A Patient-Centered Strategy to Reduce Diabetes Disparities in Chinese Americans

描述(由申请人提供)：从1991年到2001年，美国被诊断为糖尿病的成年人人数增加了61%，到2050年将翻一番。糖尿病是第六大常见死亡原因，可导致心血管和肾脏疾病、失明和截肢。改进疾病管理可以降低糖尿病的发病率和死亡率。不幸的是，糖尿病患者，特别是移民和少数民族，往往得不到建议的护理水平，这表明迫切需要制定能够纳入现有医疗实践的适合文化的有效战略。糖尿病已经成为美国一种新的流行病，亚裔美国人和太平洋岛民的糖尿病发病率增长速度比其他任何种族/民族都要快。特别是，中国人在美国的糖尿病发病率高于本国，而且已经证明，随着文化适应，糖尿病发病率会增加。大约15%的中国人被诊断患有糖尿病，大约是美国总人口(5.9%)的2.5倍。此外，华裔美国人的糖尿病发病率是他们本国的5到7倍。然而，收集中国糖尿病数据的国家、社区和学术努力仍然缺乏支持。这可能与华裔美国人相对缺乏政治影响力和模范少数族裔神话有关。这个拟议的项目是亚洲卫生服务(AHS)、亚太社区卫生组织协会和加州大学伯克利分校之间的社区-学术合作，其中包括一个由参与该项目所有阶段的华裔糖尿病患者、家庭成员、提供者和倡导者组成的华裔美国社区顾问委员会。它将评估多层次试点团队护理干预，包括精通文化和语言的临床护理、家庭教育和社区促进，与AHS服务不足的华裔美国人的常规护理模式相比，是否可行、有效和负担得起改善糖尿病护理和预后的费用。AHS 74%的患者是中国人，67%的患者处于或低于100%的联邦贫困水平，86%的患者最好使用英语以外的语言。数据将使用定性和定量技术进行分析。该项目的一个特别优势是，它将建立在一个现有的合作项目-糖尿病护理倡议的基础上，该倡议由加利福尼亚州阿拉米达县AHS的中国患者和提供者发起，AHS是一个获得联邦资格的医疗中心。这一以社区为基础的合作旨在加强以患者为中心的护理，并促进中国糖尿病患者的健康饮食和体育活动行为。最终，它的目标是在中国糖尿病患者、他们的家庭成员和整个社区中促进健康行为，以防止糖尿病的不良后果，并防止阿拉米达县及其他地区出现新的糖尿病病例。与公共健康相关：这个项目是由中国的糖尿病患者和一家诊所的医生发起的，因为糖尿病已经成为中国人的一个大问题。该诊所的患者、他们的家人和医生将与当地研究人员合作，寻找改善诊所糖尿病护理的方法，并帮助教育患者及其家人。

DESCRIPTION (provided by applicant): The number of adults with diagnosed diabetes in the US increased 61 percent from 1991 to 2001 and will double by 2050. Diabetes is the sixth most common cause of death, causing cardiovascular and kidney disease, blindness, and lower limb amputations. Improved disease management can reduce morbidity and mortality from diabetes. Unfortunately, diabetes patients, especially immigrants and minorities, often do not receive recommended levels of care, indicating a critical need for developing culturally-appropriate and effective strategies that can be incorporated into existing medical practices. Diabetes has emerged as a new epidemic across the US and diabetes rates are growing faster among Asian Americans and Pacific Islanders than in any other racial/ethnic group. In particular, diabetes rates for Chinese are higher in the US than in native countries, and rates have been demonstrated to increase with acculturation. Approximately 15 percent of Chinese are diagnosed with diabetes, ~ 2.5 times higher than in the general U.S. population (5.9 percent). Also, Chinese American diabetes rates are 5 to 7 times higher than in their native countries. However, there continues to be a lack of support for national, community and academic efforts to collect Chinese diabetes data. This may be related to the relative lack of political influence and the model minority myth among Chinese Americans. This proposed project is a community-academic collaboration between Asian Health Services (AHS), the Association of Asian Pacific Community Health Organizations, and the University of California, Berkeley that includes a Chinese American community advisory board consisting of Chinese diabetics, family members, providers, and advocates that are engaged in all phases of the project. It will assess whether a multi-level pilot team care intervention, incorporating culturally and linguistically-proficient clinical care, family education, and community promotion, is feasible, effective, and affordable for improving diabetes care and outcomes compared with usual care model among underserved Chinese Americans at AHS. 74 percent of patients at AHS are Chinese, 67 percent of patients are at or below 100 percent federal poverty level and 86 percent are best served in a language other than English. Data will be analyzed using qualitative and quantitative techniques. A particular strength of this project is that it will build on an existing collaborative, the Diabetes Care Initiative, that was started by Chinese patients and providers at AHS, a safety net federally qualified health center, in Alameda County, California. This community-based collaborative seeks to increase patient-centered care and to promote healthy dietary and physical activity behaviors in Chinese diabetics. Ultimately, it aims to promote healthy behaviors among Chinese diabetics, their family members, and the community at-large to prevent adverse diabetes outcomes and prevent new diabetes cases in Alameda County and beyond. PUBLIC HEALTH RELEVANCE: This project was started up by Chinese diabetes patients and doctors at a clinic, because diabetes has become a big issue for Chinese people. The clinic's patients, their families, and doctors will work with local researchers to find ways to improve diabetes care in the clinic and to help educate patients and their families.