Patient Voices Network for Addressing Health Disparities

描述(申请人提供)：慢性病是造成健康差距的主要因素。患者患有多种慢性疾病需要多名专家的情况日益普遍，这给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具体情况指南带来了巨大挑战。在服务不足、资源有限、慢性病常见、风险因素上升的社区，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，该市最近被美国人口普查局列为全国第三贫穷城市。人口主要是少数民族(非裔美国人)和种族多样性(来自70多个县的西班牙裔和重新安置的难民)。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，每个站点的患者行动小组网络)。这项研究使用CBPR方法的具体目的是：1)在医疗服务不足地区的2个安全网初级保健地点对复杂慢性病患者队列进行需求评估；2)设计试点自我管理干预措施，以满足基于患者报告的因素确定的需求，这些因素使18岁及以上患者能够或阻碍慢性病自我管理；以及3)在从现有登记处招募的120名慢性病患者的系统样本中实施试点自我管理干预。试点干预的可行性和有效性将在18个月内进行评估 句号。主要结果将是慢性病结果的变化。还将评估与患者赋权相关的中间结果指标(社会支持、患者激活、自我管理技能、功能状态和生活质量)。这项研究带来了 将患者和提供者结合在一起，创建以患者为中心的干预措施，满足患者的需求，并可在初级保健环境中实际实施。 相关性：患有多种慢性病的患者更为常见，尤其是在服务不足的少数群体社区。一个研究团队(由一名研究PI、两名实践现场PI和一名患者PI领导)将与患者和提供者合作，开发和实施以患者为中心的干预措施，以改善患有两种或两种以上慢性病的患者的自我管理。使用参与式方法将确保干预满足患者的需要，并且在初级保健环境中是可行的

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