A Multi-Level Evaluation of California's New Medicaid Coverage for the Diabetes Prevention Program

项目摘要/摘要 糖尿病预防计划(DPP)帮助糖尿病前期患者开始改变生活方式，推迟或 预防2型糖尿病。然而，民进党在中产阶级人群中最成功。城市发展中心 疾病控制和预防(CDC)支持的国家糖尿病预防计划取得广泛进展 但在低收入社区的覆盖面和有效性有限。在向前迈出的重要一步中， 加利福尼亚州在参议院第97号法案中规定，自2019年1月1日起，所有符合条件的医疗补助(例如Medi-Cal) 希望加入民进党的受益者必须得到这个机会。SB 97的结果将是 对医疗补助受益人的糖尿病预防有重大影响，不仅在加利福尼亚州，而且在 美国。我们建议使用Kaiser Permanente North California的数据对SB 97进行评估 和加州大学洛杉矶分校(UCLA)。使用先进的分析方法，我们将 评估这一自然实验对临床结果的影响。我们还将收集重要的上下文 主要数据来自加州43家CDC认可或待定的DPP供应商，以及两家DPP Lifestyle 教练员和民进党参与者。 我们的具体目标如下：1)确定SB 97和授权的中加州DPP的有效性 覆盖体重(主要结果)、收缩压(SBP)、DPP摄取的变化- 个人或在线，以及预计中加州受益者的未来成本节约(所有次要结果) 与KPNC和UCLA的糖尿病前期患者相比， 加州健康保险交易所(HIE)。2)描述疾控中心认可的领导人的观点 DPP供应商，包括向地中海地区受益人提供DPP的决定，例如他们的流程 确定目标人群，提高对民进党的认识和推广，并招募和登记 符合条件的参与者。3)描述中级DPP参与者和DPP生活方式教练的观点 关于参与者留住和参与的促进者和障碍。我们的团队包括一个合作小组， 卫生服务研究人员、统计学家和卫生经济学家，具有项目评估和 成果研究，他们有着长期的工作关系。如果获得资金，我们就处于有利地位，做好了准备 在立法后阶段启动拟议的政策评估。

PROJECT SUMMARY/ABSTRACT The Diabetes Prevention Program (DPP) helps patients with prediabetes initiate lifestyle changes and delay or prevent T2DM. However, the DPP has been most successful in middle-class populations. The Centers for Disease Control and Prevention (CDC)-supported National Diabetes Prevention Program achieved widespread implementation but had limited reach and effectiveness in low-income communities. In a major step forward, California has mandated in Senate Bill 97 that as of January 1, 2019, all eligible Medicaid (e.g., Medi-Cal) beneficiaries who want to enroll in the DPP must be provided this opportunity. The outcomes of SB 97 will have major implications on diabetes prevention for Medicaid beneficiaries not only in California but also across the US. We are proposing an evaluation of SB 97 using data from Kaiser Permanente Northern California (KPNC) and the University of California, Los Angeles (UCLA). Using advanced analytic approaches, we will evaluate the effects of this natural experiment on clinical outcomes. We will also collect important contextual primary data from the 43 CDC-recognized or pending DPP suppliers in California, and from both DPP lifestyle coaches and DPP participants. Our Specific Aims are as follows: 1) To determine the effectiveness of SB 97 and mandated Medi-Cal DPP coverage on change in body weight (primary outcome), systolic blood pressure (SBP), uptake of the DPP in- person or online, and projected future cost savings (all secondary outcomes) among Medi-Cal beneficiaries with prediabetes at KPNC and UCLA, versus a comparison cohort of patients with insurance coverage from the California Health Insurance Exchange (HIE). 2) To characterize perspectives from leaders of CDC-recognized DPP suppliers including decisions about providing DPP to Medi-Cal beneficiaries, such as their processes of identifying the target population, raising awareness of and promoting the DPP, and recruiting and enrolling eligible participants. 3) To characterize perspectives of Medi-Cal DPP participants and DPP lifestyle coaches on facilitators and barriers to participant retention and engagement. Our team includes a collaborative group of health services researchers, a statistician, and a health economist with experience in program evaluation and outcomes research, who have a longstanding working relationship. If funded, we are well positioned and ready to initiate the proposed policy evaluation in the post-enactment period.