Methods and initial findings from the Durham Diabetes Coalition: Integrating geospatial health technology and community interventions to reduce death and disability.

Autor:	Spratt SE; Duke University Medical Center, Division of Endocrinology, Durham, NC, USA., Batch BC; Duke University Medical Center, Division of Endocrinology, Durham, NC, USA., Davis LP; Duke Translational Medicine Institute, Duke University, Durham, NC, USA.; Duke Clinical Research Institute, Duke University, Durham, NC, USA., Dunham AA; Duke Translational Medicine Institute, Duke University, Durham, NC, USA.; Duke Clinical Research Institute, Duke University, Durham, NC, USA., Easterling M; Durham County Department of Public Health, Durham, NC, USA., Feinglos MN; Duke University Medical Center, Division of Endocrinology, Durham, NC, USA., Granger BB; Duke University School of Nursing, Duke University Health System, Durham, NC, USA., Harris G; Durham County Department of Public Health, Durham, NC, USA., Lyn MJ; Department of Community and Family Medicine, Duke University Medical Center, Durham, NC, USA., Maxson PJ; School of Natural Resources and Environment, University of Michigan, Ann Arbor, MI, USA., Shah BR; Duke Clinical Research Institute, Duke University, Durham, NC, USA., Strauss B; School of Natural Resources and Environment, University of Michigan, Ann Arbor, MI, USA., Thomas T; Durham County Department of Public Health, Durham, NC, USA., Califf RM; Duke Translational Medicine Institute, Duke University, Durham, NC, USA.; Duke Clinical Research Institute, Duke University, Durham, NC, USA., Miranda ML; School of Natural Resources and Environment, University of Michigan, Ann Arbor, MI, USA.; Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.; Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA.
Jazyk:	angličtina
Zdroj:	Journal of clinical & translational endocrinology [J Clin Transl Endocrinol] 2015 Jan 14; Vol. 2 (1), pp. 26-36. Date of Electronic Publication: 2015 Jan 14 (Print Publication: 2015).
DOI:	10.1016/j.jcte.2014.10.006
Abstrakt:	Objective: The Durham Diabetes Coalition (DDC) was established in response to escalating rates of disability and death related to type 2 diabetes mellitus, particularly among racial/ethnic minorities and persons of low socioeconomic status in Durham County, North Carolina. We describe a community-based demonstration project, informed by a geographic health information system (GHIS), that aims to improve health and healthcare delivery for Durham County residents with diabetes. Materials and Methods: A prospective, population-based study is assessing a community intervention that leverages a GHIS to inform community-based diabetes care programs. The GHIS integrates clinical, social, and environmental data to identify, stratify by risk, and assist selection of interventions at the individual, neighborhood, and population levels. Results: The DDC is using a multifaceted approach facilitated by GHIS to identify the specific risk profiles of patients and neighborhoods across Durham County. A total of 22,982 patients with diabetes in Durham County were identified using a computable phenotype. These patients tended to be older, female, African American, and not covered by private health insurance, compared with the 166,041 persons without diabetes. Predictive models inform decision-making to facilitate care and track outcomes. Interventions include: 1) neighborhood interventions to improve the context of care; 2) intensive team-based care for persons in the top decile of risk for death or hospitalization within the coming year; 3) low-intensity telephone coaching to improve adherence to evidence-based treatments; 4) county-wide communication strategies; and 5) systematic quality improvement in clinical care. Conclusions: To improve health outcomes and reduce costs associated with type 2 diabetes, the DDC is matching resources with the specific needs of individuals and communities based on their risk characteristics.
Databáze:	MEDLINE
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