Multidisciplinary Virtual Care for Young Adults with Type 1 Diabetes Living in Rural Areas

University Of Kansas Medical Center, Kansas City KS

Investigators

Abstract

PROJECT ABSTRACT Candidate: Dr. Daniel Tilden MD, MPH is an endocrinologist and rural health services researcher at the University of Kansas Medical Center (KUMC) uniquely qualified to conduct the proposed project, having completed both pediatric and adult endocrinology fellowships and clinical care activities including rural outreach and pediatric-to-adult transfer acceptance clinics. His research focuses on developing health system interventions to improve outcomes for young adults (YAs) with type 1 diabetes (T1D) living in rural areas. Dr. Tilden’s long-term goal is to become a leader in the development and implementation of clinical interventions to improve outcomes for YAs with T1D in rural areas. His combination of clinical expertise, research skills in quantitative and qualitative methods, a strong mentorship team, and unique institutional resources make him ideally suited, with the support of this award, to become a successful independent early career researcher. Research Project: People with T1D living in rural areas have lower rates of diabetes device use and lack access to guideline-directed multidisciplinary care. Among people with T1D, YAs (age 18 to 30) are a particularly high-risk group as they navigate both the complexities of obtaining adequate health care and the social, educational and economic challenges of this developmental stage. Efforts to address these care gaps, such as Project ECHO-Diabetes, while effective in delivering care in areas with strong PCP availability, fall short in more rural settings where PCP availability and referral networks are sparse. This proposal seeks to build on preliminary quantitative and qualitative data to examine provider-identified barriers, facilitators and solutions to guideline-driven care (Aim 1). We will then pilot test the Rural Emerging/Young Adult CollaboraTive care – T1D (REACT-T1D) program which builds on Project ECHO-Diabetes to partner with PCPs in the virtual delivery of direct diabetes care to YAs with T1D living in rural areas (Aim 2). Finally, we will apply implementation science frameworks to develop strategies to support testing of this model in a future fully powered, R01 funded randomized trial to test the REACT-T1D intervention. Career Development: Dr. Tilden has assembled a multidisciplinary group of content and methodological experts and didactic experiences to help him acquire the skills needed to achieve his research aims and launch his career as an independent investigator. His career development plan integrates coursework, experiential learning and direct mentorship from content experts to: 1) Develop skills in using implementation science methods to design, plan, and test novel interventions; 2) Become an expert in rural recruitment and study execution 3) Hone qualitative methods expertise to support program evaluation; 4) Develop practical skills in pragmatic trial planning, design and execution; and 5) Strengthen skills for grant development, manuscript writing and leadership of research teams.