@Article{信息:doi 10.2196 / / jmir。9515，作者=“Levy, Natalie Koch和Orzeck-Byrnes, Natasha A和Aidasani, Sneha R和Moloney, Dana N和Nguyen, Lisa H和Park, Agnes和Hu, Lu和Langford, Aisha T和Wang, Binhuan和Sevick, Mary Ann和Rogers, Erin S”，标题=“基于文本的胰岛素滴定计划从随机对照试验到现实环境的过渡:实施研究”，期刊=“J Med Internet Res”，年=“2018”，月=“3”，日=“19”，量=“20”，数=“3”，页数=“e93”，关键词=“胰岛素/长效/给药{\&}剂量;糖尿病，2型/药物治疗;医疗服务不足地区;远程医疗;背景:移动胰岛素滴定干预(MITI)项目帮助2型糖尿病患者在没有亲自护理的情况下找到正确的基础胰岛素剂量。MITI只需要基本的手机技术(短信和电话)，在安全网环境中接受治疗的患者可以很容易地获得MITI。在一项随机对照试验(RCT)中，MITI在纽约市(NYC)的安全网诊所有效，患者经常面临面对面护理的挑战。2016年，在Bellevue医院(最初的RCT所在地)和Gouverneur Health(纽约市第二家安全网诊所)，MITI作为常规护理在两种不同的人员配备模式下实施。 Objective: This implementation study examined MITI's transition into real-world settings. To understand MITI's flexibility, generalizability, and acceptability among patients and providers, we evaluated whether MITI continued to produce positive outcomes in expanded underserved populations, outside of an RCT setting. Methods: Patients enrolled in MITI received weekday text messages asking for their fasting blood glucose (FBG) values and a weekly titration call. The goal was for patients to reach their optimal insulin dose (OID), defined either as the dose of once-daily basal insulin required to achieve either an FBG of 80-130 mg/dL (4.4-7.2 mmol/L) or as the reaching of the maximum dose of 50 units. After 12 weeks, if OID was not reached, the patients were asked to return to the clinic for in-person care and titration. MITI program outcomes, clinical outcomes, process outcomes, and patient satisfaction were assessed. Results: MITI was successful at both sites, each with a different staffing model. Providers referred 170 patients to the program---129 of whom (75.9{\%}, 129/170) were eligible. Of these, 113 (87.6{\%}, 113/129) enrolled. Moreover, 84.1{\%} (95/113) of patients reached their OID, and they did so in an average of 24 days. Clinical outcomes show that mean FBG levels fell from 209 mg/dL (11.6 mmol/L) to 141 mg/dL (7.8 mmol/L), P<.001. HbA1c levels fell from 11.4{\%} (101 mmol/mol) to 10.0{\%} (86 mmol/mol), P<.001. Process outcomes show that 90.1{\%} of MITI's text message prompts received a response, nurses connected with patients 81.9{\%} of weeks to provide titration instructions, and 85{\%} of attending physicians made at least one referral to the MITI program. Satisfaction surveys showed that most patients felt comfortable sharing information over text and felt the texts reminded them to take their insulin, check their sugar, and make healthy food choices. Conclusions: This implementation study showed MITI to have continued success after transitioning from an RCT program into real-world settings. MITI showed itself to be flexible and generalizable as it easily fits into a second site staffed by general medical clinic--registered nurses and remained acceptable to patients and staff who had high levels of engagement with the program. ", issn="1438-8871", doi="10.2196/jmir.9515", url="//www.mybigtv.com/2018/3/e93/", url="https://doi.org/10.2196/jmir.9515", url="http://www.ncbi.nlm.nih.gov/pubmed/29555621" }