Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA)
Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA)
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DOI：
10.1186/s13012-017-0619-3
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发表时间：
2017-07-26
影响因子：
7.2
通讯作者：
Richardson, Caroline R.
中科院分区：
文献类型：
--
作者：
Damschroder, Laura J.;Reardon, Caitlin M.;Richardson, Caroline R.
背景：糖尿病预防计划（DPP）是一种有效的生活方式干预，以减少2型糖尿病的发病率。然而，在如何实施DPP方面存在知识空白。本研究的目的是评估实施DPP通过评估的临床示范在退伍军人健康管理局（VHA）。方法：一个为期12个月的务实的临床试验比较了退伍军人事务部糖尿病预防计划（VA-DPP）和平时的护理移动！(R)体重管理计划（MOVE！符合条件的参与者的体重指数（BMI）≥ 30 kg/m2（或BMI ≥ 25 kg/m2，伴有一种肥胖相关疾病），糖尿病前期（糖化血红蛋白（HbA 1c）5.7-6.5%或空腹血糖（FPG）100-125 mg/dL），居住在VA中心60分钟内，并且在过去一年内没有参加体重管理计划。已建立的评价和执行框架被用来指导执行情况评价。实施障碍和促进者，交付保真度，参与者的满意度和实施成本进行了评估。使用微成本计算方法，评估的资格和时间安排和保持每个参与者的坚持，以及交付每届会议的成本，成本也assessed.Results：几个障碍和促进因素，以达到，通过，实施，有效性和维护确定;相关的障碍达到网站团队遇到的最大挑战。与MOVE相比，VA-DPP交付的保真度更高！在七个评估领域中的五个。参与者的满意度很高，在这两个程序，但较高的VA-DPP的大多数项目。基于微成本计算方法，评估的资格成本为68美元/人评估，成本的调度和维护遵守是328美元/participant，和交付的成本是101美元/session.Conclusions：需要多方面的战略，以达到目标的参与者，并成功地实施DPP。需要仔细考虑评估患者合格性的费用，同时仍需最大限度地覆盖目标人群。
Background: The Diabetes Prevention Program (DPP) is an effective lifestyle intervention to reduce incidence of type 2 diabetes. However, there are gaps in knowledge about how to implement DPP. The aim of this study was to evaluate implementation of DPP via assessment of a clinical demonstration in the Veterans Health Administration (VHA).Methods: A 12-month pragmatic clinical trial compared weight outcomes between the Veterans Affairs Diabetes Prevention Program (VA-DPP) and the usual care MOVE!(R) weight management program (MOVE!). Eligible participants had a body mass index (BMI) >= 30 kg/m(2) (or BMI >= 25 kg/m(2) with one obesity-related condition), prediabetes (glycosylated hemoglobin (HbA1c) 5.7-6.5% or fasting plasma glucose (FPG) 100-125 mg/dL), lived within 60 min of their VA site, and had not participated in a weight management program within the last year. Established evaluation and implementation frameworks were used to guide the implementation evaluation. Implementation barriers and facilitators, delivery fidelity, participant satisfaction, and implementation costs were assessed. Using micro-costing methods, costs for assessment of eligibility and scheduling and maintaining adherence per participant, as well as cost of delivery per session, were also assessed.Results: Several barriers and facilitators to Reach, Adoption, Implementation, Effectiveness and Maintenance were identified; barriers related to Reach were the largest challenge encountered by site teams. Fidelity was higher for VA-DPP delivery compared to MOVE! for five of seven domains assessed. Participant satisfaction was high in both programs, but higher in VA-DPP for most items. Based on micro-costing methods, cost of assessment for eligibility was $68/individual assessed, cost of scheduling and maintaining adherence was $328/participant, and cost of delivery was $101/session.Conclusions: Multi-faceted strategies are needed to reach targeted participants and successfully implement DPP. Costs for assessing patients for eligibility need to be carefully considered while still maximizing reach to the targeted population.