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

项目概要/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， 预防T2 DM。然而，民进党在中产阶级人群中最为成功。中心的 疾病控制和预防中心（CDC）支持的国家糖尿病预防计划实现了广泛的 执行情况良好，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计划（例如，Medi-Cal） 必须向希望参加DPP的受益人提供这一机会。SB 97的结果将 不仅在加州，而且在全国范围内， 美方我们建议使用Kaiser Permanente北方加州的数据对SB 97进行评估 （KPNC）和加州大学洛杉矶分校（UCLA）。使用先进的分析方法，我们将 评估这种自然实验对临床结果的影响。我们还将收集重要的背景信息， 来自加州43家CDC认可或待定的DPP供应商的主要数据，以及来自DPP生活方式和 教练和DPP参与者。 我们的具体目标如下：1）确定SB 97和授权Medi-Cal DPP的有效性 涵盖体重变化（主要结局）、收缩压（SBP）、DPP摄取- 个人或在线，以及Medi-Cal受益人的预计未来成本节约（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。2)描述CDC认可的领导人的观点 DPP供应商，包括关于向Medi-Cal受益人提供DPP的决定，例如其 确定目标人群，提高对DPP的认识并促进DPP，招募和登记 合格的参与者。3)描述Medi-Cal DPP参与者和DPP生活方式教练的观点 关于参与者保留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，一名统计学家和一名具有项目评估经验的卫生经济学家， 结果研究，谁有一个长期的工作关系。如果得到资助，我们将做好准备， 在颁布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.