Implementing a Diabetes Screening and Referral Service Developed for Dental Clinics Within an Urban Alaska Native Health Care Setting

项目摘要/摘要--RP1 阿拉斯加原住民和美国印第安人(Anai)患糖尿病(DM)的风险增加 危险因素的流行。最近的研究表明，糖尿病的患病率和发病率正在上升，糖尿病前期的比率 阿拉斯加Anai人群中的DM与其他美国群体一样大，如果不是更大的话。此外，40% 糖尿病的并发症没有确诊，因此增加了糖尿病并发症的风险。因为糖尿病并发症开始发展 在糖尿病前期，早期筛查和干预可以预防或延缓糖尿病的发病及其并发症。 实施为城市牙科诊所开发的糖尿病筛查和转诊服务 阿拉斯加当地医疗保健环境“是一项为期4年的研究，它将使用实施科学框架来评估 中南基金会(SCF)DM测试的可接受性、适用性、可行性和后果 牙科诊所。SCF是一个部落卫生组织，为阿奈人提供初级保健和牙科服务。 居住在阿拉斯加城市安克雷奇地区--全州近一半的阿奈人的家园。 研究表明，在某一年，与医疗提供者没有接触的成年人中有27%是这样做的 去看牙医。糖尿病与牙周病的双向关系已有文献记载 建议牙科就诊提供了一个很大程度上尚未开发的机会，以筛查糖尿病高危人群并转介他们 对初级保健提供者进行跟进和治疗。这一机会在SCF得到了加强，因为牙科和 初级保健服务在同一封闭的部落保健系统内提供。 我们提出了现场岗位设计和分阶段的方法来研究实施一个有证据的- 以预防为基础的服务-糖尿病筛查、短暂干预和转诊至初级保健-在一种新的 环境，牙科诊所。经验丰富的临床和实施研究专家将与多个 使用两个理论上和互补的传播和实施科学框架的利益攸关方： REACH、有效性、采用、实施、维护(RE-AIM)和综合框架 实施研究(CFIR)以实现三个具体目标(SA)：SA1：确定障碍和促进者 在SCF牙科和初级保健诊所内实施糖尿病筛查和转诊服务。SA2： 开发牙科诊所糖尿病筛查和转诊服务，将障碍降至最低，并利用辅助者 在SA1中识别。SA3：试行、评估和反复改进提供的糖尿病筛查和转诊服务 通过SCF牙科诊所。

PROJECT SUMMARY/ABSTRACT – RP1 Alaska Native and American Indian (ANAI) people are at increased risk for diabetes (DM) with documented prevalence of risk factors. Recent studies show that DM prevalence and incidence are rising and rates of pre- DM among the ANAI population in Alaska are as great, if not greater, than other U.S. groups. Additionally, 40% of DM is undiagnosed, thus increasing risk for DM complications. Since DM complications begin to develop during pre-DM, early screening and intervention can prevent or delay DM onset and its complications. “Implementing a Diabetes Screening and Referral Service Developed for Dental Clinics within an Urban Alaska Native Health Care Setting” is a 4-year study that will use implementation science frameworks to assess acceptability, applicability, feasibility, and consequences of DM testing within Southcentral Foundation (SCF) Dental Clinics. SCF is a Tribal health organization providing primary care and dental services to ANAI people living within the urban Anchorage, Alaska area – home to nearly half of the ANAI population statewide. Research indicates that in a given year, 27% of adults who do not have contact with a medical provider did visit a dental provider. The well-documented bidirectional relationship between DM and periodontal disease suggests that dental visits offer a largely untapped opportunity to screen persons at risk for DM and refer them to primary care providers for follow up and treatment. This opportunity is enhanced at SCF because dental and primary care services are provided within the same closed Tribal health system. We propose a within-site post design, and phased approach to study the implementation of an evidenced- based preventive service – DM screening, brief intervention, and referral to primary care – delivered in a novel setting, dental clinics. Experienced clinical and implementation research experts will work with multiple stakeholders using two theoretical and complimentary dissemination and implementation science frameworks: Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) and the Consolidated Framework for Implementation Research (CFIR) to accomplish three specific aims (SAs): SA1: Identify barriers and facilitators to implementing a diabetes screening and referral service within SCF Dental and Primary Care Clinics. SA2: Develop a dental clinic diabetes screening and referral service that minimizes barriers and utilizes facilitators identified in SA1. SA3: Pilot, assess, and iteratively refine a diabetes screening and referral service delivered through SCF Dental Clinics.