Participatory design of patient-centered depression and diabetes care.

描述（由申请人提供）：迫切需要改善糖尿病患者的预后，特别是来自服务不足社区的患者。糖尿病患者有高度的抑郁症状，导致他们对护理的参与度较低，整体健康功能更差。对抑郁症和糖尿病的综合护理已被证明有助于改善临床结果。然而，许多患有抑郁症状和糖尿病的患者，特别是传统上服务不足的群体，有其他优先事项，如影响其护理的经济、社会和情感问题。以患者为中心的结果研究（PCOR） K18职业提升奖提议，通过指导计划、正式课程和相关的研究项目，培养PCOR方法的技能，并利用参与式方法激发糖尿病护理的新服务提供模式。该模型的基础是将患者的非生物医学需求作为初级保健治疗讨论和决策的一部分。与患者、医生和执业护士（lpn）作为利益相关者合作，我们的第一阶段将使用混合方法来确定抑郁症状和2型糖尿病患者在其健康背景下可能希望解决的生物医学（身体症状、饮食和运动）和非生物医学（经济、社会和情感）需求的范围。这些需求将用于填充优先级卡片排序任务，该任务将用于创建个性化管理计划，使患者能够在综合护理干预中优先考虑自己的需求。第二阶段将为一项实用的比较有效性试验做准备，通过试点测试综合抑郁症和2型糖尿病（DM）干预加上患者优先计划在初级保健患者中

DESCRIPTION (provided by applicant): There is a pressing need to improve outcomes for patients with diabetes, especially patients from underserved communities. Patients with diabetes have high levels of depressive symptoms that lead to poor engagement in care and worse overall health function. Integrated care for depression and diabetes has been shown to help improve clinical outcomes. However, many patients with depressive symptoms and diabetes, especially traditionally underserved groups, have other priorities such as financial, social and emotional concerns that affect their care. This K18 career enhancement award in Patient Centered Outcomes Research (PCOR) proposes, through a program of mentoring, formal coursework, and a linked research project, to build skills in PCOR methods and utilize a participatory approach to inspire a new services delivery model for diabetes care. The basis of this model would be to include patient's nonbiomedical needs as part of primary care treatment discussions and decisions. Partnering with patients, physicians, and licensed practical nurses (LPNs) as stakeholders, our first phase will use mixed-methods to determine the range of biomedical (physical symptoms, diet and exercise) and nonbiomedical (financial, social and emotional) needs patients with depressive symptoms and Type 2 DM may wish to address in the context of their health. These needs will be used to populate a prioritization card-sort task that will be used to create a personalized management plan that empowers patients to prioritize their own needs within an integrated care intervention. The second phase will prepare for a pragmatic comparative effectiveness trial by pilot testing an integrated depression and Type 2 diabetes mellitus (DM) intervention plus patient prioritized planning in primary care patients with depressive symptoms and Type 2 DM and a hemoglobin A1c (HbA1c) > 8% from urban clinics serving primarily older low income minority populations. Function will be our primary patient-centered outcome because of the importance patients place on being able to manage one's life circumstances. The intervention is carried out by health care staff already on site thus facilitatig its implementation in real world practices with limited resources and competing demands. Our goal is to close the health disparities gap in diabetes care among traditionally underserved groups including older adults, those in inner city areas, and members of minority groups.