A Patient-Centered Strategy to Reduce Diabetes Disparities in Chinese Americans

项目总结/摘要 1991年至2001年，美国确诊糖尿病的成年人数量增加了61%， 到2050年糖尿病是第六大最常见的死亡原因，导致心血管和肾脏疾病， 失明和下肢截肢。改善疾病管理可降低发病率和死亡率 糖尿病不幸的是，糖尿病患者，特别是移民和少数民族， 建议的护理水平，表明迫切需要制定文化上适当和有效的 这些策略可以纳入现有的医疗实践。糖尿病已成为一种新的流行病 亚裔美国人和太平洋岛民的糖尿病发病率增长速度比美国任何一个 其他种族/民族。特别是，中国人在美国的糖尿病发病率高于本土国家， 并且已经证明比率随着文化适应而增加。大约15%的中国人 被诊断为糖尿病的人，比美国普通人群（5.9%）高出约2.5倍。此外，中国 美国的糖尿病发病率比他们的祖国高5到7倍。然而， 缺乏对收集中国糖尿病数据的国家、社区和学术努力的支持。这可能是 这与华裔美国人相对缺乏政治影响力和模范少数族裔神话有关。 这个拟议的项目是亚洲卫生服务（AHS）， 亚太社区卫生组织协会和加州大学伯克利分校， 包括一个由中国糖尿病患者，家庭成员， 参与项目所有阶段的供应商和倡导者。它将评估一个多层次的试点是否 团队护理干预，包括文化和语言熟练的临床护理，家庭教育， 社区推广，是可行的，有效的，负担得起的，以改善糖尿病护理和结果 与AHS中服务不足的华裔美国人的通常护理模式相比。74%的AHS患者 中国人，67%的患者处于或低于100%的联邦贫困线，86%的患者最好用一种语言提供服务 除了英语。将使用定性和定量技术分析数据。 该项目的一个特别优势是，它将建立在现有的合作，糖尿病护理 该倡议由中国患者和AHS的提供者发起，AHS是一个联邦合格的健康安全网 位于加州的阿拉米达县。这种以社区为基础的合作旨在增加以患者为中心的 护理和促进中国糖尿病患者的健康饮食和体育活动行为。最终，它旨在 促进中国糖尿病患者及其家人和整个社区的健康行为， 在阿拉米达县及其他地区预防不良糖尿病结局并预防新发糖尿病病例。项目叙述 这个项目是由中国糖尿病患者和诊所的医生发起的，因为糖尿病 成为中国人的一个大问题。诊所的病人，他们的家人和医生将与当地的 研究人员寻找方法来改善糖尿病护理的诊所，并帮助教育病人和他们的家人。

Project Summary/Abstract The number of adults with diagnosed diabetes in the US increased 61% from 1991 to 2001 and will double by 2050. Diabetes is the sixth most common cause of death, causing cardiovascular and kidney disease, blindness, and lower limb amputations. Improved disease management can reduce morbidity and mortality from diabetes. Unfortunately, diabetes patients, especially immigrants and minorities, often do not receive recommended levels of care, indicating a critical need for developing culturally-appropriate and effective strategies that can be incorporated into existing medical practices. Diabetes has emerged as a new epidemic across the US and diabetes rates are growing faster among Asian Americans and Pacific Islanders than in any other racial/ethnic group. In particular, diabetes rates for Chinese are higher in the US than in native countries, and rates have been demonstrated to increase with acculturation. Approximately 15% of Chinese are diagnosed with diabetes, ~ 2.5 times higher than in the general U.S. population (5.9%). Also, Chinese American diabetes rates are 5 to 7 times higher than in their native countries.However, there continues to be a lack of support for national, community and academic efforts to collect Chinese diabetes data. This may be related to the relative lack of political influence and the model minority myth among Chinese Americans. This proposed project is a community-academic collaboration between Asian Health Services (AHS), the Association of Asian Pacific Community Health Organizations, and the University of Calilfornia, Berkeley that includes a Chinese American community advisory board consisting of Chinese diabetics, family members, providers, and advocates that are engaged in all phases of the project. It will assess whether a multi-level pilot team care intervention, incorporating culturally and linguistically-proficient clinical care, family education, and community promotion, is feasible, effective, and affordable for improving diabetes care and outcomes compared with usual care model among underserved Chinese Americans at AHS. 74% of patients at AHS are Chinese, 67% of patients are at or below 100% federal poverty level and 86% are best served in a language other than English. Data will be analyzed using qualitative and quantitative techniques. A particular strength of this project is that it will build on an existing collaborative, the Diabetes Care Initiative, that was started by Chinese patients and providers at AHS, a safety net federally qualified health center, in Alameda County, California. This community-based collaborative seeks to increase patient-centered care and to promote healthy dietary and physical activity behaviors in Chinese diabetics. Ultimately, it aims to promote healthy behaviors among Chinese diabetics, their family members, and the community at-large to prevent adverse diabetes outcomes and prevent new diabetes cases in Alameda County and beyond. Project Narrative This project was started up by Chinese diabetes patients and doctors at a clinic, because diabetes has become a big issue for Chinese people. The clinic's patients, their families, and doctors will work with local researchers to find ways to improve diabetes care in the clinic and to help educate patients and their families.