An intervention to enhance hypoglycemia communication and preventive action in primary care

加强初级保健中低血糖沟通和预防行动的干预措施

• 批准号: 10621874
• 负责人: Scott Pilla
• 金额: $ 19.71万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-07-15 至 2025-05-14
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10621874
• 关键词: Address; Adult; Area; Blood Glucose; Caring; Chronic Disease; Clinic; Clinical Trials; Communication; Communication Research; Complex; Counseling; Data; Development Plans; Diabetes Mellitus; Electronic Health Record; Endocrine; Enrollment; Ensure; Environment; Event; Evidence based intervention; Evidence based practice; Frequencies; Funding; Goals; Guidelines; Health; Hospitalization; Hyperglycemia; Hypoglycemia; Insulin; Internal Medicine; Interpersonal Relations; Intervention; Intervention Studies; Intervention Trial; K-Series Research Career Programs; Knowledge; Lead; Leadership; Link; Medical center; Mentors; Methodology; Methods; Modification; Morbidity - disease rate; National Institute of Diabetes and Digestive and Kidney Diseases; Outcome; Outcome Measure; Outcomes Research; Patient Outcomes Assessments; Patients; Personal Communication; Persons; Pharmaceutical Preparations; Pilot Projects; Positioning Attribute; Prevention; Prevention strategy; Preventive; Primary Care; Process; Provider; Public Health Schools; Qualitative Methods; Qualitative Research; Recommendation; Recording of previous events; Relationship-Building; Research; Research Methodology; Research Personnel; Research Proposals; Resources; Risk; Sampling; Self Management; Societies; Symptoms; Training; Translating; United States Department of Veterans Affairs; Visit; arm; behavior change; career; career development; clinical encounter; clinical practice; community based participatory research; diabetes mellitus therapy; effective intervention; evidence base; experience; high risk; hospital utilization; improved; insulin secretagogues; mortality; patient-clinician communication; post intervention; prevent; prevention practice; preventive intervention; primary care practice; primary care setting; primary care visit; programs; provider communication; side effect; skills; successful intervention; therapy design; tool

PROJECT SUMMARY / ABSTRACT To achieve optimal care for the half of U.S. adults with diabetes who are treated with insulin or insulin secretagogues, it is crucial to prevent hypoglycemia, which causes substantial morbidity and hospital utilization. However, limited evidence – including our own preliminary analyses – suggests that clinicians do not routinely assess for hypoglycemia and rarely take preventive actions such as modifying diabetes therapy or providing anticipatory guidance for hypoglycemia prevention. The Endocrine Society has called for interventions to improve hypoglycemia prevention in clinical encounters, yet no evidence-based interventions exist. In this proposal, we will fill major gaps in understanding hypoglycemia prevention and patient-provider communication in primary care encounters, and develop a scalable intervention to prevent hypoglycemia that can be integrated into the primary care workflow. Patient-provider communication is especially important for hypoglycemia prevention because it requires clinicians to gather detailed history, convey complex information, and motivate patients to make behavior change. The proposed intervention will build upon effective interventions that improve chronic disease care by using patient reported outcome measures (PROMs) to routinely assess patient symptoms and prompt clinicians to take action addressing them. The specific research aims are: Aim 1) Determine the frequency of hypoglycemia assessment and prevention practices in a national sample of Veterans Affairs primary care visits, and develop a framework for hypoglycemia communication quality. Aim 2) Develop an intervention that integrates PROMs for hypoglycemia assessment into the primary care workflow, linked to a provider toolkit to enhance hypoglycemia communication and prevention practices. Aim 3) To conduct a pilot study to evaluate the feasibility, fidelity, and acceptability of the hypoglycemia prevention intervention developed in Aim 2. These aims lay the groundwork for an R01 application to conduct a definitive clinical trial of the intervention developed here, and address the urgent need for scalable interventions that translate evidence- based practices for hypoglycemia prevention into the primary care setting. Dr. Scott Pilla’s long-term career goal is to become an independent clinician investigator developing and leading interventional research that improves the health of patients with diabetes and their management in primary care. He seeks a K23 mentored career development award to obtain critical skills and experience to lead an independently-funded research program. His career development plan includes didactics and mentored research experience in qualitative and communication research methods, patient reported outcomes research, and the conduct and leadership of clinical trials. This training will occur in the rich environment at Johns Hopkins, including the Division of General Internal Medicine and the Bloomberg School of Public Health. Dr. Pilla will receive guidance from an experienced team of mentors and advisors with expertise in patient-provider communication, qualitative research, and clinical trials, who have a track record of mentoring and funding.

