Individualizing Treatment for Nursing Home Residents with Diabetes Mellitus

描述（由申请人提供）：理由：糖尿病（DM）在疗养院（NH）人群中越来越常见。然而，有很大的不确定性的最佳血糖控制水平的NH居民与DM。我们的主要目标是建立一个证据基础，以个性化和改善护理NH居民与DM。研究目的：我们的目的是（1）确定目前的做法，血糖控制在全国样本的退伍军人事务部（VA）的NH，（2）确定血糖控制水平是否与老年人的结果，如尿失禁和福尔斯和（3）探索的目标，治疗和偏好的个人NH居民有关的治疗（如胰岛素）和结果。职业目标/Aims：这些项目将使PI能够发展专业知识（1）使用电子病历数据进行临床研究和（2）进行定性研究，从而得出患者的价值观和偏好。研究设计/方法：对于目标1和2，我们将获得所有VA NH的实验室、药学和结局数据。我们将通过确定正在接受特定治疗（例如胰岛素或口服药物）和直接并发症（例如低血糖）的VA NH糖尿病居民的比例来确定当前的做法。然后，我们将确定并发症和老年结局是否与HbA 1c水平相关，按治疗分层。对于目标3，我们将对San弗朗西斯科VA NH和San弗朗西斯科犹太人之家的居民进行半结构化访谈，以了解他们对DM治疗和结局的价值观和偏好。与公共卫生的相关性：通过确定目前的做法和血糖控制水平与老年结局（如尿失禁）之间的关系，我们将为患者和临床医生提供信息，以便他们能够对NH的糖尿病护理做出个性化的决定。此外，通过强调关系和常见的患者偏好，我们的工作将获得数据，以支持未来的研究实施工具，以促进NH糖尿病居民的个性化决策。

DESCRIPTION (provided by applicant): Rationale: Diabetes mellitus (DM) is becoming increasingly common in the nursing home (NH) population. However, there is great uncertainty about the optimal level of glycemic control for NH residents with DM. Our broad objective is to develop an evidence base to individualize and improve the care for NH residents with DM. Research Aims: Our aims are to (1) determine the current practices for blood sugar control in a national sample of veterans affairs (VA) NHs, (2) determine whether the level of glycemic control is associated with geriatric outcomes such as incontinence and falls and (3) explore the goals of treatment and preferences of individual NH residents regarding treatments (e.g. insulin) and outcomes. Career Objectives/Aims: These projects will allow the PI to develop expertise (1) using electronic medical record data for clinical research and (2) performing qualitative research eliciting patient values and preferences. Research Design/Methods: For Aims 1 and 2, we will obtain laboratory, pharmacy and outcomes data for all VA NHs. We will determine current practices by determining the proportion of VA NH residents with diabetes who are getting specific treatments (e.g. insulin or oral medications) and direct complications (e.g. hypoglycemia). We will then determine whether complications and geriatric outcomes are associated with HbA1c levels, stratified by treatment. For Aim 3, we will conduct semi-structured interviews with residents of the San Francisco VA NH and the Jewish Home of San Francisco to elicit their values and preferences regarding DM treatments and outcomes. Relevance to Public Health: By determining the current practices and the relationship between the level of blood sugar control and geriatric outcomes such as incontinence, we will provide information for patients and clinicians so that they can make individualized decisions about diabetes care in the NH. Further, by highlighting relationships and common patient preferences, our work will obtain data to support future studies implementing tools to promote individualized decision making for NH residents with diabetes.