Research Project 1

项目总结/摘要 与非西班牙裔白人相比，南亚裔美国人的糖尿病患病率更高， 种族/少数民族群体。然而，很少有文化和语言适应 对这一人群进行糖尿病管理的干预措施。社区卫生工作者（CHW）的方法 在非洲裔美国人和拉丁裔人群中证明了糖尿病控制的有效性，但尚未被证实。 在南亚社区进行了系统的调整和测试。最近扩大电子医疗的努力 记录（EHR）系统，并利用数据基础设施， 以病人为中心的护理强调了通过CHW加强护理协调团队的潜力 为服务不足的人群提供融合服务。然而，糖尿病管理的上游决定因素是 通常被视为在临床环境之外，并且在护理背景下未得到解决。通过连接社区 和卫生保健系统，社区卫生工作者可以帮助解决这些决定因素。有效联系初级教育的机制 医疗保健系统、社区卫生工作者和社区资源可以通过卫生信息技术加速发展 (HIT)工具. 在Nadia Islam博士的领导下，拟议的项目利用了一个完善的多部门和社区- 参与合作，以改善纽约市南亚糖尿病患者的糖尿病管理。 本项目将评估多层次干预措施的有效性和实施过程， 南亚糖尿病患者的糖尿病管理。综合干预解决了 多层次和多领域的影响，如NIMHD少数民族健康与健康框架所述 差异：1）基于EHR的登记系统，以识别不受控制的糖尿病患者; 2）文化和 语言适应CHW主导的干预，旨在改善患者的糖尿病自我管理 3）与具有文化相关性的社区一级资源建立联系 使用HIT工具;和4）CHW整合到初级保健团队。该项目的具体目标是： 与常规护理相比，测试多水平糖尿病管理干预的有效性; 2）使用 采用混合方法系统评估执行进程和确定因素 影响临床和社区环境中干预措施的采用、忠实性和维持。 使用阶梯楔形设计，我们将在25年内招募3，994名患有未控制糖尿病的南亚患者， 初级保健实践设置。这项研究将为在高危人群中管理糖尿病的努力提供信息。我们 还将产生一个可复制和可持续的模式，用于医疗保健和社区环境 使易受伤害的人口参与，这种做法在预防和管理其他 慢性疾病，包括心血管疾病和癌症。

Project Summary/Abstract South Asian Americans have higher diabetes prevalence compared with non-Hispanic whites, other Asian groups, and racial/ethnic minority groups. However, there are few culturally and linguistically adapted interventions for diabetes management for this population. Community health worker (CHW) approaches have demonstrated efficacy for diabetes control in African American and Latino populations, but have not been systematically adapted and tested in South Asian communities. Recent efforts to expand electronic health record (EHR) systems across health care delivery organizations and harness that data infrastructure for patient-centered care have underscored the potential of strengthening care coordination teams through CHW integration for underserved populations. However, the upstream determinants of diabetes management are often viewed as outside of the clinical setting and not addressed in the context of care. By bridging community and health care systems, CHWs can help address these determinants. Mechanisms to effectively link primary care systems, CHWs, and community resources can be accelerated through health information technology (HIT) tools. Led by Dr. Nadia Islam, the proposed project leverages a well-established multi-sector and community- engaged collaboration to improve diabetes management among New York City South Asians with diabetes. This project will evaluate the effectiveness and implementation process of a multi-level intervention to support diabetes management for South Asian patients with uncontrolled diabetes. The integrated intervention tackles multiple levels and domains of influence as described in the NIMHD Framework on Minority Health & Health Disparities: 1) EHR-based registry system to identify patients with uncontrolled diabetes; 2) Culturally and linguistically adapted CHW-led intervention designed to improve self-management of diabetes among patients using individual and family-based approaches; 3) Linkage to culturally relevant community-level resources using HIT tools; and 4) CHW-integration into primary care teams. The specific aims of the project are to: 1) Test the effectiveness of a multi-level diabetes management intervention compared to usual care; and 2) Use a mixed-methods approach to systematically assess the implementation process and delineate factors influencing adoption, fidelity, and maintenance of the intervention within clinical and community settings. Using a stepped wedge design, we will enroll 3,994 South Asian patients with uncontrolled diabetes in 25 primary care practice settings. This study will inform efforts to manage diabetes in a high-risk population. We will also generate a reproducible and sustainable model for use in healthcare and community settings engaging vulnerable populations that can potentially be replicated for the prevention and management of other chronic diseases, including cardiovascular disease and cancer.