The Flint Neuropathy Study: assessing diagnostic and management gaps in a Black, low-income population

摘要 神经病是一种非常普遍的致残性疾病，会导致疼痛和生活质量下降，但很少有 了解黑人低收入人群的神经病诊断和治疗。我们的初步数据 这表明，40年来，以黑人为主的低收入神经病患者中有61%没有得到诊断。 如果没有适当的诊断，对可改变的风险因素的最佳管理，如高血糖和 肥胖和神经性疼痛是不太可能的。计算机化临床决策支持系统(CDSS)得到改进 通过提供循证建议实现初级保健医生(PCP)的诊断和管理 根据患者的特征。这项提案的总体目标是评估神经病的诊断和 在密歇根州弗林特的两家诊所(54%黑人，40%美国贫困线)进行管理，然后适应和试行 干预措施，以解决神经病诊断和治疗中差距的决定因素。我们希望在那里 在黑人低收入患者中存在很大的神经病诊断和管理差距，而且 调整后的CDSS将缩小这些差距。这些假设将通过追求三个具体目标来检验：1) 量化以黑人为主的低收入人群在神经病诊断和管理方面的差距，2) 确定诊断和管理差距的PCP水平预测因素，以及3)采用CDSS干预 强调神经病筛查、风险因素调整和疼痛管理，并评估CDSS Reach， 采用和实施。第一个目标将使用一项试验性研究设计来评估神经疾病的患病率 并确定诊断和管理方面的差距。第二个目标将利用理论领域 评估PCP知识、态度和神经病诊断的临床水平决定因素的框架， 使用混合方法管理危险因素和神经病理性疼痛。最终目标涉及调整一个 现有的CDSS对神经病理性疼痛的干预包括神经病诊断和风险因素管理。 这项干预措施随后将在不同卫生系统的两家诊所进行试点，服务对象主要是黑人和 低收入患者。这项拟议的研究具有很高的创新性，因为它研究了神经病变之间的差距。 最有可能受到神经病及其常见病影响的人群的诊断和治疗 PCP，这是很少有研究做过的。更少的人评估了神经病诊断中差距的决定因素 以及在这群病人中的管理。揭示神经病诊断和诊断的决定因素 管理层具有重大影响，因为这将构成旨在 改善这一人群和其他类似、缺乏服务的人群的神经病诊断和管理 人口。

ABSTRACT Neuropathy is a highly prevalent, disabling condition that leads to pain and reduced quality of life, yet little is known about neuropathy diagnosis and management in Black, low-income populations. Our preliminary data indicates that 61% of primarily Black, low-income patients >40 years with neuropathy are undiagnosed. Without appropriate diagnosis, optimal management of modifiable risk factors, such as hyperglycemia and obesity, and neuropathic pain is unlikely. Computerized clinical decision support systems (CDSSs) improve primary care physician (PCP) diagnoses and management by delivering evidence-based recommendations based on patient characteristics. This proposal’s overall objective is to assess neuropathy diagnosis and management at two Flint, Michigan clinics (54% Black, 40% <US poverty line), then adapt and pilot an intervention to address determinants of gaps in neuropathy diagnosis and management. We expect that there is substantial a neuropathy diagnostic and management gap among Black, low-income patients and that an adapted CDSS will reduce these gaps. These hypotheses will be tested by pursuing three specific aims: 1) quantify gaps in neuropathy diagnosis and management in a predominantly Black, low-income population, 2) determine PCP-level predictors of gaps in diagnosis and management, and 3) adapt a CDSS intervention emphasizing neuropathy screening, risk factor modification, and pain management and evaluate CDSS reach, adoption, and implementation. The first aim will use a piloted study design to assess neuropathy prevalence and determine gaps in diagnosis and management. The second aim will utilize the Theoretical Domains Framework to assess PCP knowledge, attitudes, and clinic level determinants of neuropathy diagnosis, management of risk factors and neuropathic pain using mixed methods. The final aim involves adapting an existing CDSS intervention for neuropathic pain to include neuropathy diagnosis and risk factor management. This intervention will then be piloted at two clinics in different health systems serving predominantly Black and low-income patients. The proposed research is highly innovative because it examines gaps in neuropathy diagnosis and management among a population most likely to be affected by neuropathy and their usual PCPs, which few studies have done. Even fewer have assessed determinants of gaps in neuropathy diagnosis and management in this patient population. Uncovering determinants of neuropathy diagnosis and management represents a significant impact as this will form the foundation for an intervention aimed at improving neuropathy diagnosis and management in this population and other similar, underserved populations.