Addressing Social Determinants of Health & Diabetes Self-Management in Vulnerable Populations

解决健康的社会决定因素

基本信息

批准号：
9789264
负责人：
Stephanie Lenay Fitzpatrick
金额：
$ 23.7万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-20 至 2021-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9789264
关键词：
Address African American Blood Glucose Self-Monitoring Cardiovascular system Caring Communication Communities Community Health Community Health Aides Community Networks Complications of Diabetes Mellitus Data Diabetes Mellitus Disease Economics Emergency department visit Ethnic Origin Feasibility Studies Future Health Health system Healthcare Systems Hispanics Housing Human Resources Individual Intervention Interview Knowledge Leadership Length Link Literature Low income Measures Medicaid Medical Meta-Analysis Methodology Minority Access Modeling Organizational Change Outcome Participant Patient Self-Report Patients Pharmaceutical Preparations Pharmacy facility Pilot Projects Primary Health Care Process Process Measure Program Sustainability Provider Questionnaires Race Randomized Research Research Design Research Personnel Resources Self Management Social Work Socioeconomic Status Structure Testing Time Training Transportation Use Effectiveness Visit Vulnerable Populations arm base comparative effectiveness compare effectiveness comparison group design diabetes management diabetes risk economic need effective intervention effectiveness trial ethnic minority population evidence base feasibility trial follow-up food insecurity health care service health care service utilization health care settings high risk improved medication compliance patient population programs racial and ethnic randomized trial recruit retention rate social social health determinants success trial design two-arm study

项目摘要

PROJECT SUMMARY/ABSTRACT: Racial/ethnic minorities and low-income individuals are at increased risk for diabetes complications and adverse cardiovascular outcomes. The disparities in diabetes management have been linked to social determinants of health (e.g., food insecurity, inadequate housing, and trouble paying for medical needs). Previous diabetes management studies with racial/ethnic minorities and low-income individuals have generally demonstrated a reduction in A1C when utilizing lay health workers, such as patient navigators and community health workers (CHWs), to address social and economic needs and/or deliver diabetes self-management training. However, methodological limitations, such as lack of randomization or a comparison group and use of lay health workers in different capacities across studies, make it difficult to determine the most effective approach for integrating these personnel in health care settings to help with patient diabetes management. The purpose of this feasibility study is to inform the design of a future large-scale, randomized trial that will test if there is added benefit to addressing both social and economic needs and diabetes self-management to improve diabetes management long-term among vulnerable populations. In this pilot, we will randomize 100 African American, Hispanic, and/or Medicaid (all race/ethnicities) patients from Kaiser Permanente Northwest (KPNW) with A1C ≥ 8 and poor follow-up in primary care to one of two 6-month interventions: 1) patient navigation only; or 2) patient navigation + diabetes self-management training. In both study arms, KPNW practice-embedded patient navigators will screen for medical, social and economic needs and connect participants to internal and external resources. In the second study arm, navigators will also refer participants to CHWs embedded in local community-based organizations, who will deliver diabetes self- management training. Feasibility of the full-scale trial will be based on several measures including recruitment, retention, success rate of referrals to navigators and CHWs, and whether medical, social, and/or economic needs are met. Qualitative interviews will be conducted with various stakeholders to assess intervention acceptability and determinants of implementation. Preliminary effects on A1C, diabetes-related care gaps, health care utilization, and medication adherence will also be examined. This pragmatic study design involves a collaborative effort among researchers, health system staff, health system senior leadership, and local community-based organizations. Findings from the full-scale trial will contribute critical knowledge on the most effective, sustainable model of care for integrating lay health workers in the efforts to improve diabetes management among high risk patient populations.

项目摘要/摘要：种族/族裔少数民族和低收入个人正在增加糖尿病并发症和不良心血管结局的风险。糖尿病的分布管理层与卫生的社会决定者有关（例如粮食不安全，住房不足，以及为医疗需求支付的麻烦）。以前的糖尿病管理研究使用外行健康时，低收入个人通常表现出A1c的减少工人，例如患者导航员和社区卫生工作者（CHW），以解决社会和经济需要和/或提供糖尿病自我管理培训。但是，方法论上的局限性，例如缺乏随机化或比较组以及在研究中不同能力的外行卫生工作者的使用，很难确定将这些人员整合到医疗保健中的最有效方法帮助患者糖尿病管理的设置。这项可行性研究的目的是为未来的大规模，随机试验的设计提供信息测试是否有增加满足社会和经济需求和糖尿病自我管理的好处在脆弱人群中长期改善糖尿病管理。在这个飞行员中，我们将随机分组 100非裔美国人，西班牙裔和/或医疗补助（所有种族/民族）患者来自Kaiser Permanente 西北（KPNW），A1C≥8，初级保健的随访较差，达到了两个6个月的干预措施之一：1）仅患者导航；或2）患者导航 +糖尿病自我管理培训。在两个学习臂中， KPNW练习包裹的患者导航员将筛选出医疗，社会和经济需求，并且将参与者与内部和外部资源联系起来。在第二个研究部门，导航员也将参考嵌入本地社区组织的CHW的参与者，他们将提供糖尿病自我管理培训。全面试验的可行性将基于多种措施招聘，保留率，推荐向导航员和CHW的成功率，以及医疗，社会和/或满足经济需求。定性访谈将与各种利益相关者进行评估干预可接受性和确定实施。对A1C，糖尿病相关的初步影响还将检查护理差距，医疗保健利用和药物依从性。这项务实的研究设计涉及研究人员，卫生系统员工，卫生系统高级的合作努力领导力和本地社区组织。全面试验的发现将有助于关键了解最有效，可持续的护理模型，用于整合外行卫生工作者，以努力改善高风险患者人群中的糖尿病管理。