This career development award will allow the candidate to devote 50% of his time to the investigation of barriers to optimum care for patients with diabetes and to the mentoring of research fellows and other junior colleagues. Building on the existing Vermont Diabetes Information System (VDIS, a large scale randomized clinical trial of an information system for primary care of diabetes patients), the candidate proposes four new, complementary projects. These will advance understanding of obstacles to improved physiologic control and provide opportunities for junior colleagues to develop their own skills in clinical research, statistical analysis, and research presentation. Project 1, Practice organization as a barrier to diabetes control: Evaluating the Chronic Care Model, will test the association between conformance with an idealized model of health care and diabetes outcomes including glycemic control, hypertension, cholesterol reduction, and satisfaction with care. The subjects will be sixty primary care practices participating in the VDIS. Project 2, Medication adherence as a barrier to diabetes control: The role of adherence aids, will examine the prevalence and utility of various devices and maneuvers that patients use to remember their medications. The subjects will be 900 adult diabetics from the VDIS Field Survey who provide a comprehensive medication list, a survey of adherence aids, multiple covariates (demographics, comorbidity, complications, functional status, etc.), and physiologic outcomes including A1C, LDL cholesterol, and blood pressure. Project 3, Illiteracy as a barrier to diabetes control: Prevalence and impact of functional health literacy, will document the extent to which functional health literacy is associated with physiologic and clinical outcomes (including A1C, LDL cholesterol, blood pressure, functional status, etc.) in 900 adults with diabetes from the VDIS Field Survey. Project 4, Travel burden as a barrier to diabetes control: The role of driving distance, will assess the role of travel to care upon outcomes (both physiologic and clinical) in 6,000 subjects from the VDIS for whom laboratory results and location data are available. Upon completion, this work will have rigorously addressed four potential barriers to the effective translation of new scientific findings to clinical care while providing junior investigators with mentoring and career development opportunities in diabetes research.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Midcareer Investigator Award in Patient-Oriented Research (K24)
Project #
5K24DK068380-05
Application #
7454386
Study Section
Diabetes, Endocrinology and Metabolic Diseases B Subcommittee (DDK)
Program Officer
Hyde, James F
Project Start
2004-07-01
Project End
2009-06-30
Budget Start
2008-07-01
Budget End
2009-06-30
Support Year
5
Fiscal Year
2008
Total Cost
$157,932
Indirect Cost
Name
University of Vermont & St Agric College
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
066811191
City
Burlington
State
VT
Country
United States
Zip Code
05405
Morris, Nancy S; Maclean, Charles D; Littenberg, Benjamin (2013) Change in health literacy over 2 years in older adults with diabetes. Diabetes Educ 39:638-46
Morris, Nancy S; Grant, Steven; Repp, Allen et al. (2011) Prevalence of limited health literacy and compensatory strategies used by hospitalized patients. Nurs Res 60:361-6
Khan, Shamima; Maclean, Charles D; Littenberg, Benjamin (2010) The effect of the Vermont Diabetes Information System on inpatient and emergency room use: results from a randomized trial. Health Outcomes Res Med 1:e61-e66
Otten, Jennifer J; Littenberg, Benjamin; Harvey-Berino, Jean R (2010) Relationship between self-report and an objective measure of television-viewing time in adults. Obesity (Silver Spring) 18:1273-5
Moore, Jesse; Hyman, Neil; Callas, Peter et al. (2010) Staging error does not explain the relationship between the number of lymph nodes in a colon cancer specimen and survival. Surgery 147:358-65
Maclean, Charles D; Gagnon, Michael; Callas, Peter et al. (2009) The Vermont diabetes information system: a cluster randomized trial of a population based decision support system. J Gen Intern Med 24:1303-10
Otten, Jennifer J; Jones, Katherine E; Littenberg, Benjamin et al. (2009) Effects of television viewing reduction on energy intake and expenditure in overweight and obese adults: a randomized controlled trial. Arch Intern Med 169:2109-15
Littenberg, Benjamin; MacLean, Charles D; Zygarowski, Karl et al. (2009) The Vermedx Diabetes Information System reduces healthcare utilization. Am J Manag Care 15:166-70
Ramos-Nino, Maria E; Littenberg, Benjamin (2008) A novel combination: ranpirnase and rosiglitazone induce a synergistic apoptotic effect by down-regulating Fra-1 and Survivin in cancer cells. Mol Cancer Ther 7:1871-9
Laramee, Ann S; Morris, Nancy; Littenberg, Benjamin (2007) Relationship of literacy and heart failure in adults with diabetes. BMC Health Serv Res 7:98

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