Putting Telehealth to the Test: An Evaluation of the Use of Telehealth to Increase the Population-Level Impact of an Employer-Based Diabetes Prevention Program

项目摘要 2型糖尿病（T2 DM）是SARS-CoV-2感染后急性后遗症（PASC，临床）的最新报道 持续超过30天的感染）突出了公共卫生的迫切需要，以更好地了解和 描述COVID-19和T2 DM之间的潜在关联。PASC相关T2 DM的既往研究 生活在美国的成年人分析了来自种族/民族多样性有限的人群的数据， 结果很难推广到黑人和西班牙裔社区， 美国SARS-CoV-2感染率、COVID-19相关发病率和死亡率以及T2 DM。推进 我们对少数民族社区感染SARS-CoV-2后T2 DM风险的了解，我们将 使用OneFlorida+ Data Trust（临床研究网络（CRN））进行回顾性队列研究 在国家以患者为中心的临床研究网络（PCORnet）中， 电子健康记录（EHR）数据为1920万美国人寻求照顾的所有主要 佛罗里达（美国COVID病例数第三高的州）的大都市地区以及 SARS-CoV-2感染和T2 DM事件之间的关联尚未得到证实。 使用严格的方法和相关变量（社会 脆弱性和个人易感因素），尽管发病率明显较高， 少数民族社区的COVID-19和T2 DM。我们将采用严格的分析方法，利用高- OneFlorida+数据中的个人易感性和社会脆弱性因素的高质量数据 Trust是一个包含大量少数族裔群体（24%西班牙裔，18%黑人）的数据集，可以解决这个问题 知识上的巨大差距。除了诊断/程序代码等标准EHR数据外，实验室 价值观，药物，患者人口统计和生命体征，OneFlorida+数据信托基金包括链接到 关于自然、建筑和社会环境的令人烦恼的数据。OneFlorida+数据的其他优势 对该项目的信任包括糖尿病经验证的可计算表型（CP）的可用性，以减少 结果错误分类的可能性;医疗保健接触类型的分化;年轻人比例较大 成人和女性比之前的研究PASC相关的T2 DM;不同的支付者来源;和能力， 链接OneFlorida+ Data Trust贡献站点的患者记录。我们的具体目标是：（1）评估 使用OneFlorida+的回顾性队列中PSC相关T2 DM发生率的人种/种族差异 数据信任和（2）比较SARS-CoV-2感染后心脏代谢危险因素的变化， 使用OneFlorida+ Data Trust进行回顾性队列中的人种/种族分析。这项研究将填补关键知识 少数种族和族裔中COVID-19与新发T2 DM之间潜在关联的差距 社区.这些发现将直接为糖尿病筛查建议提供信息， 发生PASC的患者人群。

PROJECT SUMMARY Recent reports of type 2 diabetes (T2DM) as a post-acute sequela of SARS-CoV-2 infection (PASC, clinical findings lasting beyond 30 days of infection) highlight the urgent public health need to better understand and characterize the potential association between COVID-19 and T2DM. Prior studies of PASC-associated T2DM among adults living in the US have analyzed data from populations with limited racial/ethnic diversity, making the results difficult to generalize to Black and Hispanic communities that experience disproportionately higher rates of SARS-CoV-2 infection, COVID-19-related morbidity and mortality, and T2DM in the US. To advance our understanding of T2DM risk after SARS-CoV-2 infection in racial and ethnic minority communities, we will conduct a retrospective cohort study using the OneFlorida+ Data Trust, a Clinical Research Network (CRN) within the National Patient-Centered Clinical Research Network (PCORnet) that contains patient-level electronic health record (EHR) data for a diverse population of 19.2 million Americans seeking care in all major metropolitan regions in Florida (the state with the 3rd highest number of COVID cases in the US) as well as Atlanta, GA and Birmingham, AL. The association between SARS-CoV-2 infection and incident T2DM has yet to be empirically quantified by race and/or ethnicity using rigorous methods and relevant variables (social vulnerability and individual susceptibility factors) for diverse populations, despite the markedly higher rates of COVID-19 and T2DM in minority communities. We will employ a rigorous analytic approach that utilizes high- quality data available for both individual susceptibility and social vulnerability factors in the OneFlorida+ Data Trust, a dataset that includes large proportions of minority groups (24% Hispanic, 18% Black), to address this critical gap in knowledge. In addition to standard EHR data such as diagnosis/procedure codes, laboratory values, medications, patient demographics, and vital signs, the OneFlorida+ Data Trust includes linkages to exposome data on the natural, built, and social environments. Additional strengths of the OneFlorida+ Data Trust for this project include availability of validated computable phenotypes (CPs) for diabetes to reduce the chance of outcome misclassification; differentiation of healthcare encounter types; larger proportions of young adults and women than prior studies of PASC-associated T2DM; diverse payer sources; and the capacity to link patient records across OneFlorida+ Data Trust contributing sites. Our specific aims are (1) to assess racial/ethnic differences in PASC-associated T2DM incidence in a retrospective cohort using the OneFlorida+ Data Trust and (2) to compare changes in cardiometabolic risk factors following SARS-CoV-2 infection by race/ethnicity in a retrospective cohort using the OneFlorida+ Data Trust. This study will fill critical knowledge gaps in the potential association between COVID-19 and new-onset T2DM in racial and ethnic minority communities. The findings will directly inform diabetes screening recommendations in the rapidly growing population of patients experiencing PASC.