Using a RE-AIM framework to identify promising practices in National Diabetes Prevention Program implementation
Using a RE-AIM framework to identify promising practices in National Diabetes Prevention Program implementation
复制标题
DOI：
10.1186/s13012-019-0928-9
复制
发表时间：
2019-08-14
影响因子：
7.2
通讯作者：
Albright, Ann
中科院分区：
文献类型：
--
作者：
Nhim, Kunthea;Gruss, Stephanie M.;Albright, Ann
国家糖尿病预防计划（National DPP）正在迅速扩大，以帮助那些2型糖尿病高危人群预防或延迟疾病。2012年，疾病控制和预防中心资助了六个国家组织，以扩大和维持国家DPP生活方式改变干预（LCI）的多州交付。本研究旨在描述在4年资助期内的覆盖范围、采用和维护情况，并评估参与者出勤率和参与持续时间方面的站点级因素与计划有效性之间的关联。方法2012年10月至2016年9月，采用可及性、有效性、采用、实施和维护（RE-AIM）框架指导评价。多层次线性回归被用来研究参与者层面的人口统计学和网站层面的战略和参加会议的数量，在7-12个月的出席率和参与的持续时间之间的关联。六个受资助的国家组织将参与站点的数量从2012年的68个增加到2016年的164个，分布在38个州，招募了14，876名合格参与者。截至2016年9月，全国DPP LCI的承保范围已覆盖42家私人保险公司和7家公共支付公司。近200名雇主被招募到现场为他们的员工提供LCI。与较高的总体出勤率、7-12个月的出勤率和较长的参与持续时间显著相关的站点一级策略包括使用自我推荐或口碑作为招募策略、为参与提供非货币激励以及使用文化适应来满足参与者的需求。接受医疗保健提供者或卫生系统转诊的站点在7-12个月的出勤率也较高，参与时间也较长。在参与者层面，年龄在65岁以上（与18-44或45-64岁相比），超重（与肥胖相比），非西班牙裔白色（与非西班牙裔黑人或多种族/其他种族相比），以及基于血液检查或妊娠糖尿病史的合格人群（与风险测试筛查阳性的人群）取得了更好的结果。结论在国家DPP LCI快速传播的时候，这次评估的结果可以用来加强计划的实施，并将经验教训转化为类似的组织和环境。
Background The National Diabetes Prevention Program (National DPP) is rapidly expanding in an effort to help those at high risk of type 2 diabetes prevent or delay the disease. In 2012, the Centers for Disease Control and Prevention funded six national organizations to scale and sustain multistate delivery of the National DPP lifestyle change intervention (LCI). This study aims to describe reach, adoption, and maintenance during the 4-year funding period and to assess associations between site-level factors and program effectiveness regarding participant attendance and participation duration. Methods The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide the evaluation from October 2012 to September 2016. Multilevel linear regressions were used to examine associations between participant-level demographics and site-level strategies and number of sessions attended, attendance in months 7-12, and duration of participation. Results The six funded national organizations increased the number of participating sites from 68 in 2012 to 164 by 2016 across 38 states and enrolled 14,876 eligible participants. By September 2016, coverage for the National DPP LCI was secured for 42 private insurers and 7 public payers. Nearly 200 employers were recruited to offer the LCI on site to their employees. Site-level strategies significantly associated with higher overall attendance, attendance in months 7-12, and longer participation duration included using self-referral or word of mouth as a recruitment strategy, providing non-monetary incentives for participation, and using cultural adaptations to address participants' needs. Sites receiving referrals from healthcare providers or health systems also had higher attendance in months 7-12 and longer participation duration. At the participant level, better outcomes were achieved among those aged 65+ (vs. 18-44 or 45-64), those who were overweight (vs. obesity), those who were non-Hispanic white (vs. non-Hispanic black or multiracial/other races), and those eligible based on a blood test or history of gestational diabetes mellitus (vs. screening positive on a risk test). Conclusions In a time of rapid dissemination of the National DPP LCI the findings of this evaluation can be used to enhance program implementation and translate lessons learned to similar organizations and settings.