Clinical Identification and Referral of Adults With Prediabetes to a Diabetes Prevention Program
Clinical Identification and Referral of Adults With Prediabetes to a Diabetes Prevention Program
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DOI：
10.5888/pcd16.180540
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发表时间：
2019-06-01
影响因子：
5.5
通讯作者：
Kandula, Namratha R.
中科院分区：
文献类型：
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作者：
Holliday, Christopher S.;Williams, Janet;Kandula, Namratha R.
目的和目标预防或延迟2型糖尿病发病的社区项目是有效的，但实施这些项目以最大限度地扩大其覆盖范围和影响仍然是一个挑战。美国医学协会（AMA）与美国基督教青年会合作，作为医疗保险和医疗补助创新示范项目中心的一部分，开发，实施和评估创新的质量改进战略，以增加常规筛查，测试，以及将患有前驱糖尿病的医疗保险患者转介到糖尿病预防项目（DPPs）干预方法AMA在17个美国社区招募了26个初级保健实践和卫生系统，以实施即时护理和回顾性方法（或两者的组合）用于筛查、检测和转诊患有前驱糖尿病的医疗保险患者。Evaluation MethodsWe评估了参与实践的患者的转诊率和入组率的变化。我们使用了混合方法的前测-后测评估设计，以确定是否使用某些工具和资源，再加上系统的变化，导致增加筛选和referreration.ResultsPractices提到了共5,640例患者，其中1,050参加了基督教青年会民进党（19%;范围，2%-98%）。使用回顾性的实践（n = 12）（即电子病历[EMR]）系统，以确定合格的医疗保险病人通过登记转介更多的人（n = 4，601），而不是实践（n = 10），仅使用床旁的方法（n = 437例患者）或使用这些方法组合的实践（n = 4）（n = 602例患者）。所有的方法都表明，增加登记与点的护理方法是最成功的。公共卫生的影响，从这种干预中吸取的教训可以用来提高糖尿病预防在美国和支持医疗保险和医疗补助服务中心（CMS）决定扩大医疗保险覆盖范围，包括所有医疗保险受益人的民进党。
Purpose and ObjectivesCommunity programs to prevent or delay the onset of type 2 diabetes are effective, but implementing these programs to maximize their reach and impact remains a challenge. The American Medical Association (AMA) partnered with the YMCA of the USA, as part of a Centers for Medicare and Medicaid Innovation demonstration project, to develop, implement, and evaluate innovative quality improvement strategies to increase routine screening, testing, and referral of Medicare patients with prediabetes to diabetes prevention programs (DPPs) at local YMCAs.Intervention ApproachAMA recruited 26 primary care practices and health systems in 17 US communities to implement point-of-care and retrospective methods (or a combination of both) for screening, testing, and referral of Medicare patients with prediabetes.Evaluation MethodsWe assessed changes in rates of referral and enrollment of patients among participating practices. We used a mixed-methods pretest-posttest evaluation design to determine if use of certain tools and resources, coupled with systems changes, led to increased screening and referrals.ResultsPractices referred a total of 5,640 patients, of whom 1,050 enrolled in a YMCA DPP (19%; range, 2%-98%). Practices (n = 12) that used retrospective (ie, electronic medical record [EMR]) systems to identify eligible Medicare patients via a registry referred more people (n = 4,601) to the YMCA DPP than practices (n = 10) that used a point-of-care method alone (n = 437 patients) or practices (n = 4) that used a combination of these approaches (n = 602 patients). All approaches showed increased enrollment with point-of-care methods being most successful.Implications for Public HealthLessons learned from this intervention can be used to increase diabetes prevention in the United States and support the Centers for Medicare and Medicaid Services (CMS) decision to expand Medicare coverage to include the DPP for all Medicare beneficiaries.