Feasibility of a Web-based Collaborative Care Support(SM)Model to Improve Care fo

描述(由申请人提供)：糖尿病每年给美国造成的损失估计为1,740亿美元。大约三分之二的费用来自直接医疗支出，其余的费用来自残疾、工作损失和过早死亡。相关的心血管并发症导致进一步的死亡率和发病率；75%(75%)的糖尿病患者还患有高血压，在68%的糖尿病相关死亡证明中，心脏病是促成死亡的原因之一。通过适当的生活方式改变和初级和二级预防护理，可以显著减少糖尿病的心血管并发症；然而，在目前的执业环境中，初级保健提供者发现很难提供确保充分减少危险因素所需的全面教育和行为支持。如果患者要为这种复杂的慢性疾病接受更高质量的护理，那么就需要一种计划的护理模式，更好地支持降低风险的行为方法，并与初级保健实践工作流程相结合。我们建议测试Collaborative Care SupportSM(CCS)的可行性，这是一个基于网络的交流平台，结合个人健康指导，将患有2型糖尿病和至少一个其他心血管风险因素(高血压、高脂血症和/或吸烟)的成年患者纳入以患者为中心的、基于行为的协作式干预，该干预与初级保健提供者的工作流程相结合，以提高患者的积极性。以前为患者赋权的尝试包括疾病管理和自我管理支持，但这些计划不涉及初级保健提供者，而且由于可获得性有限，许多人无法获得这些计划。由于在可能的情况下，零散的护理被计划的和协调的护理所取代是重要的，CCS可能比传统的疾病管理和自我管理支持更成功。

DESCRIPTION (provided by applicant): Diabetes costs the United States an estimated $174 billion annually. About two-thirds of costs arise from direct medical expenditures, and the remainder accrues from disability, work loss, and premature mortality. Associated cardiovascular comorbidities result in further mortality and morbidity; seventy-five percent (75%) of patients with diabetes also have hypertension, and heart disease is a contributing cause on 68% of diabetes-related death certificates. The cardiovascular complications of diabetes can be significantly reduced with appropriate lifestyle modification and primary and secondary preventive care; yet in the current practice environment, primary care providers find it difficult to deliver the comprehensive education and behavioral support needed to ensure adequate risk factor reduction. If patients are to receive better quality of care for this complex, chronic disease, then a model of planned care that better supports behavioral approaches to risk reduction and is integrated with the primary care practice workflow is needed. We propose to test the feasibility of Collaborative Care SupportSM (CCS), a web-based communication platform coupled with personal health guidance that enrolls adult patients who have type 2 diabetes and at least one other cardiovascular risk factor (hypertension, hyperlipidemia, and/or smoking) in a collaborative, patient-centered, behaviorally-based intervention that integrates with primary care provider workflows to improve patient activation. Previous attempts to empower patients have included disease management and self-management support, but these programs do not involve the primary care provider and are not accessible to many because of limitations their limited availability.. Because it is important that fragmented care is replaced by planned and coordinated care where possible, CCS is likely to meet with more success than traditional disease management and self-management support.