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首页> 外文期刊>International Journal of General Medicine >Rationale and design of the Miami Healthy Heart Initiative: a randomized controlled study of a community health worker intervention among Latino patients with poorly controlled diabetes
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Rationale and design of the Miami Healthy Heart Initiative: a randomized controlled study of a community health worker intervention among Latino patients with poorly controlled diabetes

机译：迈阿密健康心脏计划的原理和设计：一项对社区卫生工作者干预较差的糖尿病患者的社区卫生工作者干预的随机对照研究

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Background: Type 2 diabetes mellitus disproportionately affects the Latino community. Latinos with diabetes are also less likely to have adequate control of cardiovascular risk factors such as cholesterol and blood pressure. Community health workers (CHWs) are increasingly being used to address various health disparity conditions, including diabetes. However, evidence of their effectiveness from randomized controlled trials is limited. Methods: The Miami Health Heart Initiative is a randomized controlled trial of 300 Latino patients with diabetes. Patients with hemoglobin A1c (HbA1c) ≥8.0% were recruited from Miami-Dade's public hospital system. At baseline, all patients underwent phlebotomy, physical examination, and a structured 90-minute research interview. They were then randomized to either usual care or a CHW intervention called Cari?o. For participants in the Cari?o arm of the study, CHW services included assistance with nonmedical social services, health education, and patient navigation in which the CHWs serve as a bridge between patients and the health care system. These services were delivered through home visits, phone calls, and group visits. At 12 months, all subjects had a follow-up examination. The primary outcomes at 1 year are changes in systolic blood pressure, low-density lipoprotein, and HbA1c. Secondary outcomes include medication adherence, medication intensification, diabetes self-efficacy, physical activity, and self-reported fruit and vegetable intake. Discussion: The Miami Healthy Heart Initiative is one of the first rigorously conducted randomized controlled trials to provide evidence on the impact of CHWs on diabetes intermediate outcomes among Latinos. If the data support our primary hypotheses, the study would lend added support to ongoing efforts to incorporate CHWs as part of our national efforts to reduce and ultimately eliminate health disparities.
机译：背景：2型糖尿病对拉丁裔社区的影响不成比例。患有糖尿病的拉丁裔人也不太可能充分控制心血管危险因素，例如胆固醇和血压。社区卫生工作者（CHW）越来越多地用于解决各种卫生差距状况，包括糖尿病。但是，来自随机对照试验的有效性证据有限。方法：迈阿密健康心脏计划是一项针对300名拉丁裔糖尿病患者的随机对照试验。从迈阿密戴德的公立医院系统招募血红蛋白A1c（HbA1c）≥8.0％的患者。在基线时，所有患者均接受了放血，体格检查和90分钟的结构化研究访谈。然后将他们随机分为常规护理或称为Cari？o的CHW干预。对于研究的Cari？o部门的参与者，CHW服务包括非医疗社会服务，健康教育和患者导航方面的援助，其中CHW充当患者与医疗保健系统之间的桥梁。这些服务是通过家庭访问，电话访问和小组访问来提供的。在12个月时，所有受试者均接受了随访检查。 1年时的主要结局是收缩压，低密度脂蛋白和HbA1c的变化。次要结果包括药物依从性，药物强化，糖尿病自我效能，体育锻炼以及自我报告的水果和蔬菜摄入量。讨论：迈阿密健康心脏计划是首批严格进行的随机对照试验之一，旨在提供证据证明CHW对拉丁美洲人中间糖尿病中间结局的影响。如果数据支持我们的主要假设，则该研究将为正在进行的将CHW纳入工作的努力提供更多支持，这是我们为减少并最终消除健康差异而进行的全国努力的一部分。

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