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Health Literacy Intervention to Improve Diabetes Outcomes among Rural Primary Care Patients

Award Number: R01DK107572
ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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¿ DESCRIPTION (provided by applicant): We will test the effectiveness and fidelity of embedding the American College of Physicians (ACP) diabetes health literacy intervention among patient-centered medical homes throughout rural Arkansas. Proper diabetes self-care requires patients to have considerable knowledge, a range of skills, and to sustain multiple health behaviors. Self-management interventions are needed that have been designed for individuals with lower literacy skills, that can be readily implemented and sustained among rural clinics with limited resources that disproportionately care for patients with limited literacy. Researchers on our team developed an evidence-based, patient-centered, low literacy ACP intervention promoting diabetes self-care that includes: 1) a diabetes guide that uses plain language and descriptive photographs to teach core diabetes concepts and empower patients to initiate behavior change; 2) a brief counseling strategy to assist patients in developing short-term, explicit and attainable goals for behavior change (`action plans'); 3) a training module for providers (physicians, nurses, medical assistants) that prepares them to assume educator/counselor roles with the Diabetes Guide as a teaching tool; 4) electronic tracking and monitoring tools for primary care practices. While the intervention has previously been field tested and found to significantly improve patient knowledge, self-efficacy, and engagement in related health behaviors, it has not yet been comprehensively tested in practices, and its optimal implementation is not known. We now have a unique opportunity to learn from our prior evaluation, modify and disseminate an ACP health literacy intervention among patients with type 2 diabetes cared for at rural clinics in Arkansas that are Patient-Centered Medical Homes (PCMH). These practices are embedding care coordination services that can be leveraged to improve chronic disease management. All are supervised by a new University of Arkansas for Medical Sciences (UAMS) Center for Health Literacy. Our revised intervention will blend outsourced and clinic-based approaches and redeploy health coaches for counseling self-management mostly via phone, but also at the point-of-care. This is a feasible way to reach rural, vulnerable patients. We will conduct a patient-randomized, pragmatic clinical trial among 6 rural PCMHs in Arkansas, targeting individuals with uncontrolled type 2 diabetes. Our primary aims are to: 1) test the effectiveness of the ACP diabetes health literacy intervention to improve a range of diabetes-related outcomes among rural patients; 2) compared to usual care, evaluate whether the intervention reduces disparities by patient literacy level. Our secondary aims are to: 3) investigate whether a threshold or gradient effect exists between the amount of follow-up counseling (number of action plans) and intervention effectiveness; 4) determine the fidelity of all intervention components, and explore any identified patient, provider (physician, nurse, health coach), and/or health system barriers to implementation; and 5) assess the costs associated with implementing the intervention from a health system perspective.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2022 ( Subtotal = $1 )
2022	2019	UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES	4301 W MARKHAM ST	LITTLE ROCK	AR	72205	PULASKI	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	4	9/26/2022	NON-COMPETING CONTINUATION	$1
														Subtotal = $1

Issue Date FY: 2021 ( Subtotal = -$131,103 )
2021	2019	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	4	10/15/2020	NON-COMPETING CONTINUATION	$0
2021	2019	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	001	4	3/10/2021	NON-COMPETING CONTINUATION	-$131,103
														Subtotal = -$131,103

Issue Date FY: 2019 ( Subtotal = $619,110 )
2019	2019	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	4	2/27/2019	NON-COMPETING CONTINUATION	$619,110
														Subtotal = $619,110

Issue Date FY: 2018 ( Subtotal = $647,033 )
2018	2018	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	3	3/1/2018	NON-COMPETING CONTINUATION	$582,330
2018	2018	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	001	3	7/26/2018	NON-COMPETING CONTINUATION	$64,703
														Subtotal = $647,033

Issue Date FY: 2017 ( Subtotal = $653,108 )
2017	2017	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	2	1/13/2017	NON-COMPETING CONTINUATION	$587,798
2017	2017	UNIVERSITY OF ARKANSAS SYSTEM	4301 W MARKHAM ST SLOT 812 BIO-MED BLDG 1 STE 102	LITTLE ROCK	AR	72205	PULASKI	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	001	2	6/14/2017	NON-COMPETING CONTINUATION	$65,310
														Subtotal = $653,108

Issue Date FY: 2016 ( Subtotal = $673,622 )
2016	2016	UNIVERSITY OF ARKANSAS FOR MEDICAL SCIENCES	4301 W MARKHAM ST, M S 545	LITTLE ROCK	AR	72205	PULASKI	USA	Diabetes, Digestive, and Kidney Diseases Extramural Research	000	1	2/29/2016	NEW	$673,622
														Subtotal = $673,622

Grand Total All Awards = $2,461,770

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Health Literacy Intervention to Improve Diabetes Outcomes among Rural Primary Care Patients

Award Number: R01DK107572

ORGANIZATION: NATIONAL INSTITUTE OF DIABETES & DIGESTIVE & KIDNEY DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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