Design and Implementation of An Intervention to Improve Prediabetes Management in Primary Care

项目摘要/摘要 在美国，糖尿病预防对于减轻糖尿病的公共健康负担至关重要。8400万 美国成年人患有前驱糖尿病，但90%的人没有确诊。美国国立卫生研究院优先考虑寻找有效的翻译方法 将糖尿病预防试验中取得的成果转化为常规医疗实践。《国家糖尿病》 预防计划认可符合特定指标的生活方式改变计划，以帮助预防或延迟 糖尿病。然而，让卫生系统和初级保健提供者参与促进 缺乏对这些项目的筛选、测试和转介。目前还没有系统的方法来 在初级保健环境中加强糖尿病前期管理，但这对于解决糖尿病负担是必不可少的。 为了解决这一需要，我们提出了以下相互关联的具体目标：1)进行回溯性队列 描述围绕糖尿病前期诊断和治疗的纵向初级保健提供者做法的研究 使用关联的索赔和电子病历(EMR)数据集，2)与关键线人进行面谈 与糖尿病预防相关的利益攸关方，包括来自卫生保健系统/诊所、保险的领导层 计划领导者、提供者和患者，以确定实施的障碍和促进者，3)设计和试行 在马里兰州巴尔的摩的一家初级保健诊所内测试糖尿病预防临床路径，并评估其 在供应商筛查和干预方面的有效性，以及患者在糖尿病预防方面的参与度 为期12个月。 Eva Tseng博士是普通内医学部助理教授和临床研究员 约翰霍普金斯大学医学院。她的长期职业目标是成为一名独立的 临床医生-研究人员进行务实干预研究，重点是改善预防 初级保健中的糖尿病。 拟议的职业发展计划包括教学和研究培训活动，这些活动将大大 培养她制定和实施干预措施的技能。其中将包括执行方面的培训。 科学，临床试验方法，大型索赔/电子病历数据库的定量数据分析方法，以及 定性数据收集和分析方法。本次培训将在丰富的培训环境中进行 约翰霍普金斯大学医疗机构，包括彭博公共卫生学院和韦尔奇中心 预防、流行病学和临床研究。她将接受她杰出的团队的指导 在进行计划的研究所需的方法方面具有专业知识的导师和顾问，以及 指导和资助方面的记录。奖励和保护时间将允许曾博士建立一个 独立的NIH资助的研究生涯，并成为改善 在初级保健中预防糖尿病，并可能应用于其他慢性病。

PROJECT SUMMARY/ABSTRACT Diabetes prevention is crucial for reducing the public health burden of diabetes in the United States. 84 million U.S. adults have prediabetes but 90% are undiagnosed. The NIH has prioritized finding efficient ways to translate outcomes achieved in diabetes prevention trials into routine healthcare practice. The National Diabetes Prevention Program recognizes lifestyle change programs meeting specific metrics that help prevent or delay diabetes. However, an effective model for engaging health systems and primary care providers in facilitating screening, testing and referral to these programs is lacking. There is currently no systematic approach to prediabetes management in the primary care setting, but it is essential for addressing the burden of diabetes. To address this need, we propose the following interrelated Specific Aims: 1) To conduct a retrospective cohort study to describe longitudinal primary care provider practices around the diagnosis and treatment of prediabetes using a linked claims and electronic medical record (EMR) dataset, 2) To conduct key informant interviews with stakeholders relevant to diabetes prevention, including leadership from health care system/clinics, insurance plan leaders, providers and patients, to identify barriers and facilitators to implementation, 3) To design and pilot test the diabetes prevention clinical pathway within a primary care clinic in Baltimore, MD, and evaluate its effectiveness on provider screening and intervention, and patient engagement in diabetes prevention over a period of 12 months. Dr. Eva Tseng is an Assistant Professor in the Division of General Internal Medicine and a clinical researcher at The Johns Hopkins University School of Medicine. Her long-term career goal is to become an independent clinician-investigator conducting pragmatic intervention studies with a focus on improving the prevention of diabetes in primary care. The proposed career development plan includes didactic and research training activities that will substantially build her skills in developing and implementing an intervention. These will include training in implementation science, clinical trial methods, quantitative data analytic methods for large claims/EMR databases, as well as qualitative data collection and analytic methods. This training will occur in the rich training environment of the Johns Hopkins Medical Institutions, including the Bloomberg School of Public Health and the Welch Center for Prevention, Epidemiology, and Clinical Research. She will receive guidance from her outstanding team of mentors and advisors with expertise in the methodologies needed for conducting the planned research, and a track record of mentoring and funding. The award and protected time will allow Dr. Tseng to build an independent NIH-funded research career and become a leader in pragmatic approaches to improve the prevention of diabetes in primary care with potential applications to other chronic diseases.