项目概要/摘要 为一半接受胰岛素或胰岛素治疗的美国成人糖尿病患者提供最佳护理 促泌剂，预防低血糖至关重要，低血糖会导致大量发病率和医院利用率。 然而，有限的证据——包括我们自己的初步分析——表明临床医生通常不会 评估低血糖，很少采取预防措施，例如修改糖尿病治疗或提供 预防低血糖的预期指导。内分泌学会呼吁采取干预措施以改善 临床上存在低血糖预防，但尚无循证干预措施。 在这项提案中，我们将填补在理解低血糖预防和患者提供者方面的主要空白 初级保健中的沟通，并制定可扩展的干预措施来预防低血糖 可以集成到初级保健工作流程中。患者与提供者的沟通尤其重要 预防低血糖，因为它需要临床医生收集详细的病史，传达复杂的信息， 并激励患者改变行为。拟议的干预措施将建立在有效干预措施的基础上 通过使用患者报告结果测量 (PROM) 进行常规评估来改善慢性病护理 患者症状并提示临床医生采取行动解决这些问题。具体研究目标是： 目标1) 确定全国退伍军人样本中低血糖评估和预防实践的频率 事务初级保健访问，并制定低血糖沟通质量框架。目标 2) 发展 将用于低血糖评估的 PROM 整合到初级保健工作流程中的干预措施，与 提供者工具包，以加强低血糖沟通和预防实践。目标 3) 进行试点 研究评估低血糖预防干预措施的可行性、保真度和可接受性 目标 2。这些目标为 R01 申请进行最终临床试验奠定了基础 在此制定了干预措施，并解决了对可扩展干预措施的迫切需求，这些干预措施将证据转化为 初级保健机构中预防低血糖的基础实践。 Scott Pilla 博士的长期职业目标是成为一名独立的临床研究人员，开发和 领先的介入研究，改善糖尿病患者的健康及其管理 初级保健。他寻求 K23 指导的职业发展奖，以获得关键技能和经验 领导一个独立资助的研究项目。他的职业发展计划包括教学和指导 在定性和交流研究方法、患者报告结果研究方面的研究经验， 以及临床试验的进行和领导。该培训将在约翰·霍普金斯大学丰富的环境中进行， 包括普通内科和彭博公共卫生学院。皮拉博士将 接受经验丰富的导师和顾问团队的指导，他们具有患者提供者方面的专业知识 沟通、定性研究和临床试验，他们拥有指导和资助的记录。

项目成果

Hospital utilization for hypoglycemia among patients with type 2 diabetes using pooled data from six health systems.

• DOI: 10.1136/bmjdrc-2021-002153
• 发表时间: 2021-12
• 期刊: BMJ open diabetes research & care
• 影响因子: 4.1
• 作者: Pilla SJ;Kraschnewski JL;Lehman EB;Kong L;Francis E;Poger JM;Bryce CL;Maruthur NM;Yeh HC
• 通讯作者: Yeh HC

Trialing precision medicine for type 2 diabetes.

试验 2 型糖尿病的精准医学。

• DOI: 10.1038/s41591-022-02168-5
• 发表时间: 2023
• 期刊: Nature medicine
• 影响因子: 82.9
• 作者: Pilla,ScottJ;Mathioudakis,NestorasN;Maruthur,NisaM
• 通讯作者: Maruthur,NisaM

Assessment and prevention of hypoglycaemia in primary care among U.S. Veterans: a mixed methods study.

• DOI: 10.1016/j.lana.2023.100641
• 发表时间: 2023-12
• 期刊: LANCET REGIONAL HEALTH-AMERICAS
• 作者: Pilla, Scott J.;Meza, Kayla A.;Beach, Mary Catherine;Long, Judith A.;Gordon, Howard S.;Bates, Jeffrey T.;Washington, Donna L.;Bokhour, Barbara G.;Tuepker, Anais;Saha, Somnath;Maruthur, Nisa M.
• 通讯作者: Maruthur, Nisa M.

Stakeholder Perspectives on an Inpatient Hypoglycemia Informatics Alert: Mixed Methods Study.

• DOI: 10.2196/31214
• 发表时间: 2021-11-26
• 期刊: JMIR human factors
• 影响因子: 2.7
• 作者: Mathioudakis N;Aboabdo M;Abusamaan MS;Yuan C;Lewis Boyer L;Pilla SJ;Johnson E;Desai S;Knight A;Greene P;Golden SH
• 通讯作者: Golden SH