Patient centered intervention to improve care among diabetic older americans

由于糖尿病是一种慢性疾病，在少数民族老年人中发病率很高，并且自我管理在预防并发症方面尤为重要，因此我们开始实施和评估以患者为中心的文化量身定制的干预措施，通过提高患者知识、自我管理技能和社区少数民族老年糖尿病患者的赋权来改善血糖控制。该项目的具体目标是：1)确定侧重于增加糖尿病护理知识、增强能力和自我管理技能的多维度、适合文化的干预措施是否会改善血糖、血脂和体重控制，减少急性糖尿病相关症状，并改善与健康相关的生活质量；2)确定这种干预是否会导致护理过程的改善；3)与常规护理相比，确定干预措施的成本效益。为了评估干预的有效性，研究小组将进行一项对照临床试验，该试验将随机选取600名老年非裔美国人和拉丁裔糖尿病患者，这些患者在马丁·路德·金·德鲁大学医学中心附属的6家公立诊所接受治疗。随机化将在患者水平上进行。试验的主要终点将是积极干预组与常规护理对照组的糖化血红蛋白随时间的平均差异所反映的血糖控制的差异。该试验还将跟踪干预前后的一些重要次要终点：自我管理技能、糖尿病知识、糖尿病特异性症状、生活质量、低密度脂蛋白水平、血压、体重、护理质量和卫生保健服务使用情况。该研究还将收集可能改变干预效果的变量的数据，如文化适应、保险状况和福利结构以及社会支持。这些数据将为评估老年非裔美国人和拉丁裔糖尿病患者干预的有效性和成本效益提供必要的信息。由于干预的有效性和具体设计可能受到文化因素的影响，文化因素，临床试验将为预先计划的非裔美国人和拉丁美洲人的亚组分析提供动力。拟议的干预措施的内容将取决于一项资助的试点研究的结果，该研究目前正在设计干预措施并评估其对非洲裔美国人和拉丁裔糖尿病老年人是否可接受和可行。综上所述，通过设计和测试干预措施，并评估其对非裔美国人和拉丁裔老年糖尿病患者是否可接受和可行。总之，通过设计和测试一种专注于患者而不是护理系统的干预措施，我们希望为老年糖尿病患者提供所需的技能、知识和授权，使他们无论在护理环境中是否有可用的资源，都能获得最佳的血糖控制和医疗保健过程。

Because diabetes is a chronic condition with substantial associated morbidity among minority elders and is a condition in which self- management is particularly crucial in the prevention of complications, we set out to implement and evaluate culturally tailored patient-centered intervention to improve glycemic control by improving patient knowledge, self-management skills, and empowerment among community-residing minority older adults with diabetes. Specific aims of the project are: 1) to determine whether a multidimensional, culturally tailored intervention that focuses on increasing knowledge about diabetes care, empowerment, and self-management skills, will lead to better glycemic, lipid blood pressure, and weight control, fewer acute diabetes- related symptoms, and improvements in health-related quality of life; 2) to determine whether this intervention will lead to improvements in process of care; 3) to determine the cost-effectiveness of the intervention when compared to usual care. To evaluate the effectiveness of the intervention, the research team will conduct a controlled clinical trial that will randomize 600 older African American and Latino persons with diabetes who are cared for in 6 public clinics affiliated with the Martin Luther King-Drew University Medical Center. Randomization will occur at the patient level. The primary endpoint for the trial will be differences in glycemic control as reflected by mean difference in hemoglobin A1c over time for the active intervention versus usual care control group. The trial will also track a number of important secondary endpoints both before and after exposed to the intervention: self-management skills, knowledge about diabetes, diabetes-specific symptoms, quality of life, low density lipoprotein levels, blood pressure, weight, quality of care, and health care service use. The study will also collect data on variables that are likely to modify the effectiveness of the intervention, such as acculturation, insurance status and benefit structure, and social support. These data will provide the needed information to evaluate both the effectiveness and the cost effectiveness of the intervention among older African Americans and Latinos with diabetes. Because the effectiveness and specific design of the intervention is likely to be influenced by cultural factors, the cultural factors, the clinical trial will be powered for pre-planned sub-group analyses among African Americans and Latinos. The content of the proposed intervention will be determined by the result of a funded pilot study that is currently designing the intervention and assessing whether it is acceptable and feasible for African American and Latino older persons with diabetes. In summary, by designing and testing the intervention and assessing whether it is acceptable and feasible for African American and Latino older persons with diabetes. In summary, by designing and testing an intervention that focuses on the patient rather than the system of care, we hope to arm older diabetes with the needed skills, knowledge, and empowerment to have the best possible glycemic control and process of health care regardless of the resources available in their care setting.