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，导致对护理的投入不足，整体健康功能更差。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，如影响他们护理的经济、社会和情感方面的担忧。这项以患者为中心的结果研究(PCOR)K18职业提升奖建议，通过一个指导计划、正式的课程作业和一个相关的研究项目，培养PCOR方法的技能，并利用参与式方法来启发糖尿病护理的新服务交付模式。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。我们的第一阶段将与患者、医生和有执照的执业护士(LPN)作为利益相关者合作，使用混合方法来确定具有抑郁症状和2型糖尿病患者可能希望在其健康背景下解决的生物医学(身体症状、饮食和锻炼)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排序卡片分类任务，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对自己的需求进行优先排序。第二阶段将通过试点测试综合抑郁症和2型糖尿病(DM)干预以及患者优先计划在初级保健患者中进行务实的比较有效性试验。 抑郁症状和2型糖尿病和一种血红蛋白A1c(HbA1c)&Gt；8%来自主要服务于老年低收入少数民族人口的城市诊所。功能将是我们以患者为中心的主要结果，因为患者重视能够管理自己的生活环境。干预是由已经在现场的卫生保健工作人员进行的，从而促进了在资源有限和相互竞争的需求的现实世界实践中的实施。我们的目标是缩小传统上服务不足的群体在糖尿病护理方面的健康差距，包括老年人、市中心地区的人和少数群体成员。

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.