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.
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