Patient Voices Network for Addressing Health Disparities

描述（由申请人提供）：慢性疾病是造成健康差距的主要因素。越来越多的患者患有多种慢性疾病，需要多名专科医生，这对初级保健提供者和患者管理相互竞争的需求和适当使用不考虑多种疾病并发症的特定疾病指南提出了重大挑战。在资源有限、慢性病常见、风险因素升高的服务不足社区，挑战更加复杂。这项基于社区的参与性研究（CBPR）将在纽约州布法罗市中心进行，布法罗最近被美国人口普查局列为全国第三贫穷的城市。人口主要是少数民族（非裔美国人）和种族多样化（西班牙裔和来自70多个县的重新安置难民）。研究团队包括来自现有合作伙伴关系的四个Pi（一个研究Pi，两个实践站点Pi和一个代表患者声音的患者Pi，一个来自每个站点的患者行动团队网络）。本研究采用CBPR方法的具体目的是：1)进行需求评估的一群复杂的慢性疾病患者2安全网初级保健网站在医疗水平地区,2)设计一个飞行员自我管理干预解决识别需要基于patient-reported启用或阻碍因素慢性疾病患者自我管理18岁以上,和3)实现一个飞行员自我管理干预与CCD系统的120名患者的样本中,招募从现有的注册表。试点干预措施的可行性和有效性将在18个月的时间内进行评估

DESCRIPTION (provided by applicant): Chronic disease is a major contributor to health disparities. It is increasingly common for patients to have multiple chronic conditions requiring multiple specialists, posing significant challenges for primary care providers and patients to manage competing demands and make appropriate use of condition-specific guidelines that do not account for complications of multiple conditions. Challenges are compounded in underserved communities where resources are limited, chronic disease is common, and risk factors are elevated. This Community Based Participatory Research (CBPR) study will be conducted in inner-city Buffalo, NY, which was recently ranked by the U. S. Census Bureau as the third-poorest city in the nation. The population is predominantly minority (African American) and ethnically diverse (Hispanic and resettled refugees from over 70 counties). The Research team includes four Pi's from an existing partnership (one research PI, two practice site PIs and one patient PI representing Patient Voices, a network of Patient Action Teams from each of the sites). The specific aims of this study, using a CBPR approach, are to: 1) Conduct a needs assessment of a cohort of patients with complex chronic disease at 2 safety net primary care sites in medically underserved areas, 2) Design a Pilot Self-Management Intervention to address identified needs based on patient-reported factors that enable or hinder chronic disease self-management among patients age 18 and older, and 3) Implement a Pilot Self-Management Intervention among a systematic sample of 120 patients with CCD, recruited from an existing registry. Feasibility and effectiveness of the pilot intervention will be assessed over an 18-month period. The primary outcome will be change in the chronic disease outcomes. Intermediate outcome measures related to patient empowerment (social support, patient activation, self-management skills, functional status, and quality of life) will also be assessed. This study brings together patients and providers to create a patient centered intervention that meets patients' needs and can be practically implemented in the primary care setting. RELEVANCE: Patients with multiple chronic diseases are more common particularly in minority underserved communities. A research team (led by a research PI, two practice site PIs, and a patient PI) will develop and implement a patient-centered intervention, in partnership with both patients and providers, to improve self-management among patients with two or more chronic diseases. Using a participatory approach will ensure that the intervention meets patients' needs and is practical in the primary care setting