Improving glycemic control among underserved patients with insulin-treated type 2 diabetes through nurse-led, app-based behavioral intervention

通过护士主导、基于应用程序的行为干预，改善接受胰岛素治疗的 2 型糖尿病患者的血糖控制

• 批准号: 10591769
• 负责人: Helen Nai-Chi Chen
• 金额: $ 16.24万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-20 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10591769
• 关键词: Address; Area; Award; Behavior; Behavior Therapy; Blood Glucose; Care given by nurses; Caring; Cellular Phone; Characteristics; Chronic Disease; Clinic; Clinical; Collaborations; Complex; Coping Skills; Cultural Sensitivity; Data; Development; Diabetes Mellitus; Diet; Disease; Disease Management; Documentation; Education; Educational Materials; Educational Technology; Electronic Health Record; Electronics; Environment; Evaluation; Event; Evidence based intervention; Exercise; Face; Failure; Feedback; Focus Groups; Funding; Future; Goals; Health Services Accessibility; Health system; Indiana; Informatics; Insulin; Intervention; Manuals; Mentors; Methods; Modeling; Neighborhoods; Non-Insulin-Dependent Diabetes Mellitus; Nurses; Outcome; Participant; Patient Education; Patients; Pharmaceutical Preparations; Phase; Pilot Projects; Population; Population Characteristics; Practice Guidelines; Problem Solving; Procedures; Protocols documentation; Public Health Informatics; Qualitative Methods; Recommendation; Reduce health disparities; Registries; Reporting; Research; Resources; Secure; Self Management; Technology; Therapeutic; Time; Training; Universities; Visit; Work; Writing; barrier to care; biomedical informatics; career; data exchange; design; diabetes educator; effectiveness evaluation; effectiveness testing; experience; family management; food insecurity; glycemic control; health care quality; health disparity; health information technology; health management; high risk; implementation science; implementation strategy; improved; improved outcome; low health literacy; low socioeconomic status; member; minority health; minority health disparity; operation; patient engagement; patient outreach; patient portal; patient-clinician communication; pilot test; population health; pragmatic trial; programs; recruit; remote monitoring; remote patient monitoring; social determinants; technology validation; therapy development; tool; transmission process; virtual

“Therapeutic inertia,” defined as a lack of timely adjustment to therapy when a patient’s treatment goals are not met, is a major cause of poor outcomes in Type 2 Diabetes (T2D). This is especially true for low socioeconomic status (low-SES) populations, who often face barriers to effective disease self-management at three levels: (1) patient (e.g., limited resources, low health literacy, and limited access to care); (2) clinician (e.g., lack of time and/or poor cultural sensitivity); and (3) health system (e.g., poor or absent decision support and effective patient panel management). One way to address the complex challenges of chronic disease management at these three levels is with multi-level health information technology (HIT)-supported behavioral interventions. Such interventions combine changes to clinical workflows and self-management support to help patients track diabetes electronically, transmit data to clinicians, and receive feedback for adjusting treatment. Currently, minimal data exist to inform optimal design, implementation, and use of such multi-level behavioral interventions, particularly for low-SES populations. My career goal is to establish an independently funded research program that helps decrease health disparities using technologies that support effective long-term self-management and improve outcomes. In this project, I propose a 5-year training and research plan for a multi-level app-based intervention to improve outcomes for T2D in low-SES populations. I will develop and pilot-test a nurse-led, app-based behavioral intervention consisting of three evidence-based interventions: (1) education on A1C results and goal setting via MyChart, the patient portal in the Epic electronic health record; (2) a problem-solving action plan developed by clinicians in collaboration with their patients; and (3) remote monitoring via OnTrack, a top-rated diabetes app, to analyze blood glucose and identify the need to adjust treatment. Training in population health informatics, HIT implementation science, health disparities, and pragmatic trials will not only allow me to complete the proposed project, but will set the stage for expanding the concept to other diseases and clinical use cases. Indiana University and the Regenstrief Institute, an informatics powerhouse, plus a strong team of mentors in biomedical informatics, HIT implementation, health disparity, and qualitative methods, provide an exceptional scientific environment. The proposed work includes: (1) time-to-event analysis to understand population characteristics associated with persistent therapeutic inertia, used to guide intervention development and tailoring [Aim 1]; (2) input from diabetes care team to adapt the intervention and implementation strategies to the clinical operations level [Aim 2]; (3) a focus group study with low-SES patients to help tailor the intervention [Aim 3]; and (4) a pilot study at two clinics (n=60, 30 patients per clinic) to assess the feasibility of the intervention for low-SES patients with insulin-treated T2D [Aim 4]. The project will support a future R01 application for a pragmatic trial to assess the effectiveness of a multi-level app-based behavioral intervention for low-SES populations with T2D.

“治疗惯性”的定义是当患者的治疗目标没有达到时，对治疗缺乏及时的调整