A Patient-Centered Strategy to Reduce Diabetes Disparities in Chinese Americans

描述（由申请人提供）：从1991年到2001年，美国诊断为糖尿病的成人人数增加了61%，到2050年将翻一番。糖尿病是第六大最常见的死亡原因，会导致心血管和肾脏疾病、失明和下肢截肢。改善疾病管理可以降低糖尿病的发病率和死亡率。不幸的是，糖尿病患者，特别是移民和少数民族患者，往往得不到建议的护理水平，这表明迫切需要制定适合文化的有效战略，并将其纳入现有的医疗实践。糖尿病已成为一种新的流行病，在美国，亚裔美国人和太平洋岛民的糖尿病发病率增长速度比其他任何种族/族裔群体都要快。尤其值得一提的是，中国人在美国患糖尿病的比例高于他们在本国的比例，而且随着文化的适应，这一比例也在上升。大约15%的中国人被诊断患有糖尿病，是美国总人口（5.9%）的2.5倍。此外，美籍华人的糖尿病发病率比他们的祖国高5到7倍。然而，对于收集中国糖尿病数据的国家、社区和学术努力仍然缺乏支持。这可能与美国华人相对缺乏政治影响力和模范少数族裔神话有关。这个拟议的项目是亚洲健康服务（AHS）、亚太社区卫生组织协会和加州大学伯克利分校之间的社区学术合作，其中包括一个由中国糖尿病患者、家庭成员、提供者和倡导者组成的美籍华人社区顾问委员会，他们参与了项目的各个阶段。与常规护理模式相比，该研究将评估在美国医院服务不足的华裔美国人中，结合文化和语言熟练的临床护理、家庭教育和社区推广的多层次试点团队护理干预是否可行、有效和负担得起，以改善糖尿病护理和结果。在AHS， 74%的患者是中国人，67%的患者处于或低于100%的联邦贫困水平，86%的患者最好使用英语以外的语言。数据将使用定性和定量技术进行分析。该项目的一个特别优势在于，它将以现有的合作项目“糖尿病护理计划”为基础。该计划是由加利福尼亚州阿拉米达县的美国糖尿病协会（AHS）的中国患者和医疗服务提供者发起的。这项以社区为基础的合作旨在增加以患者为中心的护理，并促进中国糖尿病患者健康的饮食和体育活动行为。最终，该项目旨在促进中国糖尿病患者、其家庭成员和整个社区的健康行为，以预防糖尿病的不良后果，并预防阿拉米达县及其他地区的新发糖尿病病例。公共卫生相关性：这个项目是由中国的糖尿病患者和诊所的医生发起的，因为糖尿病已经成为中国人的一个大问题。诊所的病人、他们的家人和医生将与当地研究人员合作，寻找改善诊所糖尿病护理的方法，并帮助教育病人和他们的家人。

DESCRIPTION (provided by applicant): The number of adults with diagnosed diabetes in the US increased 61 percent from 1991 to 2001 and will double by 2050. Diabetes is the sixth most common cause of death, causing cardiovascular and kidney disease, blindness, and lower limb amputations. Improved disease management can reduce morbidity and mortality from diabetes. Unfortunately, diabetes patients, especially immigrants and minorities, often do not receive recommended levels of care, indicating a critical need for developing culturally-appropriate and effective strategies that can be incorporated into existing medical practices. Diabetes has emerged as a new epidemic across the US and diabetes rates are growing faster among Asian Americans and Pacific Islanders than in any other racial/ethnic group. In particular, diabetes rates for Chinese are higher in the US than in native countries, and rates have been demonstrated to increase with acculturation. Approximately 15 percent of Chinese are diagnosed with diabetes, ~ 2.5 times higher than in the general U.S. population (5.9 percent). Also, Chinese American diabetes rates are 5 to 7 times higher than in their native countries. However, there continues to be a lack of support for national, community and academic efforts to collect Chinese diabetes data. This may be related to the relative lack of political influence and the model minority myth among Chinese Americans. This proposed project is a community-academic collaboration between Asian Health Services (AHS), the Association of Asian Pacific Community Health Organizations, and the University of California, Berkeley that includes a Chinese American community advisory board consisting of Chinese diabetics, family members, providers, and advocates that are engaged in all phases of the project. It will assess whether a multi-level pilot team care intervention, incorporating culturally and linguistically-proficient clinical care, family education, and community promotion, is feasible, effective, and affordable for improving diabetes care and outcomes compared with usual care model among underserved Chinese Americans at AHS. 74 percent of patients at AHS are Chinese, 67 percent of patients are at or below 100 percent federal poverty level and 86 percent are best served in a language other than English. Data will be analyzed using qualitative and quantitative techniques. A particular strength of this project is that it will build on an existing collaborative, the Diabetes Care Initiative, that was started by Chinese patients and providers at AHS, a safety net federally qualified health center, in Alameda County, California. This community-based collaborative seeks to increase patient-centered care and to promote healthy dietary and physical activity behaviors in Chinese diabetics. Ultimately, it aims to promote healthy behaviors among Chinese diabetics, their family members, and the community at-large to prevent adverse diabetes outcomes and prevent new diabetes cases in Alameda County and beyond. PUBLIC HEALTH RELEVANCE: This project was started up by Chinese diabetes patients and doctors at a clinic, because diabetes has become a big issue for Chinese people. The clinic's patients, their families, and doctors will work with local researchers to find ways to improve diabetes care in the clinic and to help educate patients and their families.