UNIVERSITY OF CALIFORNIA, DAVIS
Grant: $595,841 - National Institutes of Health - Sep. 25, 2009
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Award Description: The optimal treatment of chronic diseases represents a major challenge, including overcoming barriers such as access to health care. This proposal addresses the growing public health issue of diabetes and its complications. The incidence of diabetes is soaring, and the solutions go beyond appropriate diagnosis and pharmacological treatment to include lifestyle and behavioral changes. Improving health for persons with diabetes requires interdisciplinary approaches and community outreach, particularly to underserved communities where prevalence is higher and resources are less available. Further, this proposal involves the participation of two CTSA institutions, UC Davis and the Oregon Health and Science University (OHSU), and will develop and test the deployment of nurses (RN) as health coaches, focusing on patient education and motivation to adopt healthy behaviors in a rural and underserved region. The proposal will enhance collaborations using telehealth, increase community engagement in rural communities, and increase capacity for translational research throughout the vast area of northern California and southern Oregon. This proposal builds on previous work of the UC Davis CTSC and concurrent projects underway within several programs at UC Davis, such as the Chronic Disease Management Program; the Center for Health and Technology; and the newly formed Betty Irene Moore School of Nursing. This proposal is responsive to the NCRR Administrative Supplements for Collaborative Community Engagement Research. Specifically, we will expand our existing telehealth networks to provide RN support as health coaches in rural communities, targeting diabetes self-management education for patients with diabetes. We will collect data on the level of patient participation, patient self-efficacy, health planning skills, satisfaction, and project costs in order to evaluate the effectiveness and cost-efficiency of the program. This program complements parallel projects that are evaluating the efficacy of self-management training classes, delivered via telehealth throughout the region, and will serve to create and preserve employment opportunities in an economically underserved region.
Project Description: AIM 1: To evaluate the feasibility of delivering health coaching with telehealth support. We will use several indicators of feasibility and acceptability, including refusal rate, number of sessions attended, and the amount of time spent in each session. We will also assess satisfaction with the program and ratings of advantages and drawbacks. Finally, satisfaction with overall care will be assessed for both cases and controls. AIM 2: Improve health planning skills in persons with diabetes. Health coaches will document outcomes of each of the six coaching sessions, including specific goals identified by participants. AIM 3: Enhance self-efficacy among persons with diabetes so that they can make optimal use of available information, resources and skills. A 6-item measure of self-efficacy that has been validated in motivational interviewing studies with adults will be used. AIM 4: Compare the outcomes of patients participating in the health coaching model with those receiving usual care. Satisfaction and health planning skills will be compared between the health coaching group and the control group using t-tests. Project Timetable Development Finalize intervention protocols, purchase supplies: Year 1, quarters 1 Finalize measures, recordkeeping documents, operations manual; Year 1, quarters 1 and 2 Hire and train RN Health Coach: Year 1, quarter 2 Recruitment, enrollment, and baseline measurement Recruit, enroll participants, baseline measurement (6 sites staggered over 10 months):Year 1, quarters 2, 3 and 4, and Year 2, quarter 1 Intervention and evaluation Conduct intervention: :Year 1, quarters 2, 3 and 4, and Year 2, quarters 1 and 2 Data analysis, interpretation and dissemination Data entry and management:Year 1, quarter 4, and Year 2, quarters 1, 2 and 3 Data analysis: Year 2, quarters 2 and 3 Present results and write manuscripts: Year 2, quarters 3 and 4
Jobs Summary: TBN, RN Health Coach The RN Health Coach will be the interventionist for this study, helping individuals make decisions, set goals, and take action to improve health. The RN Health Coach will enroll participants, obtain informed consent, and administer study instruments. The RN Health Coach will be responsible for completing the intervention and documenting the intervention with each participant. TBN, Project Manager The project manager will be responsible for the daily management and coordination of the project. S/he will be responsible for the recruitment and identification of the healthcare sites including meeting with the physicians and site coordinators, and for developing processes for communication with the sites, participant recruitment materials, and class evaluations. She will provide budgetary management and oversight. S/he will coordinate the submission and management of institutional review board requirements and consult on the IRB certification of project staff and the participant consent process. S/he will assure compliance with the data safety and monitoring plan. S/he will serve as the administrative contact with the Center for Health and Technology, helping to resolve any scheduling or equipment issues, with the Health System’s IT unit to set up required services. S/he will participate in the analysis of project findings and results. TBN, Evaluation Data Analyst The Evaluation Data Analyst will be responsible for conducting comprehensive statistical data analysis using current software and statistical methods to ensure project data is provided and measured in a statistically sound and acceptable format. He/She will provide data analysis regarding outcomes and project results. TBN, Evaluation Assistant The Evaluation Assistant is responsible for the project data management. He/she will ensure that all data from participant survey and sources is obtained, stored and prepared for data analysis. TBN, Project Statistician The research project statistician will work with the project team in the evaluation of project activities. During the first year of the grant, the statistician will assist in the design of the project databases and assist in the set up. In the second year, the statistician will work with the PIs to analyze the project findings. Project Evaluation The PI is an experienced health services researcher and evaluator. For this project, she will collaborate with Drs. Berglund and Young to develop an evaluation plan and methodology designed to identify the effectiveness and outcomes of this project. She will assist in the development of the survey instruments and chart auditing process to ensure that the data being collected will answer the project questions. She will take the lead in the analysis of project findings and work with the other PIs and the project statistician to summarize project results. Nurse Advisor Our nurse advisor is the Program Director for the UCD Chronic Disease Management Program and a Certified Diabetes Educator. She was named the UCD Health System’s Nurse Educator of the Year in 2008. For this project, she will be responsible for assisting in the training of the health coach hired for the project. She will lead the team in developing the curriculum, monitor the instruction provided in videoconference classes, and give feedback as to effective teaching methods and styles. She will be available for consultation with the participating community physicians, project PI and co-investigators throughout the project. Additionally, six site coordinators will be funded in rural communities over the grant period. (Total jobs reported: 0)
Project Status: Not Started
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