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

项目概要/摘要：种族/少数民族和低收入个人的人数增加， 糖尿病并发症和不良心血管结局的风险。糖尿病的差异 管理与健康的社会决定因素有关（例如，粮食不安全，住房不足， 以及支付医疗费用的困难）。既往在少数种族/民族中进行的糖尿病管理研究 低收入人群在使用非专业医疗服务时， 工作人员，如病人导航员和社区卫生工作者（CHW），以解决社会和经济问题， 需要和/或提供糖尿病自我管理培训。然而，方法上的局限性，如缺乏 随机分组或对照组以及在研究中以不同身份使用非专业卫生工作者， 难以确定将这些人员纳入卫生保健的最有效方法， 帮助患者进行糖尿病管理。 这项可行性研究的目的是为未来的大规模随机试验设计提供信息， 测试满足社会和经济需求以及糖尿病自我管理是否有额外的好处 改善脆弱人群的糖尿病长期管理。在这个试点中，我们将随机 来自Kaiser Permanente的100名非裔美国人、西班牙裔和/或Medicaid（所有人种/种族）患者 西北地区（KPNW），A1 C ≥ 8，两种6个月干预措施之一的初级保健随访较差：1） 仅患者导航;或2）患者导航+糖尿病自我管理培训。在两个研究组中， KPNW实践嵌入式患者导航器将筛选医疗，社会和经济需求， 将参与者与内部和外部资源联系起来。在第二个研究组中，导航员还将参考 参与者的CHW嵌入在当地社区为基础的组织，谁将提供糖尿病自我， 管理培训。全面试验的可行性将基于几项措施，包括 招募、保留、向导航员和社区卫生工作者转介的成功率，以及医疗、社会和/或 经济需求得到满足。将与各利益攸关方进行定性访谈， 干预的可接受性和实施的决定因素。对A1 C的初步影响，糖尿病相关 还将审查护理差距、卫生保健利用率和药物依从性。这一务实的研究 设计涉及研究人员、卫生系统工作人员、卫生系统高级官员 领导和当地社区组织。全面试验的结果将有助于 了解最有效、可持续的护理模式，以便将非专业卫生工作者纳入努力， 改善高危患者人群糖尿病管理。

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.