Putting Telehealth to the Test: An Evaluation of the Use of Telehealth to Increase the Population-Level Impact of an Employer-Based Diabetes Prevention Program

测试远程医疗：评估使用远程医疗来增加基于雇主的糖尿病预防计划的人群影响

• 批准号: 10632758
• 负责人: Rosette J Chakkalakal
• 金额: $ 37.11万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-12 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10632758
• 关键词: Acute; Address; Adult; Age; American; Black race; Blood Pressure; Body mass index; COVID-19; COVID-19 diagnosis; COVID-19 morbidity; COVID-19 mortality; COVID-19 test; Censuses; Chronic Disease; Clinical; Clinical Research; Code; Data; Data Analyses; Data Set; Data Sources; Diabetes Mellitus; Diagnosis; Education; Electronic Health Record; Employment; Ethnic Origin; Florida; Healthcare; Hispanic; Hospitalization; Hospitals; Housing; Incidence; Income; Individual; Infection; Inpatients; Knowledge; Laboratories; Link; Low-Density Lipoproteins; Methods; Minority; Minority Groups; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Outpatients; Patients; Persons; Pharmaceutical Preparations; Phase; Population; Population Analysis; Population Heterogeneity; Post-Acute Sequelae of SARS-CoV-2 Infection; Predisposition; Prevalence; Privatization; Procedures; Public Health; Race; Recommendation; Records; Reporting; Retrospective cohort; Retrospective cohort study; Risk; Risk Assessment; Risk Factors; SARS-CoV-2 infection; SARS-CoV-2 negative; SARS-CoV-2 positive; Severities; Site; Social Environment; Source; System; Test Result; Trust; Uninsured; Woman; base; blocking factor; built environment; cardiometabolic risk; care seeking; cohort; computable phenotypes; coronavirus disease; demographics; diabetes prevention program; diabetes risk; ethnic difference; ethnic diversity; ethnic minority; evaluation/testing; experience; follow-up; hispanic community; male; metropolitan; minority communities; mortality; pandemic disease; patient oriented; patient population; post SARS-CoV-2 infection; racial and ethnic; racial and ethnic disparities; racial minority; screening; screening guidelines; sex; social vulnerability; study population; telehealth; young adult; young woman

PROJECT SUMMARY Recent reports of type 2 diabetes (T2DM) as a post-acute sequela of SARS-CoV-2 infection (PASC, clinical findings lasting beyond 30 days of infection) highlight the urgent public health need to better understand and characterize the potential association between COVID-19 and T2DM. Prior studies of PASC-associated T2DM among adults living in the US have analyzed data from populations with limited racial/ethnic diversity, making the results difficult to generalize to Black and Hispanic communities that experience disproportionately higher rates of SARS-CoV-2 infection, COVID-19-related morbidity and mortality, and T2DM in the US. To advance our understanding of T2DM risk after SARS-CoV-2 infection in racial and ethnic minority communities, we will conduct a retrospective cohort study using the OneFlorida+ Data Trust, a Clinical Research Network (CRN) within the National Patient-Centered Clinical Research Network (PCORnet) that contains patient-level electronic health record (EHR) data for a diverse population of 19.2 million Americans seeking care in all major metropolitan regions in Florida (the state with the 3rd highest number of COVID cases in the US) as well as Atlanta, GA and Birmingham, AL. The association between SARS-CoV-2 infection and incident T2DM has yet to be empirically quantified by race and/or ethnicity using rigorous methods and relevant variables (social vulnerability and individual susceptibility factors) for diverse populations, despite the markedly higher rates of COVID-19 and T2DM in minority communities. We will employ a rigorous analytic approach that utilizes high- quality data available for both individual susceptibility and social vulnerability factors in the OneFlorida+ Data Trust, a dataset that includes large proportions of minority groups (24% Hispanic, 18% Black), to address this critical gap in knowledge. In addition to standard EHR data such as diagnosis/procedure codes, laboratory values, medications, patient demographics, and vital signs, the OneFlorida+ Data Trust includes linkages to exposome data on the natural, built, and social environments. Additional strengths of the OneFlorida+ Data Trust for this project include availability of validated computable phenotypes (CPs) for diabetes to reduce the chance of outcome misclassification; differentiation of healthcare encounter types; larger proportions of young adults and women than prior studies of PASC-associated T2DM; diverse payer sources; and the capacity to link patient records across OneFlorida+ Data Trust contributing sites. Our specific aims are (1) to assess racial/ethnic differences in PASC-associated T2DM incidence in a retrospective cohort using the OneFlorida+ Data Trust and (2) to compare changes in cardiometabolic risk factors following SARS-CoV-2 infection by race/ethnicity in a retrospective cohort using the OneFlorida+ Data Trust. This study will fill critical knowledge gaps in the potential association between COVID-19 and new-onset T2DM in racial and ethnic minority communities. The findings will directly inform diabetes screening recommendations in the rapidly growing population of patients experiencing PASC.

项目摘要 最近的2型糖尿病（T2DM）作为SARS-COV-2感染后急性后遗症的报道（PASC，临床 持续30天感染的发现）强调了紧急公共卫生需要更好地理解和 表征COVID-19和T2DM之间的潜在关联。 PASC相关T2DM的先前研究 在美国居住的成年人中，分析了种族/种族多样性有限的人群的数据，使 结果很难推广到黑人和西班牙裔社区，这些社区的经历不成比例不成比例 美国SARS-COV-2感染的发生率，与19岁相关的发病率和死亡率以及美国T2DM的发生率。前进 我们对种族和少数民族社区SARS-COV-2感染后T2DM风险的理解，我们将 使用Oneflorida+ Data Trust，临床研究网络（CRN）进行回顾性队列研究 在包含患者级的国家以患者为中心的临床研究网络（PCORNET）中 电子健康记录（EHR）数据，可用于在所有主要专业中寻求护理的1,920万美国人的多样化人群 佛罗里达州的大都市地区（美国案件的最高数量）以及 佐治亚州亚特兰大和阿拉巴马州伯明翰。 SARS-COV-2感染与事件T2DM之间的关联尚未 使用严格的方法和相关变量（社会 脆弱性和个人敏感性因素）对于不同种群的人口），尽管率明显更高 少数民族社区的Covid-19和T2DM。我们将采用一种严格的分析方法，利用高 在Oneflorida+数据中，可用于个人易感性和社会脆弱性因素的质量数据 信任，包括大量少数群体（24％西班牙裔，18％黑色）的数据集，以解决这个问题 知识的关键差距。除了标准EHR数据（例如诊断/程序代码）外，实验室 价值，药物，患者人口统计和生命体征，Oneflorida+数据信任包括与 关于自然，建筑和社会环境的揭示数据。 Oneflorida+数据的其他优势 该项目的信任包括糖尿病的经过验证的可计算表型（CPS）的可用性，以减少 结果错误分类的机会；医疗保健遭遇类型的区分；年轻的比例较大 成人和女性比先前对PASC相关T2DM的研究；多样化的付款人来源；以及能力 链接Oneflorida+ Data Trust构成网站的患者记录。我们的具体目的是（1）评估 使用Oneflorida+ 数据信任和（2）比较SARS-COV-2感染后心脏代谢风险因素的变化 使用OneFlorida+数据信任的回顾人群中的种族/民族。这项研究将填补关键知识 Covid-19与种族和少数民族新闻T2DM之间潜在关联的差距 社区。这些发现将直接告知糖尿病筛查建议 经历PASC的患者人群。