PROmoting Diabetes Education and Management Through Peer Support and Team Referral
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 87
- 试验地点
- 2
- 主要终点
- Odds of referral for DSMES Placed through the Electronic Health Record (EHR)
研究概览
简要总结
A 3-step project is proposed. Step 1 will test which BPA time point(s) maximize referral rates to DSMES services in the real world clinic setting (Aim 1). Step 2 will utilize that approach within a pilot study of six sites, comparing the effectiveness of peer support to improve attendance to DSMES services (Aim 2). Step 3 will engage stakeholders in designing a future large scale DSMES services trial to improve referral and attendance to DSMES classes.
详细描述
Living with diabetes can be challenging, however Diabetes Self-Management Education and Support (DSMES) is well known to help persons with diabetes (PWDM) learn to cope with the uncertainties of life with diabetes. Unfortunately, DSMES is underutilized in the current health care setting. This is a multifactorial problem with the two largest issues being providers not referring patients and patients not attending the DSMES programs. These programs and the health care workers who support them have the potential to modify the disease course for many PWDM, including potentially modifying long term morbidity and mortality. A feasibility study to test the impact of Best Practice Advisories (BPAs) delivered to the health care provider and the Diabetes Care and Education Specialists (DCES)via the electronic health record when a PWDM is identified as qualifying for DSMES. The investigators will determine if the BPAs influence the time to referral for DSMES as well as the factors that predict whether a patient is referred to DSMES. The investigators also propose to assess the impact of a peer support on motivating PWDM to attend DSMES and make healthier lifestyle choices. The investigators hypothesize that if PWDM are able to connect with a peer who is also living with diabetes, they may be more likely to attend DSMES. Finally, the investigators will assess qualitatively how the health care providers felt about the use of the BPA reminders, explore how the PWDM felt about the utility of the peer supporters, and the overall relevance of the diabetes education they received. From these lessons learned the investigators will work with the stakeholders to design a large, pragmatic randomized trial designed to increase the uptake of DSMES, a vital piece of the diabetes puzzle.
Aim 1. Evaluate the relative impact of BPAs on DSMES services among providers at 6 primary care clinics.The investigators will identify six primary care practices to deploy the suite of tools designed to increase patient referrals to DSMES classes. All six practices will be from within the state of North Carolina. The providers will be a mix of genders, and ages. Providers will be a convenience sample based upon the six practices that are identified to be a part of this study.
Aim 2. Conduct a 6-month pilot of DSMES among 90 PWDM randomized to one of two groups: usual care or peer support. The investigators will identify 90 PWD who are active adult patients with type 2 diabetes from one of the six practices identified in Aim 1.
Aim 3. Engage stakeholders in designing a future large scale DSMES services trial. The investigators will interview providers and patients from Aims 1 and 2 for the qualitative interviews planned in Aim 3.
Practices: Six primary care practices within the UNC Physicians Network (UNCPN) will be recruited. Based upon the strong relationship the investigators have built with the UNCPN over the past decade, the investigators will work with the UNCPN leadership team to identify practices most likely to be interested in participation. The investigators will ensure a diverse group of practices, including a mix of rural and urban locations. Upon identification of the potential practices, the seasoned practice facilitator will arrange lunch and learn sessions within the potential practices, where they will present the project and discuss the requirements of participating. Practices will have the opportunity to discuss participation amongst their team members, and the practice facilitator will follow up with them within a week to determine their interest in enrolling.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Primary Care Providers employed at the participating practices
排除标准
- •Primary Care Providers that are not employed at the participating practices
- •Inclusion Criteria Patients:
- •Adult, English-speaking patients diagnosed with type 2 diabetes who are referred to DSMES classes from a provider at one of the study practices.
- •Exclusion Criteria Patients:
- •Any patients who are not referred to DSMES classes from the study practices
结局指标
主要结局
Odds of referral for DSMES Placed through the Electronic Health Record (EHR)
时间窗: 30 days
EHR data from the Carolina Data Warehouse. Referral defined as within 30 days of patient seen in of office
Odds of attending 1 DSMES class
时间窗: 3 months
EHR data -odds of attending 1 DSMES class within 3 months of referral
Number of Patients Referred for Diabetes Self-Management Education and Support (DSMES) Placed Through the Electronic Health Record (EHR)
时间窗: 30 days
The number of patients from an EHR data from the Carolina Data Warehouse for Health. Referral defined as within 30 days of patient seen in of office.
Number of Patients Attending 1 DSMES Class
时间窗: within 3 months of referral
Number of patients attending 1 DSMES class within 3 months of referral.
次要结局
- Time from index patient visit to referral to DSMES(3 months)
- Number of PWD who attended at least 2 DSMES group classes(3 months)
- Number of PWD who completed the entire DSMES class(3 months)
- Time to get to DSMES class(3 months)
- Change in A1c from baseline to 3 months(Baseline, Month 3)
- Change in A1c from baseline to 6 months(Baseline, Month 6)
- Change in Diabetes Distress from baseline to 3 months(Baseline, Month 3)
- Change in Diabetes Distress from baseline to 6 months(Baseline, Month 6)
- Change in Diabetes Self-Efficacy from baseline to 3 months(Baseline, Month 3)
- A1c - Baseline(Baseline)
- Change in Diabetes Self-Efficacy from baseline to 6 months(Baseline, Month 6)
- Diabetes Self-Efficacy Baseline(Baseline)
- Diabetes Distress - Baseline(Baseline)
- Time to Get to DSMES Class(3 months)
- Number of PWDM Who Attended at Least 2 DSMES Group Classes(3 months)
- Number of PWD Who Completed the Entire DSMES Class(3 months)
- HbA1c - Baseline(Baseline)
- Change in HbA1c From Baseline to 3 Months(Baseline, Month 3)
- Change in HbA1c From Baseline to 6 Months(Baseline, Month 6)
- Change in Diabetes Distress From Baseline to 3 Months(Baseline, Month 3)
- Change in Diabetes Self-Efficacy From Baseline to 3 Months(Baseline, Month 3)