Partnerships for Cardiometabolic Disparities in Native and Pacific Peoples

描述（由申请人提供）：“消除心脏代谢差异（ECD）的比较有效性研究（CER）方法”是一项修订申请，包括4项CER活动，旨在将比较有效性研究方法与现有的健康差异方法相结合，以解决土著和太平洋岛屿居民在心脏代谢医疗保健差异方面的持续差距。这4项活动是：#1：按成果付费（P40）研究：减少糖尿病差异的激励伙伴关系。#2：建设人力资本：提供4个新的CER健康差异培训活动。#3：数据基础设施：将建立糖尿病和心脏代谢疾病的CER患者登记系统。第四：传播和翻译：将把防止再住院的心力衰竭干预转化为临床实践，并建立临床提供者网络。所有 4项活动投资于土著和太平洋健康差异研究中心（中心），以利用其现有的基础设施，支持CER消除夏威夷土著、阿拉斯加土著和太平洋人民（菲律宾人、 西萨摩亚人等）。P40研究是一项创新的干预措施，它整合了CER和健康差异方法，以解决低收入，种族/少数民族之间的糖尿病差异，并在糖尿病护理方面存在已知的差距。具体目标是：1.在多种族、低收入的糖尿病患者中，比较激励伙伴关系与常规护理在将平均HbAlc降低至<7%方面的有效性。2. 计算与常规治疗相比，为实现血糖控制目标，经济激励加教育的增量成本效益。3.检查有效性和增量成本效益比是否因种族和民族而异。P40研究将使用区组随机对照试验设计来检查与种族多样化的医疗补助人群中的常规护理相比，对患者-提供者对的教育和经济激励对于将HbAlc水平提高到目标（HbAlc <7%）的有效性。本研究的潜在影响和所有4项CER活动的投资是巨大的，因为在面临次优糖尿病护理挑战的种族/少数民族中，哪种治疗最有效存在相当大的不确定性。我们的CER-ECD倡议在解决其他组织不可能做到的医疗保健差距方面发挥了独特的作用，我们的战略伙伴关系将使CER投资在整个太平洋地区以及包括土著和太平洋民族在内的各种优先人群中产生倍增和深远的回报。

DESCRIPTION (provided by applicant): The Comparative Effectiveness Research (CER) Approaches to Eliminate Cardiometabolic Disparities (ECD)" is a revision application that includes 4 CER activities to integrate comparative effectiveness research methods with existing health disparities approaches to address persistent gaps in cardiometabolic health care disparities in Native and Pacific Peoples. These 4 activities are: #1: The Pay-for-Outcomes (P40) Study: Incentivized Partnerships to Reduce Diabetes Disparities. #2: Building Human Capital: provides 4 new CER-health disparities training activities. #3: Data Infrastructure: will establish CER patient registries for diabetes and cardiometabolic diseases. #4: Dissemination and Translation: will translate a heart failure intervention to prevent re-hospitalization into clinical practice and build a clinical providers network. All 4 activities invests in the Center for Native and Pacific Health Disparities Research (The Center) to leverage its existing Infrastructure to support CER for eliminating health disparities, especially cardiometabolic health disparities, in the priority populations of Native Hawaiians, Alaska Natives and Pacific Peoples (Filipino, Micronesian, Samoan. etc.). The P40 Study is an innovative Intervention that integrates CER and health disparities approaches to address diabetes disparities among low Income, racial/ethnic minorities with known gaps in diabetes care. The specific aims are: 1. Compare the effectiveness of incentivized partnerships on reducing mean HbAlc to <7% in multi-ethnic, low-income patients with diabetes versus usual care. 2. Compute the incremental cost-effectiveness of financial incentives plus education to achieve glycemic goals compared with usual care. 3. Examine whether effectiveness and incremental cost-effectiveness ratios differ by race and ethnicity. The P40 Study will use a block randomized control trial design to examine the effectiveness of education and financial incentives to patient-provider pairs for improving HbAlc levels to goal (HbAlc <7%) compared with usual care in an ethnically diverse Medicaid population. The potential impact of this study and the investment of all 4 CER activities are substantial since considerable uncertainty exists on which treatments are most effective among racial/ethnic minorities who are challenged with suboptimal diabetes care. Our CER-ECD initiative fills a unique role In addressing health care disparities that other organizations are unlikely to do and our strategic partnerships will allow for the CER investments to have multiplicative and far reaching returns throughout the Pacific region and across diverse priority populations including Native and Pacific Peoples.