Internet Intervention For Improving Rural Diabetes Care

描述(由申请人提供)： 背景资料。阿拉巴马州的糖尿病患病率为8%，是所有州中发病率最高的州之一。我们提出了一项为期5年的基于互联网的干预措施的随机试验，旨在提高阿拉巴马州乡村医生对成年2型糖尿病患者的指南遵从性。阿拉巴马州农村有许多弱势和少数族裔患者，医疗保健渠道有限，与城市患者相比，阿拉巴马州农村糖尿病患者得到的护理质量较差，预后更差。目标。(1)评估实施糖尿病指南的障碍，并通过焦点小组和基于病例的小插曲调查确定解决方案；(2)开发和实施互动互联网干预措施，并定期更新；(3)在随机对照试验中评估干预措施；(4)评估可归因于反馈的表现变化；以及(5)检查一旦反馈停止后，改善指南遵守情况的可持续性。方法：研究方法。我们将与阿拉巴马大学乡村医学项目合作，将200名乡村医生随机分配到干预或对照小组。我们为期30个月的干预是为个别医生实时定制的，包括基于案例的教育、绩效反馈和基准的互联网学习模块。结果将基于以前开发和验证的糖尿病质量衡量标准。干预措施将包括筛查、诊断、治疗和预防。我们将为每名医生审查10名糖尿病患者的基线和随访病历。主要的分析是在医生层面进行的，将比较研究部门之间在指南遵从性方面的差异改善。辅助分析将检查医生特征(例如，专业)和患者特征(例如，共病、种族、性别、年龄和社会经济地位)的影响。在适当的时候，多变量技术将根据医生对患者的重复测量和分组进行调整。意义重大。这项研究提供了一种技术先进、以理论为基础的提供者级别的干预措施，以改善对高危、服务不足人群的护理。我们的多学科团队拥有久经考验的合作记录，并拥有将研究转化为实践、乡村医学、行为医学和临床糖尿病的专业知识。该项目将产生一种以证据为基础的、可复制的尖端干预措施，这种干预措施可以在“真实世界”中持续下去，很容易传播，也很容易针对其他疾病进行修改。

DESCRIPTION (provided by applicant): Background. The prevalence of diabetes in Alabama is 8%, one of the highest among all states. We propose a 5- year randomized trial of an Internet-based intervention designed to improve guideline adherence by rural Alabama physicians caring for adult patients with type 2 diabetes. Rural Alabama has many disadvantaged and minority patients with limited health care access, and rural Alabama patients with diabetes receive poorer quality of care and have worse outcomes compared to urban patients. Objectives. (1) Assess barriers to implementation of diabetes guidelines and identify solutions through focus groups and case-based vignette surveys; (2) Develop and implement an interactive Internet intervention, updated regularly; (3) Evaluate the intervention in a randomized controlled trial; (4) Assess changes in performance attributable to feedback; and (5) Examine the sustainability of improved guideline adherence once feedback ceases. Methods. In partnership with the University of Alabama rural medicine program, we will randomize 200 rural physicians to an intervention or control arm. Our 30-month intervention, customized to the individual physician in real-time, consists of Internet learning modules with casebased education, performance feedback, and benchmarks. Outcomes will be based on previously developed and validated quality measures for diabetes. The intervention will cover screening, diagnosis, treatment, and prevention. We will review baseline and follow up medical records of 10 diabetic patients for each physician. The main analysis, conducted at the physician level, will compare differential improvement in guideline adherence between the study arms. Ancillary analyses will examine the effects of physician characteristics (e.g., specialty) and patient characteristics (e.g., comorbidities, ethnicity, gender, age, and socioeconomic status). When appropriate, multivariable techniques will adjust for repeated measures and clustering of patients within physicians. Significance. This study offers a technologically advanced, theory-grounded, provider-level intervention for improving care of a high-risk, underserved population. Our multidisciplinary team has a proven record of collaboration and contains expertise in translating research into practice, rural medicine, behavioral medicine, and clinical diabetes. This project will produce an evidence-based and replicable cutting-edge intervention that can be sustained in the "real world," readily disseminated, and easily modified for other diseases.