Evaluating Real-world Diabetes Prevention Programs in a Multi-campus University System and a Three-state Regional Health Network

项目摘要/摘要 在研究人员、加州大学校长办公室(UCOP)和 山间医疗，我们将利用现有的电子健康记录(EHR)、保险索赔和 用于检查糖尿病预防的长期有效性和成本效益的DPP队列数据 方案(DPP)，以及在现实世界环境中参与DPP的障碍和促进者。我们 使用加州大学(UC)的各种数据源提出了一项严格的评估，这是一项 多校区大学系统和加利福尼亚州最大的雇主之一，以及 山间医疗，这是一个由三个州组成的地区性医疗网络。我们将创建一个合并的多- 种族和地理不同的成年人患2型糖尿病风险的电子队列 参加DPP的人和没有参加DPP的倾向匹配的对照组。我们将包括所有民进党交付的 在这两个系统中都存在了近十年的模式。评估……的有效性 现实世界中的DPP交付，我们将在5年的跟踪调查中检查有风险的成年人的体重变化百分比 对于发生2型糖尿病，比较完成DPP的人和未参加DPP的人，以及 还比较了那些开始但没有完成DPP的人和那些没有注册的人(初级 结果)。次要结果将检查心血管危险因素的变化(例如，血压， 烟草使用)、2型糖尿病发病率和与糖尿病相关的医疗服务利用率以及 相关成本。为了评估现实世界民进党交付的成本效益，我们将估计每个案例的成本 在5年的随访中，2型糖尿病的预防和每质量调整生命年(QALY)的成本增加。我们 还将审查长期效力和成本效益是否因几个因素而不同，包括 DPP进入标准(例如，血液测试与风险测试)、计划实施模式、健康的社会决定因素、年龄 群体，或种族和民族。为了研究民进党参与的障碍和推动者，我们将进行一项调查。 民进党参与者和非参与者的代表性子集。我们将利用我们团队的专业知识在 DPP的评估和协作的跟踪记录，我们将与协调中心密切合作 开展此次多点综合评价研究。这项研究的发现将为未来的UC 解决肥胖和2型糖尿病预防的系统和山间保健战略 将有效战略传播到其他大型大学系统、医疗保健系统和 雇主。

Project Summary/Abstract In an innovative scientific partnership between researchers, the UC Office of the President (UCOP), and Intermountain Healthcare, we will leverage existing electronic health record (EHR), insurance claims and DPP cohort data to examine the long-term effectiveness and cost-effectiveness of the Diabetes Prevention Program (DPP), as well as barriers and facilitators of participation in DPP in real-world settings. We proposed a rigorous evaluation using diverse data sources from the University of California (UC), which is a multi-campus university system and one of the largest employers in the State of California, and Intermountain Healthcare, which is a three-state regional health network. We will create a merged multi- ethnic and geographically diverse electronic cohort of adults at-risk of developing type 2 diabetes who enrolled in DPP and propensity-matched controls who did not enroll in DPP. We will include all DPP delivery models that have been in existence for nearly a decade in both systems. To assess the effectiveness of real-world DPP delivery, we will examine percent weight change at 5-years follow-up among adults at risk for developing type 2 diabetes, comparing those who completed DPP with those who did not enroll, and also comparing those who started but did not complete DPP with those who did not enroll (primary outcome). Secondary outcomes will examine changes in cardiovascular risk factors (e.g., blood pressure, tobacco use), rates of incident type 2 diabetes and diabetes-related healthcare service utilization and related costs. To assess the cost-effectiveness of real-world DPP delivery, we will estimate cost per case of type 2 diabetes prevented and cost per quality-adjusted life years (QALYs) gained at 5-years follow-up. We will also examine whether long-term effectiveness and cost-effectiveness vary by several factors, including DPP entry criteria (e.g., blood test vs. risk test), program delivery mode, social determinants of health, age group, or race and ethnicity. To examine barriers and facilitators to DPP participation, we will survey a representative subset of DPP participants and non-participants. We will leverage our team's expertise in DPP evaluation and track record of collaboration, and we will work closely with the coordinating center to carry out this comprehensive multi-site evaluation study. Findings from this study will inform future UC System and Intermountain Healthcare strategies addressing obesity and type 2 diabetes prevention, as well as dissemination of effective strategies to other large university systems, healthcare systems and employers.