Eurich Dean T, Majumdar Sumit R, Wozniak Lisa A, Soprovich Allison, Meneen Kari, Johnson Jeffrey A, Samanani Salim
School of Public Health, University of Alberta, Edmonton, AB, T6G 1C9, Canada.
Alliance for Canadian Heath Outcomes Research in Diabetes, University of Alberta, Edmonton, AB, T6G 2E1, Canada.
BMC Health Serv Res. 2017 Feb 6;17(1):117. doi: 10.1186/s12913-017-2049-y.
Type-2 diabetes rates in First Nations communities are 3-5 times higher than the general Canadian population, resulting in a high burden of disease, complications and comorbidity. Limited community nursing capacity, isolated environments and a lack of electronic health records (EHR)/registries lead to a reactive, disorganized approach to diabetes care for many First Nations people. The Reorganizing the Approach to Diabetes through the Application of Registries (RADAR) project was developed in alignments with federal calls for innovative, culturally relevant, community-specific programs for people with type-2 diabetes developed and delivered in partnership with target communities.
RADAR applies both an integrated diabetes EHR/registry system (CARE platform) and centralized care coordinator (CC) service that will support local healthcare. The CC will work with local healthcare workers to support patient and community health needs (using the CARE platform) and build capacity in best practices for type-2 diabetes management. A modified stepped wedge controlled trial design will be used to evaluate the model. During the baseline phase, the CC will work with local healthcare workers to identify patients with type-2 diabetes and register them into the CARE platform, but not make any management recommendations. During the intervention phase, the CC will work with local healthcare workers to proactively manage patients with type-2 diabetes, including monitoring and recall of patients, relaying clinical information and coordinating care, facilitated through the shared use of the CARE platform. The RE-AIM framework will provide a comprehensive assessment of the model. The primary outcome measure will be a 10% improvement in any one of A1c, BP, or cholesterol over the baseline values. Secondary endpoints will address other diabetes care indicators including: the proportion of clinical measures completed in accordance with guidelines (e.g., foot and eye examination, receipt of vaccinations, smoking cessation counseling); the number of patients registered in CARE; and the proportion of patients linked to a health services provider. The cost-effectiveness of RADAR specific to these communities will be assessed. Concurrent qualitative assessments will provide contextual information, such as the quality/usability of the CARE platform and the impact/satisfaction with the model.
RADAR combines innovative technology with personalized support to deliver organized diabetes care in remote First Nations communities in Alberta. By improving the ability of First Nations to systematically identify and track diabetes patients and share information seamlessly an overall improvement in the quality of clinical care of First Nations people living with type-2 diabetes on reserve is anticipated.
ISRCTN study ID ISRCTN14359671 , retrospectively registered October 7, 2016.
原住民社区的2型糖尿病发病率比加拿大普通人群高3至5倍，导致疾病、并发症和合并症负担沉重。社区护理能力有限、环境偏远以及缺乏电子健康记录（EHR）/登记系统，使得许多原住民的糖尿病护理采用被动、无序的方式。通过应用登记系统重组糖尿病护理方法（RADAR）项目是根据联邦要求开发的，旨在为2型糖尿病患者制定和提供创新的、符合文化特点的、针对社区的项目，并与目标社区合作实施。
RADAR应用集成的糖尿病EHR/登记系统（CARE平台）和集中护理协调员（CC）服务，以支持当地医疗保健。CC将与当地医护人员合作，以满足患者和社区的健康需求（使用CARE平台），并培养2型糖尿病管理最佳实践的能力。将采用改良的阶梯楔形对照试验设计来评估该模型。在基线阶段，CC将与当地医护人员合作，识别2型糖尿病患者并将其登记到CARE平台，但不提出任何管理建议。在干预阶段，CC将与当地医护人员合作，积极管理2型糖尿病患者，包括监测和召回患者、传递临床信息以及协调护理，通过共享使用CARE平台来促进。RE-AIM框架将对该模型进行全面评估。主要结局指标将是糖化血红蛋白（A1c）、血压或胆固醇中的任何一项相对于基线值提高10%。次要终点将涉及其他糖尿病护理指标，包括：按照指南完成的临床测量比例（如足部和眼部检查、接种疫苗、戒烟咨询）；在CARE中登记的患者数量；以及与医疗服务提供者建立联系的患者比例。将评估RADAR针对这些社区的成本效益。同时进行的定性评估将提供背景信息，如CARE平台的质量/可用性以及对该模型的影响/满意度。
RADAR将创新技术与个性化支持相结合，在艾伯塔省偏远的原住民社区提供有组织的糖尿病护理。通过提高原住民系统识别和跟踪糖尿病患者以及无缝共享信息的能力，预计居住在保留地的2型糖尿病原住民的临床护理质量将得到全面改善。
ISRCTN研究编号ISRCTN14359671，于2016年10月7日追溯注册。
