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

项目总结/摘要 来自斯坦福大学、哈佛、俄亥俄州州立大学和 Impactivo，LLC提出了与实践相关的研究，重点关注联邦合格健康机构的糖尿病护理 中心（CNOHC）。大约3730万美国人患有2型糖尿病， 在护理质量和病人安全方面仍然存在差距。美国少数民族服务于七分之一的美国种族/少数民族， 糖尿病患病率更高（21%美国，21%美国），为创新提供了一个有前途的场所， 注重公平的糖尿病护理。iPATH项目将完善和实施一种实践方法， 最初设想的转型是为了支持国家质量保证委员会 以病人为中心的医疗之家。一名飞行员表现出显著下降（平均31% 在波多黎各的7家附属于一家CMEHC的诊所中， Rico在2017 - 20。患者糖尿病控制的改善在新冠肺炎大流行前后持续。 目标1.通过确定组织条件来完善iPATH实施方法， 促进或阻碍NIH 2型糖尿病护理有效性的CNOHC流程- 指定的美国健康差距人口在大流行前后。研究团队将 同时进行12个深入的区域案例研究，以便在被认为是高风险国家的国家之间进行对比， 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方法实施 确保糖尿病患者的慢性、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， 加快向联合国人道主义事务协调厅领导人传播定制反馈， 实施iPATH实践转型。 目标2.实施多层次、多要素、技术赋能的实践转型 改善8个多诊所糖尿病中心患者2型糖尿病的策略。团队将适应，调整， 实施、测试并在位于以下地区的各CNOHC中推广以公平为中心的实践转型战略： 加州、马萨诸塞州、俄亥俄州和波多黎各。iPATH实施方法将模块化 可定制以适应组织准备、患者需求和社会背景， 为每个独特的企业人力资源管理人员实践转型工作。 目标3.通过混合2型研究全面评估iPATH实施方法， 包括一项阶梯楔形群随机试验。包括形成性、过程性和总结性 在探索-准备-实施-维持模式指导下的评价要素，研究将 评估实践转变的影响，并确定影响实施的流程要素 有效性分析将利用按种族和族裔分列的卫生和健康委员会数据来审查健康差距。

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.