Latinos Understanding the Need for Adherence in Diabetes using Care Coordination, Integrated Medical and Behavioral Care and E-Health (LUNA-E)

项目总结/摘要 拟议的拉丁美洲人了解糖尿病使用护理坚持的必要性 协调、综合医疗和行为护理以及电子健康（LUNA-E） 对照试验将测试创新的以患者为中心，以团队为基础，主要 护理干预改善圣伊西德罗健康（SYH）拉丁美洲患者的糖尿病结局， 一个大型的联邦合格的健康中心（CFDHC）。该提案建立在17年多来 由我们的学术（圣地亚哥州立大学; SDSU）社区（SYH）合作伙伴进行研究。 LUNA-E将招募N=400名糖尿病控制不佳的拉丁裔成年人，并将其随机分为“普通”组和“普通”组。 附加护理（UCP）或特殊干预（SI）。UCP代表了最近发起的方法， SYH以患者为中心的医疗之家倡议，其中医疗助理提供护理 与初级保健提供者合作进行协调、转诊和简短的健康教育。 LUNA-E SI是一种高度整合的、针对糖尿病文化的、基于团队的方法 了解慢性病护理模式的医疗保健和资源，并支持自我， 行为改变的管理模式。SI包括：1）由专门的 受过训练的健康导航员; 2）与具有糖尿病知识的行为健康提供者一起访问， 糖尿病护理的当地文化、综合模式和心理社会方面; 3）护理整合 在初级保健提供者、行为健康提供者和护理协调员之间， 患者电子健康记录（EHR）中的决策支持“仪表板”; 4）基于证据， 通过患者门户网站提供适应文化的糖尿病自我管理教育。这项研究将 检验LUNA-E SI将导致血糖控制（HbA 1c）更大改善的假设 水平;目标1）和心理困扰（抑郁和焦虑症状;目标2）在6个月 与UCP相比，随机化后，以及这些差异的程度 由概念驱动的调解人解释（改善资源和支持自我， 管理、患者激活、药物依从性和自我管理行为;目标3） 匹配的回顾性真实医疗护理（TUC）组（N=200）将使用 倾向评分匹配，以评价UCP和SI患者与 几乎没有护理协调和健康教育，也没有研究访问。一个彻底的进程 评价将评估干预措施的范围、有效性、采用情况、实施情况， 维护（RE-AIM）。LUNA-E具有巨大影响和广泛传播的巨大潜力 由于其社区合作的方法，对EHR和E-Health的依赖， 在一个大型的，示范性的CMEHC初级保健环境中。

Project Summary/Abstract The proposed Latinos Understanding the Need for Adherence in Diabetes using Care Coordination, Integrated Medical and Behavioral Care and E-Health (LUNA-E) randomized controlled trial will test the effectiveness of an innovative patient-centered, team-based, primary care intervention in improving diabetes outcomes in Latino patients of San Ysidro Health (SYH), a large federally qualified health center (FQHC). The proposal builds on more than 17 years of research by our academic (San Diego State University; SDSU) community (SYH) partnership. LUNA-E will recruit and randomize N=400 Latino adults with poorly controlled diabetes into "usual care plus" (UCP) or "special intervention" (SI). UCP represents methods recently initiated by the SYH Patient Centered Medical Home initiative, in which a medical assistant provides care coordination, referrals, and brief health education in collaboration with the primary care provider. The LUNA-E SI is a highly integrated, culturally specific for diabetes, team-based approach informed by the Chronic Care Model of healthcare and Resources and Supports for Self- Management Model of behavior change. The SI includes: 1) Care Coordination by a specially trained health navigator; 2) Visits with a Behavioral Health Provider with knowledge of diabetes, local culture, the integrated model, and psychosocial aspects of diabetes care; 3) Care integration among the Primary Care Provider, Behavioral Health Provider and Care Coordinator via a clinical decision support “dashboard” in the patient electronic health record (EHR); 4) Evidence-based, culturally adapted diabetes self-management education delivered via patient portal. The study will test hypotheses that the LUNA-E SI will lead to larger improvements in glycemic control (HbA1c levels; Aim 1) and psychological distress (depression and anxiety symptoms; Aim 2) at 6-months post randomization when compared to UCP, and the degree to which these differences are explained by conceptually driven mediators (improved resources and supports for self- management, patient activation, medication adherence and self-management behaviors; Aim 3) A matched retrospective True Usual Care (TUC) group (N=200) will be extracted from EHR using propensity score matching, to evaluate diabetes outcomes in UCP and SI versus patients with little to no care coordination and health education and no study visits. A thorough process evaluation will assess intervention reach, effectiveness, adoption, implementation, and maintenance (RE-AIM). LUNA-E has excellent potential for high impact and broad dissemination due to its community partnered approach, reliance on EHR and E-Health, and implementation within a large, exemplar FQHC primary care environment.