Implementing a Diabetes Screening and Referral Service Developed for Dental Clinics Within an Urban Alaska Native Health Care Setting

项目总结/摘要-RP 1 阿拉斯加原住民和美洲印第安人（ANAI）患糖尿病（DM）的风险增加， 风险因素的普遍性。最近的研究表明，糖尿病的患病率和发病率正在上升， 阿拉斯加ANAI人群中的DM与美国其他群体一样大，如果不是更大的话。此外，40% 的糖尿病未被诊断，从而增加了糖尿病并发症的风险。由于DM并发症开始发展 在糖尿病前期，早期筛查和干预可以预防或延迟糖尿病及其并发症的发生。 “实施糖尿病筛查和转介服务开发的牙科诊所在城市 阿拉斯加原住民医疗保健环境”是一项为期4年的研究，将使用实施科学框架来评估 中南基金会（SCF）内DM测试的可接受性、适用性、可行性和后果 牙科诊所。SCF是一个部落卫生组织，为ANAI人提供初级保健和牙科服务。 居住在阿拉斯加州安克雷奇市-全州近一半的ANAI人口的家园。 研究表明，在给定的一年中，27%的成年人没有与医疗服务提供者接触， 去看牙医。糖尿病与牙周病的双向关系 表明牙科访问提供了一个很大程度上尚未开发的机会，筛选糖尿病风险的人，并将他们转介 到初级保健提供者进行随访和治疗。这种机会在SCF得到了加强，因为牙科和 初级保健服务在同一封闭的部落保健系统内提供。 我们建议采用内部职位设计，并分阶段研究如何推行一个有实证依据的 基于预防服务-糖尿病筛查，简短的干预，并转介到初级保健-提供了一个新的 环境牙科诊所经验丰富的临床和实施研究专家将与多个 利益攸关方使用两个理论和互补的传播和实施科学框架： 覆盖、有效性、采用、实施、维护（RE-AIM）和 实施研究（CFIR），以实现三个具体目标（SA）：SA 1：确定障碍和促进因素 在SCF牙科和初级保健诊所内实施糖尿病筛查和转诊服务。SA2： 发展牙科诊所糖尿病筛查和转诊服务，最大限度地减少障碍，并利用调解人 在SA 1中识别。SA 3：试点、评估和迭代地完善所提供的糖尿病筛查和转诊服务 SCF牙科诊所

PROJECT SUMMARY/ABSTRACT – RP1 Alaska Native and American Indian (ANAI) people are at increased risk for diabetes (DM) with documented prevalence of risk factors. Recent studies show that DM prevalence and incidence are rising and rates of pre- DM among the ANAI population in Alaska are as great, if not greater, than other U.S. groups. Additionally, 40% of DM is undiagnosed, thus increasing risk for DM complications. Since DM complications begin to develop during pre-DM, early screening and intervention can prevent or delay DM onset and its complications. “Implementing a Diabetes Screening and Referral Service Developed for Dental Clinics within an Urban Alaska Native Health Care Setting” is a 4-year study that will use implementation science frameworks to assess acceptability, applicability, feasibility, and consequences of DM testing within Southcentral Foundation (SCF) Dental Clinics. SCF is a Tribal health organization providing primary care and dental services to ANAI people living within the urban Anchorage, Alaska area – home to nearly half of the ANAI population statewide. Research indicates that in a given year, 27% of adults who do not have contact with a medical provider did visit a dental provider. The well-documented bidirectional relationship between DM and periodontal disease suggests that dental visits offer a largely untapped opportunity to screen persons at risk for DM and refer them to primary care providers for follow up and treatment. This opportunity is enhanced at SCF because dental and primary care services are provided within the same closed Tribal health system. We propose a within-site post design, and phased approach to study the implementation of an evidenced- based preventive service – DM screening, brief intervention, and referral to primary care – delivered in a novel setting, dental clinics. Experienced clinical and implementation research experts will work with multiple stakeholders using two theoretical and complimentary dissemination and implementation science frameworks: Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) and the Consolidated Framework for Implementation Research (CFIR) to accomplish three specific aims (SAs): SA1: Identify barriers and facilitators to implementing a diabetes screening and referral service within SCF Dental and Primary Care Clinics. SA2: Develop a dental clinic diabetes screening and referral service that minimizes barriers and utilizes facilitators identified in SA1. SA3: Pilot, assess, and iteratively refine a diabetes screening and referral service delivered through SCF Dental Clinics.