Barriers to Optimum Diabetes Outcomes

描述（由申请人提供）： 该职业发展奖将允许候选人将50%的时间用于调查糖尿病患者获得最佳护理的障碍，并指导研究人员和其他初级同事。在现有的佛蒙特州糖尿病信息系统（VDIS，糖尿病患者初级保健信息系统的大规模随机临床试验）的基础上，候选人提出了四个新的互补项目。这些将促进对改善生理控制障碍的理解，并为初级同事提供机会，以发展自己在临床研究，统计分析和研究报告方面的技能。 项目1，实践组织作为糖尿病控制的障碍：评估慢性病护理模式，将测试符合理想化的医疗保健模式和糖尿病结局（包括血糖控制，高血压，胆固醇降低和护理满意度）之间的关联。受试者将是参与VDIS的60家初级保健机构。 项目2，药物依从性作为糖尿病控制的障碍：依从性辅助工具的作用，将检查患者用于记住药物的各种设备和策略的流行和实用性。受试者将是来自VDIS现场调查的900名成年糖尿病患者，他们提供了全面的药物列表、依从性辅助调查、多个协变量（人口统计学、合并症、并发症、功能状态等），和生理结果，包括A1C、LDL胆固醇和血压。 项目3，文盲作为糖尿病控制的障碍：功能性健康素养的流行和影响，将记录功能性健康素养与生理和临床结果（包括A1C、LDL胆固醇、血压、功能状态等）的相关程度。在900名成年糖尿病患者中， 项目4，旅行负担作为糖尿病控制的障碍：驾车距离的作用，将评估旅行对VDIS中6，000名受试者的结果（生理和临床）的作用，这些受试者的实验室结果和位置数据可用。 完成后，这项工作将严格解决将新的科学发现有效转化为临床护理的四个潜在障碍，同时为初级研究人员提供糖尿病研究方面的指导和职业发展机会。

DESCRIPTION (provided by applicant): This career development award will allow the candidate to devote 50% of his time to the investigation of barriers to optimum care for patients with diabetes and to the mentoring of research fellows and other junior colleagues. Building on the existing Vermont Diabetes Information System (VDIS, a large scale randomized clinical trial of an information system for primary care of diabetes patients), the candidate proposes four new, complementary projects. These will advance understanding of obstacles to improved physiologic control and provide opportunities for junior colleagues to develop their own skills in clinical research, statistical analysis, and research presentation. Project 1, Practice organization as a barrier to diabetes control: Evaluating the Chronic Care Model, will test the association between conformance with an idealized model of health care and diabetes outcomes including glycemic control, hypertension, cholesterol reduction, and satisfaction with care. The subjects will be sixty primary care practices participating in the VDIS. Project 2, Medication adherence as a barrier to diabetes control: The role of adherence aids, will examine the prevalence and utility of various devices and maneuvers that patients use to remember their medications. The subjects will be 900 adult diabetics from the VDIS Field Survey who provide a comprehensive medication list, a survey of adherence aids, multiple covariates (demographics, comorbidity, complications, functional status, etc.), and physiologic outcomes including A1C, LDL cholesterol, and blood pressure. Project 3, Illiteracy as a barrier to diabetes control: Prevalence and impact of functional health literacy, will document the extent to which functional health literacy is associated with physiologic and clinical outcomes (including A1C, LDL cholesterol, blood pressure, functional status, etc.) in 900 adults with diabetes from the VDIS Field Survey. Project 4, Travel burden as a barrier to diabetes control: The role of driving distance, will assess the role of travel to care upon outcomes (both physiologic and clinical) in 6,000 subjects from the VDIS for whom laboratory results and location data are available. Upon completion, this work will have rigorously addressed four potential barriers to the effective translation of new scientific findings to clinical care while providing junior investigators with mentoring and career development opportunities in diabetes research.