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

项目概要/摘要 在研究人员之间的创新科学伙伴关系中，UC总统办公室（UCOP）， Intermountain Healthcare，我们将利用现有的电子健康记录（EHR），保险索赔和 DPP队列数据，以检查糖尿病预防的长期有效性和成本效益 程序（DPP），以及在现实世界中参与DPP的障碍和促进因素。我们 提出了一个严格的评估使用不同的数据来源，从加州大学（UC），这是一个 多校区大学系统和加州最大的雇主之一， Intermountain Healthcare是一个由三个州组成的区域卫生网络。我们将创建一个合并的多- 具有发展2型糖尿病风险的不同种族和地理位置的成年人电子队列， 入组DPP的受试者和未入组DPP的倾向匹配对照者。我们将包括所有DPP交付 在这两个系统中已经存在了近十年的模型。的有效性进行评估 真实世界的DPP交付，我们将在5年随访中检查处于风险中的成年人的体重变化百分比 2型糖尿病的发生率，比较完成DPP的患者与未参加的患者，以及 还比较了那些开始但没有完成DPP的人与那些没有入学的人（小学 结果）。次要结局将检查心血管风险因素的变化（例如，血压， 烟草使用）、2型糖尿病发病率和糖尿病相关医疗服务利用率， 相关费用。为了评估真实世界DPP交付的成本效益，我们将估算每例DPP的成本。 预防2型糖尿病和5年随访时获得的每质量调整生命年（Qs）成本。我们 还将研究长期有效性和成本效益是否因几个因素而异，包括 DPP进入标准（例如，血液测试与风险测试），计划交付模式，健康的社会决定因素，年龄 种族和民族。为了研究民进党参与的障碍和促进因素，我们将调查 DPP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， DPP评估和合作记录，我们将与协调中心密切合作， 开展这项多地点综合评价研究。这项研究的结果将为未来的UC提供信息 系统和山间医疗保健战略，解决肥胖和2型糖尿病的预防，以及 作为向其他大型大学系统、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.