A Medical Home Model for Successful Management of Diabetes in Vulnerable Adults

描述（由申请人提供）：初级保健医生如何向患者提供护理可能会减少弱势成人2型糖尿病（以下简称糖尿病）结局的差异。虽然提供者可以提供良好的技术质量的护理（即，提供的临床服务和提出的治疗建议），但在提供者如何使患者获得这些服务、与患者就复杂的管理方案进行双向沟通的程度以及如何与照顾患者病情的其他提供者协调护理方面存在已知的缺陷。这些缺陷对于弱势成年人种族/少数民族，社会经济地位低的人和依赖国家安全网医疗保健系统的人来说尤其严重，并且可能导致糖尿病结果的差异。拟议研究的目标是了解向糖尿病成人提供初级保健服务的方式是否影响患者最终接受的临床服务以及患者如何遵守提供者的建议以成功管理其病情。我们认为，而且有大量证据表明，按照“医疗家庭模式”提供护理有助于改善患者体验，并可能改善患者对适当护理的接受和反应。医疗之家应广泛开放，促进与患者的持续关系，包括有效的双向沟通，提供全面的服务，在需要时帮助协调服务，并考虑到整个家庭环境和文化背景。 具体目标一：为了检验以下假设：更好的医疗家庭性能增加了对推荐的糖尿病护理的接受，改善了与更好地管理病情相关的患者生理指标，并减少了不良的医疗保健利用。 具体目标2：探讨提供初级保健的实践环境（即，社区健康中心、团体实践和个人实践）影响医生的医疗家庭表现，并因此影响患者对糖尿病护理的反应。 公共卫生相关性：拟议的研究将提供有关提供初级卫生保健的不同方法的关键信息，这些方法可以改善脆弱成年人糖尿病的成功护理和结果。随着糖尿病发病率达到流行水平，研究结果将有助于指导如何最好地提高质量，减少糖尿病管理和结果的差异。

DESCRIPTION (provided by applicant): in how primary care physicians deliver care to their patients are likely to reduce disparities in Type 2 diabetes (hereafter referred to as diabetes) outcomes for vulnerable adults. While providers may offer good technical quality of care (i.e., the clinical services provided and therapeutic recommendations made), there are known deficits in how providers make those services accessible to patients, how well two-way communication occurs with patients about complex management regimens, and how care is coordinated with other providers caring for the patients' condition. These deficits are particularly acute for vulnerable adults-racial/ethnic minorities, those with low socioeconomic status and those who rely on the nation's safety net health care system-and are likely to contribute to disparities in diabetes outcomes. The goal of the proposed research is to understand whether the way in which primary care services are delivered to diabetic adults influences what clinical services are ultimately received by patients and how well patients adhere to providers' recommendations to successfully manage their condition. We think, and there is a body of evidence to suggest, that delivering care in accordance with a "medical home model" helps to improve patient experiences and may improve patients' receipt of, and response to, appropriate care. A medical home should be widely accessible, facilitate a continuous relationship with patients including effective two-way communication, provide comprehensive services, help to coordinate services when needed, and account for family context and cultural background throughout. ' Specific Objective 1: To test the hypothesis that better medical home performance increases the receipt of recommended diabetes care, improves patient physiologic measures associated with better management of the condition, and reduces adverse health care utilization. ' Specific Objective 2: To explore whether the practice setting in which primary care is delivered (i.e., community health centers, group practices, and solo practices) affects the medical home performance of physicians and, as a result, the response of patients to diabetes care. PUBLIC HEALTH RELEVANCE: The proposed research will provide critical information about different approaches to delivering primary health care that can improve the successful care and outcomes of diabetes among vulnerable adults. With rates of diabetes at epidemic levels, the results will help inform how to best improve quality and reduce disparities in diabetes management and outcomes.