Adapting and assessing the feasibility of a diabetes self-management education and support telehealth intervention for rural populations to reduce disparities in diabetes care

项目摘要 糖尿病患病率较高的农村地区，有较低的资源，糖尿病自我管理教育 和支持（DSMES），最佳糖尿病管理的基石。一个时间效率高的DSMES程序 由多学科专家通过远程保健提供，也鼓励护理伙伴和同伴的支持， 创造性的解决方案，以增加获得DSMES和减少差距。这项研究是由 研究、有效性、采用、实施和维护（RE-AIM）框架。具体地说， 参与者和护理伙伴将在农村诊所接受一次性的8小时远程保健干预， 他们得到多学科小组的常规护理。农村临床实践将提供反馈 分三轮进行，并进行迭代实践层面的更改，以解决流程和/或工作流问题。我们的整体 目标是调整、实施、改进和评估通过远程医疗提供的时间效率高的DSMES计划 由多学科专家组成的团队，鼓励护理伙伴和同伴支持，以改善A1 C， 在农村社区开展糖尿病自我管理，以减少差距。我们的多学科团队包括 具有糖尿病护理、DSMES交付、社区- 参与研究、基于实践的研究和农村卫生问题。犹他州和高平原大学 研究网络为这一特定的研究提供了一个强大的环境。拟议的研究将1）调整 退出糖尿病一日计划（D1 D），用于农村社区（农村糖尿病一日计划或 R-D1 D），2）在参与者和实践层面实施、完善和评估R-D1 D，以及3）进行 RE-AIM有效性（患者结局）和维持维度的探索性评价 （实践成果）。我们的最终目标是通过增加获得服务的机会， 糖尿病专科护理使用远程保健。初步数据支持D1 D干预，但需要 适应转化为农村人口，然后在实践层面反复完善，以支持长期 上维护这样一种经过测试的、被接受的干预措施应该对糖尿病自身有有益的影响。 管理多个农村地区。

Project Summary Diabetes prevalence is higher in rural areas that have lower resources to diabetes self-management education and support (DSMES), a cornerstone to optimal diabetes management. A time efficient DSMES program delivered via telehealth by multidisciplinary experts that also encourages care partner and peer support is a creative solution to increasing access to DSMES and reducing disparities. This study is guided by the Research, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Specifically, participants and care partners will receive a one-time, 8-hour telehealth intervention at the rural clinic where they receive their usual care, from the multidisciplinary team. The rural clinical practices will provide feedback in three rounds, with iterative practice-level changes, to address process and/or workflow issues. Our overall objective is to adapt, implement, refine, and evaluate a time efficient DSMES program delivered via telehealth by a team of multidisciplinary experts that encourages care partner and peer support to improve A1C and diabetes self-management in rural communities to reduce disparities. Our multidisciplinary team includes researchers and clinical healthcare providers with experience in diabetes care, DSMES delivery, community- engaged research, practice-based research, and rural health issues. The University of Utah and High Plains Research Network provide a strong environment for this particular study. The proposed study will 1) adapt the exiting Diabetes One-Day Program (D1D) for use in rural communities (Rural Diabetes One-Day Program or R-D1D), 2) implement, refine, and evaluation R-D1D at the participant and practice level, and 3) conduct an exploratory evaluation of the RE-AIM dimensions of effectiveness (patient outcomes) and maintenance (practice outcomes). Our ultimate goal is to reduce health disparities in rural populations by increasing access to diabetes specialty care using telehealth. Preliminary data support the D1D intervention, but will require adaptation to translate for rural populations, then iterative refinement at the practice level to support long-term maintenance. Such a tested, accepted intervention should have a beneficial effect on diabetes self- management across multiple rural locations.