Implementing Scalable, PAtient-centered Team-based Care for Adults with Type 2 Diabetes and Health Disparities (iPATH)

项目摘要/摘要 由来自斯坦福大学、哈佛大学、俄亥俄州立大学和 Impactive，LLC建议进行实践相关的研究，重点是联邦合格医疗机构中的糖尿病护理 中心(FQHC)。约3730万美国人患有2型糖尿病，并存在显著的种族和社会经济问题 在护理质量和患者安全方面仍然存在差距。FQHC为美国七分之一的种族/少数民族提供服务， 肩负着更高的糖尿病患病率(21%的FQHC，11%的美国)，提供了一个有希望的创新场所 专注于股权的糖尿病护理。IPath项目将完善和实施一种实践方法 转变最初的构想是为了支持FQHC追求国家质量保证委员会 公认为以病人为中心的医疗之家。飞行员表现出显著的下降(平均31% 在波多黎各7家附属于FQHC的诊所的患者中，糖尿病控制不良(A1c&Gt；9%) 2017-20赛季的RICO。在新冠肺炎大流行前后，患者糖尿病控制的改善是持续的。 目标1.通过确定组织条件和 促进或阻碍NIH 2型糖尿病护理有效性的FQHC的过程- 指定的美国健康差距人口在大流行前和大流行后。研究团队将 同时进行12个深入的地区性案例研究，使被视为高- 在糖尿病控制方面表现良好和表现不佳。团队将确定可操作的、如何实施 确保对糖尿病患者进行慢性、预防性和急性护理的因素。采用创新的 快速数据收集和报告方法，团队将快速收集、分析和共享数据以 加快向FQHC领导人传播定制反馈，并告知适应和 实施iPath练习改造。 目标2.实施多层次、多组件、支持技术的实践转型 在8个多诊所的FQHC改善2型糖尿病患者的策略。团队将适应，量身定制， 在位于以下位置的FQHC中实施、测试和传播以股权为重点的实践转型战略 加利福尼亚州、马萨诸塞州、俄亥俄州和波多黎各。IPath的实施方法将模块化 并且可定制以适应组织就绪性、患者需求和社交环境， 针对每个独一无二的FQHC进行改造。 目的3.通过第二类混合研究全面评估IPATH实施方法， 包括一项阶梯式楔形整群随机试验。包括形成性、过程性和终结性 在Exploration-Preparation-Implementation-Sustainment模型指导下的评价要素，研究将 评估实践转型的影响并确定影响实施的流程要素 有效性。分析将利用按种族和民族划分的FQHC数据来检查健康差异。

PROJECT SUMMARY / ABSTRACT A collaborative network of research teams from Stanford, Harvard, The Ohio State University, and Impactivo, LLC propose practice-relevant research focused on diabetes care in federally qualified health centers (FQHCs). Some 37.3 million Americans have type 2 diabetes and significant racial and socioeconomic disparities persist in care quality and patient safety. FQHCs serve 1 in 7 U.S. racial/ethnic minorities and shoulder a higher prevalence of diabetes (21% FQHC, 11% U.S.), offering a promising venue for innovating in equity-focused diabetes care. The iPATH project will refine and implement an approach to practice transformation originally conceived to support FQHCs’ pursuit of National Committee for Quality Assurance recognition as patient-centered medical homes. A pilot demonstrated significant decreases (average 31% reduction) in poorly controlled diabetes (A1c>9%) among patients at 7 clinics affiliated with an FQHC in Puerto Rico in 2017-20. Improvements in patients’ diabetes control were sustained pre- to post- Covid-19 pandemic. Aim 1. Refine the iPATH implementation approach by identifying organizational conditions and processes at FQHCs that promoted or impeded the effectiveness of type 2 diabetes care for NIH- designated U.S. health disparity populations pre- and post-pandemic. Research teams will simultaneously conduct 12 in-depth regional case studies, enabling contrast between FQHCs considered high- performing and low-performing for diabetes control. Teams will identify actionable, how-to implementation factors for ensuring chronic, preventive, and acute care for patients with diabetes. Employing an innovative Rapid Data Collection and Reporting methodology, teams will rapidly collect, analyze, and share data to accelerate dissemination of customized feedback to FQHC leaders and to inform adaptation and implementation of the iPATH practice transformation. Aim 2. Implement a multi-level, multi-component, technology-enabled practice transformation strategy to improve type 2 diabetes for patients at 8 multi-clinic FQHCs. Teams will adapt, tailor, implement, test, and spread an equity-focused practice transformation strategy across FQHCs located in California, Massachusetts, Ohio, and Puerto Rico. The iPATH implementation approach will be modularized and customizable to accommodate organizational readiness, patient needs, and social contexts, tailoring practice transformation efforts to each unique FQHC. Aim 3. Comprehensively evaluate the iPATH implementation approach with a hybrid type 2 study, including a stepped wedge cluster randomized trial. Including formative, process, and summative evaluation elements guided by the Exploration-Preparation-Implementation-Sustainment model, the study will evaluate impact of practice transformation and identify process elements affecting implementation effectiveness. Analyses will leverage FQHC data by race and ethnicity to examine health disparities.