Barriers to Optimum Diabetes Outcomes

描述(由申请人提供)： 这一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最佳护理的障碍，并指导研究员和其他初级同事。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补充项目。这些课程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，发展他们在临床研究、统计分析和研究陈述方面的技能。 项目1，实践组织作为糖尿病控制的障碍：评估慢性护理模式，将测试遵循理想化的卫生保健模式与糖尿病结果之间的联系，包括血糖控制、高血压、降低胆固醇和护理满意度。受试者将是参与VDIS的60名初级保健医生。 项目2，作为糖尿病控制的障碍的用药依从性：依从性辅助的作用，将检查患者用来记住他们的药物的各种装置和手法的流行率和实用性。受试者将是VDIS现场调查中的900名成年糖尿病患者，他们提供了一份全面的药物清单、依从性辅助工具的调查、多种协变量(人口统计数据、合并症、并发症、功能状态等)以及包括A1C、低密度脂蛋白胆固醇和血压在内的生理结果。 项目3，文盲是糖尿病控制的障碍：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、低密度脂蛋白胆固醇、血压、功能状态等)的关系程度。来自VDIS现场调查的900名患有糖尿病的成年人。 项目4，旅行负担是糖尿病控制的障碍：驾车距离的作用，将评估旅行对VDIS中有实验室结果和位置数据的6000名受试者的结果(生理和临床)的护理作用。 完成后，这项工作将严格解决将新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.