Improving Diabetes Self Management in Minorities

改善少数族裔的糖尿病自我管理

• 批准号: 7666922
• 负责人: LAURIE RUGGIERO
• 金额: $ 64.72万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-27 至 2011-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7666922
• 关键词: Absenteeism at work; Administrator; Admission activity; African American; Behavior; Behavioral; Blood Pressure; Caring; Case Management; Chicago; Cholesterol; Clinic; Collaborations; Community Health Networks; Computers; Controlled Study; Data; Diabetes Mellitus; Dietitian; Discipline of Nursing; Distance Education; Distress; Education; Effectiveness; Epidemic; Federally Qualified Health Center; Glycosylated hemoglobin A; Health; Health system; Healthcare; Healthy People 2010; Illinois; Individual; Institutes; Intervention; Latino; Lipids; Low income; Measures; Mediator of activation protein; Medical; Medicine; Minority; Minority Groups; Modeling; Movement; Non-Insulin-Dependent Diabetes Mellitus; Nurses; Ophthalmic examination and evaluation; Outcome; Participant; Pattern; Pharmacists; Physicians; Policy Research; Population; Prevalence; Primary Health Care; Psychology; Public Health Schools; Quality of life; Questionnaires; Randomized; Reporting; Research Infrastructure; Research Personnel; Risk; Sampling; Screening procedure; Self Care; Self Efficacy; Self Management; Site; Specialist; Staging; System; Target Populations; Telephone; Time; Training; Training Support; Translations; Underserved Population; Universities; Visit; Work; base; behavioral health; cost; data management; design; diabetes educator; efficacy trial; evidence base; experience; foot; glycemic control; improved; innovation; meetings; multidisciplinary; primary outcome; programs; prospective; psychosocial; secondary outcome; service utilization; tertiary prevention; treatment as usual; trial comparing

DESCRIPTION (provided by applicant): Diabetes has been identified as an epidemic in the U. S. and is continuing to grow in prevalence, especially type 2 diabetes. In addition, the burden of diabetes, including prevalence and risk of complications, is greater for low-income individuals and minority groups, especially Latinos and African Americans. The Healthy People 2010 report notes that the burden of diabetes can be reduced through secondary and tertiary prevention and facilitating optimal self-management. Few controlled studies have focused on strategies to enhance diabetes self-management in minority or other underserved populations. One approach to increasing our reach and impact is to train nonprofessionals or paraprofessionals to work with multidisciplinary diabetes care teams to support optimal diabetes self-management with minimal added expense. The purpose of this study is to develop, implement, and evaluate the impact of an innovative intervention that combines diabetes self-management education, training, and support with aspects of case management delivered by Medical Assistant Coaches (MACs), to support optimal diabetes self-management (and secondary and tertiary prevention) in low-income minority populations with type 2 diabetes. This efficacy trial compares the Medical Assistant self-management coach (MAC) Intervention with "treatment as usual" (TAU). The target populations will form a total sample of 914 African Americans and Latinos receiving care at five Federally Qualified Health Centers serving low-income individuals in Chicago. The proposed study will use a prospective randomized two-group split-plot repeated measures design. Specifically, it will be a two (treatment groups: TAU, MAC) by four (time: baseline, 6-month, 12-month, 18- month) repeated measures design. The MAC Intervention will be individually tailored based on the Transtheoretical Model and culturally tailored, including Spanish translation where needed. The MAC intervention will be delivered monthly over a one-year period, including both face-to-face contacts during routine primary care visits and regular telephone coaching contacts. The primary outcome variable will be glycemic control measured by HbA1C values. Secondary outcomes include: psychosocial mediators, behavioral outcomes, and short- and longer term biomedical outcomes. If effective in improving glycemic control and/or other measures of diabetes self-management, this intervention has the potential to be easily implemented in other primary care clinics serving minority populations. Furthermore, this intervention has the potential to help contain costs while maximizing our reach and facilitating sustainability.

描述（由申请人提供）：糖尿病已被确定为一种流行病，在美国。S.并且患病率持续增长，尤其是2型糖尿病。此外，糖尿病的负担，包括并发症的患病率和风险，对于低收入个人和少数群体，特别是拉丁美洲人和非洲裔美国人来说更大。《2010年健康人群报告》指出，糖尿病的负担可以通过二级和三级预防以及促进最佳自我管理来减轻。很少有对照研究集中在少数民族或其他服务不足的人群中加强糖尿病自我管理的策略。增加我们的覆盖面和影响力的一种方法是培训非专业人员或准专业人员与多学科糖尿病护理团队合作，以最小的额外费用支持最佳的糖尿病自我管理。本研究的目的是开发，实施和评估一种创新干预措施的影响，该干预措施将糖尿病自我管理教育，培训和支持与医疗助理教练（MAC）提供的病例管理方面相结合，以支持低收入少数人群2型糖尿病的最佳糖尿病自我管理（以及二级和三级预防）。这项疗效试验比较了医疗助理自我管理教练（MAC）干预与“照常治疗”（TAU）。目标人群将形成914名非洲裔美国人和拉丁美洲人的总样本，这些人在芝加哥的五个联邦合格卫生中心接受护理，为低收入个人提供服务。拟定研究将采用前瞻性随机化两组裂区重复测量设计。具体而言，将采用2（治疗组：TAU、MAC）× 4（时间：基线、6个月、12个月、18个月）重复测量设计。MAC干预将根据跨理论模型和文化定制，包括西班牙语翻译。MAC干预将在一年内每月进行一次，包括常规初级保健访视期间的面对面接触和定期电话辅导接触。主要结局变量将是通过HbA 1C值测量的血糖控制。次要结局包括：心理社会中介、行为结局以及短期和长期生物医学结局。如果能有效改善血糖控制和/或其他糖尿病自我管理措施，这种干预措施有可能在其他服务少数群体的初级保健诊所容易实施。此外，这种干预有可能帮助控制成本，同时最大限度地扩大我们的覆盖面并促进可持续性。