An intervention to enhance hypoglycemia communication and preventive action in primary care

项目总结/摘要 为接受胰岛素或胰岛素治疗的一半美国成年糖尿病患者提供最佳护理 促分泌素，预防低血糖症是至关重要的，低血糖症会导致大量的发病率和医院利用率。 然而，有限的证据--包括我们自己的初步分析--表明临床医生并不经常 评估低血糖，很少采取预防措施，如修改糖尿病治疗或提供 预防低血糖的预期指导。内分泌学会呼吁采取干预措施， 低血糖症的预防在临床上遇到，但没有证据为基础的干预措施存在。 在本提案中，我们将填补了解低血糖预防和患者-提供者的主要空白 沟通，并制定一个可扩展的干预措施，以防止低血糖， 可以整合到初级保健工作流程中。患者与提供者的沟通尤其重要， 低血糖预防，因为它需要临床医生收集详细的病史，传达复杂的信息， 并激励患者做出行为改变。拟议的干预措施将以有效的干预措施为基础 通过使用患者报告的结果测量（PROM）来常规评估 患者症状，并提示临床医生采取行动解决这些问题。具体的研究目标是：目标1） 在全国退伍军人样本中确定低血糖评估和预防措施的频率 处理初级保健访视，并制定低血糖沟通质量框架。目标2）发展 将用于低血糖评估的PROM集成到初级护理工作流程中的干预，链接到 提供者工具包，以加强低血糖沟通和预防实践。目标3）进行试点 一项旨在评价低血糖预防干预的可行性、真实性和可接受性的研究 目标2这些目标为R 01申请进行确定的临床试验奠定了基础。 在这里制定的干预措施，并解决迫切需要可扩展的干预措施，转化证据- 将基于实践的低血糖预防纳入初级保健环境。 Scott Pilla博士的长期职业目标是成为一名独立的临床研究者， 领先的干预性研究，改善糖尿病患者的健康及其管理， 初级保健.他寻求K23指导职业发展奖，以获得关键技能和经验， 领导一个独立资助的研究项目他的职业发展计划包括教学和指导 在定性和沟通研究方法，患者报告的结果研究， 以及临床试验的开展和领导。这项培训将在约翰霍普金斯大学丰富的环境中进行， 包括普通内科和彭博公共卫生学院。皮拉医生会 从经验丰富的导师和顾问团队获得指导，他们在患者-提供者方面具有专业知识 沟通，定性研究和临床试验，谁有指导和资金的跟踪记录。

PROJECT SUMMARY / ABSTRACT To achieve optimal care for the half of U.S. adults with diabetes who are treated with insulin or insulin secretagogues, it is crucial to prevent hypoglycemia, which causes substantial morbidity and hospital utilization. However, limited evidence – including our own preliminary analyses – suggests that clinicians do not routinely assess for hypoglycemia and rarely take preventive actions such as modifying diabetes therapy or providing anticipatory guidance for hypoglycemia prevention. The Endocrine Society has called for interventions to improve hypoglycemia prevention in clinical encounters, yet no evidence-based interventions exist. In this proposal, we will fill major gaps in understanding hypoglycemia prevention and patient-provider communication in primary care encounters, and develop a scalable intervention to prevent hypoglycemia that can be integrated into the primary care workflow. Patient-provider communication is especially important for hypoglycemia prevention because it requires clinicians to gather detailed history, convey complex information, and motivate patients to make behavior change. The proposed intervention will build upon effective interventions that improve chronic disease care by using patient reported outcome measures (PROMs) to routinely assess patient symptoms and prompt clinicians to take action addressing them. The specific research aims are: Aim 1) Determine the frequency of hypoglycemia assessment and prevention practices in a national sample of Veterans Affairs primary care visits, and develop a framework for hypoglycemia communication quality. Aim 2) Develop an intervention that integrates PROMs for hypoglycemia assessment into the primary care workflow, linked to a provider toolkit to enhance hypoglycemia communication and prevention practices. Aim 3) To conduct a pilot study to evaluate the feasibility, fidelity, and acceptability of the hypoglycemia prevention intervention developed in Aim 2. These aims lay the groundwork for an R01 application to conduct a definitive clinical trial of the intervention developed here, and address the urgent need for scalable interventions that translate evidence- based practices for hypoglycemia prevention into the primary care setting. Dr. Scott Pilla’s long-term career goal is to become an independent clinician investigator developing and leading interventional research that improves the health of patients with diabetes and their management in primary care. He seeks a K23 mentored career development award to obtain critical skills and experience to lead an independently-funded research program. His career development plan includes didactics and mentored research experience in qualitative and communication research methods, patient reported outcomes research, and the conduct and leadership of clinical trials. This training will occur in the rich environment at Johns Hopkins, including the Division of General Internal Medicine and the Bloomberg School of Public Health. Dr. Pilla will receive guidance from an experienced team of mentors and advisors with expertise in patient-provider communication, qualitative research, and clinical trials, who have a track record of mentoring and funding.