Improving Diabetes Risk Assessment and Screening in Minority-Predominant Community Health Center Patients

项目摘要 2型糖尿病不成比例地影响美国种族/少数民族，这一点可以通过较高的 西班牙裔、黑人、亚裔美国人、太平洋岛民、 和美国原住民相比。2015年10月，美国预防服务工作组 （USPSTF）发布了一项新的建议，对40-70岁的无症状成年人进行筛查， 超重/肥胖的糖尿病和前驱糖尿病（统称为糖尿病）。这些筛选标准是 可能会发现少数种族/族裔中的精神障碍病例相对较少， 与白人相比，年轻人和体重较轻的人风险更高。相比之下，美国糖尿病 美国糖尿病协会（ADA）建议筛查至少有两个糖尿病风险因素的成年人，包括非白人 种族/民族。筛查标准是基于使用风险因素来预测 精神障碍然而，现有的风险模型在实践中的应用有限，因为它们包括 并不是常规收集的，它们不能准确地预测种族/民族少数群体的精神障碍。使用 来自全国社区卫生中心网络的数据，其患者主要是种族/民族 这项及时的研究将调查糖尿病风险的评估和 替代筛选标准。芝加哥社区卫生服务联盟（Alliance of Chicago Community Health Services）是一个全国性的数据库。 200多个社区卫生中心的仓库，将社会人口统计学、实验室和医疗保健联系起来 来自超过80万名患者的电子健康记录（EHR）的使用数据。使用纵向联盟 从2006年到2015年的数据，我们将比较三种不同方法的预测性能 基于：1）USPSTF标准; 2）ADA标准;和3）来自新型风险预测模型的标准 我们将使用相同的EHR数据进行开发。在第二个目标中，我们将估计和比较成本和短期- 根据同一套标准进行筛选的长期成本效益。这一经济分析对于 促进在实践中采用最佳的糖尿病筛查方法。这项研究的结果可以用于 改善糖尿病筛查建议，以更好地识别高风险个体，特别是种族/民族 少数群体因此，这项研究可能有助于减少种族/民族差异，通过检测精神障碍的早期， 这些群体，以便可以启动预防和治疗战略。此外，这项研究将导致 未来的研究，测试新的干预措施，用于筛查，诊断和治疗精神障碍， 审查筛选方法的长期成本效益。我们的多学科团队拥有广泛的 成功进行拟议的二次数据处理所需的内容领域和方法方面的专业知识 分析，然后探讨研究结果在实践中的应用。这项研究是及时的， 检查新的糖尿病筛查标准;新纳入了一名大型少数民族患者 样本;并显着的潜力，以最大限度地提高人口健康和健康公平的糖尿病。

Project Summary Type 2 diabetes disproportionately affects U.S. racial/ethnic minorities, as evidenced by a higher prevalence of the condition and its complications among Hispanics, blacks, Asian Americans, Pacific Islanders, and Native Americans compared to whites. In October 2015, the U.S. Preventive Services Task Force (USPSTF) released a new recommendation to screen asymptomatic adults who are 40-70 years old and overweight/obese for diabetes and prediabetes (collectively called dysglycemia). These screening criteria are likely to identify proportionately fewer cases of dysglycemia among racial/ethnic minorities, who experience higher risk at younger ages and lower body weights compared to whites. By contrast, the American Diabetes Association (ADA) recommends screening in adults with at least two diabetes risk factors, including non-white race/ethnicity. Screening criteria are based on models that use risk factors to predict the development of dysglycemia. However, existing risk models have limited application in practice because they include data that are not routinely collected, and they do not accurately predict dysglycemia in racial/ethnic minorities. Using data from a national network of community health centers whose patients are predominantly racial/ethnic minorities, this timely research will investigate the assessment of diabetes risk and the effectiveness of alternate screening criteria. The Alliance of Chicago Community Health Services (Alliance) is a national data warehouse for over 200 community health centers, which links sociodemographic, laboratory, and healthcare utilization data from the electronic health records (EHR) of over 800,000 patients. Using longitudinal Alliance data from 2006 to 2015, we will compare the performance of three different approaches for predicting dysglycemia, based on: 1) USPSTF criteria; 2) ADA criteria; and 3) criteria from a novel risk prediction model we will develop using the same EHR data. In a second aim, we will estimate and compare the costs and short- term cost-effectiveness of screening based on the same sets of criteria. This economic analysis is essential to promote the uptake of optimal diabetes screening approaches in practice. Findings from this study can be used to improve diabetes screening recommendations to better identify high-risk individuals, especially racial/ethnic minorities. This study may therefore help reduce racial/ethnic disparities by detecting dysglycemia earlier in these groups, so that prevention and treatment strategies can be initiated. In addition, this study will lead to future research that tests novel interventions for screening, diagnosing, and treating dysglycemia, and examines the long-term cost effectiveness of screening approaches. Our multidisciplinary team has extensive expertise in the content areas and methods needed to successfully conduct the proposed secondary data analysis, and then investigate the application of study findings in practice. This study is timely in its examination of new diabetes screening criteria; novel in its inclusion of a large, minority-predominant patient sample; and significant in its potential to maximize both population health and health equity in diabetes.