Working with the Urban Underserved in the UCSF Collaborative Research Network Final rept. (Sept. 29, 2002-Sept. 30, 2004)

摘要

Purpose: To build capacity within the CRN to carry out rigorous research that utilizes health systems data for population-based recruitment, with a focus on underserved communities. The goal of the IDEALL Project is to implement diabetes management strategies tailored to patientsliteracy and language needs within the Community Health Network (CHNSF). Scope: While safety net systems care for a disproportionate share of patients with communication barriers, few have developed systematic ways to improve the quality of care for this population. Methods: We are comparing the reach and effectiveness of technologically-oriented (Automated Telephone Diabetes Management: ATDM) to interpersonally-oriented (Group Medical Visits: GMVs) interventions, to usual care in a randomized trial among English, Spanish and Cantonese-speaking patients with diabetes in CHNSF health centers. The standardization of the interventions as well as the development of a merged CHNSF- IDEALL database has allowed for population-based recruitment and retention strategies. Results: We have built on existing electronic data systems to: recruit eligible physicians, determine if patients are eligible, and recruit eligible patients when receiving primary care services by determining appointment times. We have created a separate database that combines these datasets from the CHNSF with patient level data to provide an up-to-date profile of study patient and clinician information. We anticipate that this database will serve as a model for other CRN studies and practice improvement projects. We have also created standardized ATDM and GMV interventions in 3 languages and have developed appropriate outcome measures to evaluate the effects of the interventions.