患者，包括25，000多名糖尿病患者。倡导Aurora Health（AAH） 一个大型的，多样化的，综合性的私人非营利卫生系统，在伊利诺伊州拥有超过129个初级保健诊所 为超过117，000名糖尿病患者提供服务。培训、实施和评估虚拟团体访问的能力 在两个不同的卫生系统提供了一个独特的机会，了解适应和障碍， 促进方案实施。本研究将采用I型混合有效性-实施设计 通过一项实用的随机分组试验，评估成人T2 DM患者的临床结局变化， 虚拟糖尿病GVs与常规护理。我们将首先在一个ACCESS NHC中心调整和实施维达 和一个AAH初级保健诊所使用复杂健康干预的形式和功能域 框架.我们将评估维达与临床工作流程的整合，并确定 需要培训和技术支持，以协助工作人员将虚拟糖尿病GV整合到临床环境中。我们 然后，我将在9个干预部位（180名成人患者）进行虚拟GV的实用性群集随机试验 A1 C>9%的T2 DM患者）和9个对照部位（360名匹配患者），并评估A1 C较基线的变化 至12个月，以及其他临床结局的变化，包括收缩压和体重指数。我们 将使用RE-AIM框架评估跨系统虚拟GV的采用、实施和维护。

PROJECT SUMMARY Of the 30 million adults with DM in the United States, 97% have at least one comorbid condition (e.g. hypertension, heart disease, kidney disease). DM and DM-related complications disproportionately affect people of color. The prevalence of DM is higher among Hispanics (12.5%) and African-Americans (11.7%) compared to non-Hispanic whites (7.5%); Hispanics and African-Americans have higher rates of diabetes-related complications, including amputations and CKD. Group visits (GVs) can provide patients with comprehensive care for their multimorbid chronic condition. Diabetes GVs—shared appointments where patients receive self- management education in a group setting and an individual medical visit—can improve glycemic control, decrease healthcare utilization, and provide social support and co-learning among peers. While virtual appointments have become a routine part of clinical care during the COVID-19 pandemic, group visits via virtual platforms remain uncommon and understudied. Before the model can be widely adopted, important questions about the effectiveness and implementation of the virtual diabetes GV model need to be addressed. We propose to build on an established program of in-person diabetes GVs and a virtual diabetes GV pilot by the University of Chicago and MidWest Clinician’s Network. We aim to implement the virtual GV model (VIDA: Virtual Diabetes Group Visits Across Health Systems) in two distinct health systems in the Chicago region: ACCESS and Advocate Aurora Health (AAH). ACCESS is one of the largest federally qualified health centers (FQHCs) in the U.S. with 35 sites across the Chicago metropolitan area, providing care for 175,000 medically underserved and low-income patients each year, including over 25,000 patients with diabetes. Advocate Aurora Health (AAH) is a large, diverse, integrated private not-for profit health system with more than 129 primary care clinics in Illinois serving over 117,000 patients with diabetes. The ability to train, implement and evaluate virtual group visits across two distinct health systems provides a unique opportunity to learn about adaptation and the barriers and facilitators for program implementation. This study will use a type I hybrid effectiveness-implementation design via a pragmatic cluster randomized trial to assess changes in clinical outcomes among adults with T2DM in virtual diabetes GVs versus usual care. We will first adapt and implement VIDA at one ACCESS FQHC center and one AAH primary care clinic using the Form and Function domains of the Complex Health Intervention Framework. We will assess integration of VIDA into clinical workflow and determine the type of and amount of training and technical support needed to assist staff in integrating virtual diabetes GV into the clinical setting. We will then conduct a pragmatic cluster randomized trial of virtual GVs across 9 intervention sites (180 adult patients with T2DM with A1C >9%) and 9 control sites (360 matched patients) and assess change in A1C from baseline to 12-months and change in other clinical outcomes including systolic blood pressure and body mass index. We will assess adoption, implementation, and maintenance of virtual GVs across systems using RE-AIM framework.