Document text
Principal Investigator: Julia Elizabeth Winterrowd Price
Organization: NEMOURS CHILDREN'S HOSPITAL, DELAWARE
Fiscal Year: 2024
Award: $137,351
Funding agency: National Institute of Diabetes and Digestive and Kidney Diseases
PROJECT SUMMARY/ABSTRACT
Type 1 diabetes (T1D) is one of the most prevalent pediatric chronic illnesses and requires a complex
treatment regimen. Youth with T1D, particularly those from ethnic minority and lower income backgrounds,
struggle to adhere to treatment demands; fewer than 30% achieve recommended levels of glycemic control.
Youth with poorly controlled T1D are at risk for health complications. Behavioral Family Systems Therapy for
Diabetes (BFST-D), a family-based behavioral intervention, is efficacious in improving health outcomes for
youth with T1D and initial effectiveness data suggest a brief version of BFST-D (bBFST-D) is associated with
improved glycemic control when delivered as part of standard care. However, few receive these services,
particularly those most at-risk, which complicates further evaluation of bBFST-D effectiveness when delivered
as part of standard care. Increasing the uptake of bBFST-D may lead to improved overall health of this
population. Implementation strategies are methods for integrating evidence-based practices into standard care.
The proposed K23 career development award aims to address these gaps in research and provides the means
by which Dr. Julia Price will complete scholarly training and practical experience to become an independent
investigator in pediatric T1D. The proposed study will develop a toolkit of implementation strategies to increase
the reach of bBFST-D by first conducting qualitative interviews with stakeholder groups to identify barriers and
facilitators of this care (Aim 1). The Consolidated Framework for Implementation Research (CFIR) will guide
these interviews. Second, using results from Aim 1 and drawing from literature identifying conceptually unique
implementation strategies, a toolkit of implementation strategies will be developed (Aim 2). Iterative feedback
from a Diabetes Advisory Board comprised of stakeholders will facilitate this development process and support
identification of three implementation strategies to pilot. Third, the feasibility and acceptability of the selected
strategies will be evaluated through a single-case experiment at the PIs institution, and exploratory outcomes
(effectiveness of these strategies, change in patient health outcomes among those attending bBFST-D as part
of standard care) will also be examined (Aim 3). To explore potential healthcare disparities, provider referral
patterns across youth demographic variables will be examined. Through a combination of formal didactics and
direct mentored training experiences with her mentoring team (Drs. Kazak, Deatrick, Haire-Joshu, Bunnell,
Wysocki), Dr. Price will acquire skills and expertise in the following areas: 1) mixed methods research, 2)
implementation science, 3) optimizing electronic health record use for research and for implementing evidence-
based healthcare, and 4) designing and conducting clinical trials. Nemours, a national leader in pediatric T1D
behavioral research and health informatics, will provide Dr. Price with the ideal environment to successfully
complete the proposed project and achieve her goals of becoming an independent investigator and applying
for R01 funding to conduct a large multisite randomized hybrid implementation-effectiveness trial of bBFST-D.
Terms: <Acute><Address><Adherence><Adolescent><Adolescent Youth><Affect><Area><Attitude><Awareness><Baycol><Behavior Conditioning Therapy><Behavior Modification><Behavior Therapy><Behavior Treatment><Behavioral><Behavioral Conditioning Therapy><Behavioral Modification><Behavioral Research><Behavioral Therapy><Behavioral Treatment><Belief><Brittle Diabetes Mellitus><Cardiac Diseases><Cardiac Disorders><Career Development Awards><Career Development Awards and Programs><Career Development Programs K-Series><Caring><Cessation of life><Childhood><Children's Hospital><Chronic><Chronic Disease><Chronic Illness><Clinic><Coma hyperglycemic><Complex><Complications of Diabetes Mellitus><Conditioning Therapy><Conduct Clinical Trials><Consolidated Framework for Implementation Research><Consolidated Framework for Implementation Science><Consolidated Framework for Implementing Change><Data><Death><Development><Diabetes Complications><Diabetes Mellitus><Diabetes-Related Complications><Diabetic Acidosis><Diabetic Coma><Diabetic Complications><Diabetic Ketoacidosis><Diabetic Ketosis><Disease><Disorder><Educational Materials><Effectiveness><Effectiveness of Interventions><Electronic Health Record><Eligibility><Eligibility Determination><Endocrinology><Environment><Evaluation><Evidence based practice><Exhibits><Family><Feedback><Funding><Goals><Health><Health Care Providers><Health Informatics><Health Personnel><Healthcare><Healthcare Providers><Healthcare worker><Healthy People 2020><Heart Diseases><IDDM><Individual><Institution><Insulin-Dependent Diabetes Mellitus><Interview><Investigators><Juvenile-Onset Diabetes Mellitus><K-Awards><K-Series Research Career Programs><Kazak><Ketosis-Prone Diabetes Mellitus><Knowledge><Leadership><Lipobay><Literature><Low income><Medical><Mentors><Metabolism and Endocrinology><Methods><Outcome><Parents><Patient Schedules><Patient outcome><Patient-Centered Outcomes><Patient-Focused Outcomes><Patients><Pattern><Pediatric Hospitals><Penetration><Persons><Price><Process><Protocol Screening><Provider><Public Health Informatics><QOL><Quality of life><Randomized><Recommendation><Regimen><Research><Research Career Program><Research Methodology><Research Methods><Research Personnel><Research Resources><Research Support><Researchers><Resources><Risk><Sampling><Services><Site><Specific qualifier value><Specified><Sudden-Onset Diabetes Mellitus><System><T1 DM><T1 diabetes><T1D><T1DM><Testing><Training><Treatment Protocols><Treatment Regimen><Treatment Schedule><Type 1 Diabetes Mellitus><Type 1 diabetes><Type I Diabetes Mellitus><United States><Youth><Youth 10-21><acceptability and feasibility><behavior intervention><behavioral health><behavioral intervention><burden of disease><burden of illness><care delivery><cerivastatin><chronic disorder><consumer informatics><design><designing><developmental><diabetes><diabetes mellitus therapy><diabetes therapy><diabetic ketoacidotic><disease burden><disparity in care><disparity in healthcare><effectiveness and implementation trial><effectiveness/implementation hybrid trial><effectiveness/implementation trial><efficacious intervention><electronic health care record><electronic health medical record><electronic health plan record><electronic health registry><electronic medical health record><ethnic minority><evidence base><experience><experiment><experimental research><experimental study><experiments><facilitators to implementation><glycemic control><health care><health care disparity><health care inequality><health care inequity><health care personnel><health care worker><health provider><health workforce><healthcare disparity><healthcare inequality><healthcare inequity><healthcare personnel><heart disorder><hypoglycemic coma><implementation facilitators><implementation science><implementation strategy><implementation trial><improved><innovate><innovation><innovative><insulin dependent diabetes><insulin dependent type 1><integrated care><integrated model of care><juvenile><juvenile diabetes><juvenile diabetes mellitus><juvenile human><ketosis prone diabetes><medical personnel><parent><patient oriented outcomes><pediatric><physical conditioning><physical health><pilot trial><population health><pricing><programs><psychosocial><randomisation><randomization><randomly assigned><research and methods><skill acquisition><skill development><standard care><standard treatment><strategies for implementation><testing uptake><theories><treatment provider><type I diabetes><type one diabetes><uptake>