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、加州大学校长办公室 (UCOP) 和 Intermountain Healthcare，我们将利用现有的电子健康记录 (EHR)、保险索赔和 DPP 队列数据可检验糖尿病预防的长期有效性和成本效益 计划 (DPP)，以及现实环境中参与 DPP 的障碍和促进因素。我们 提出了使用来自加州大学 (UC) 的不同数据源进行严格评估，这是 多校区大学系统和加利福尼亚州最大的雇主之一，以及 Intermountain Healthcare，这是一个由三个州组成的区域医疗网络。我们将创建一个合并的多 种族和地域不同的有患 2 型糖尿病风险的成年人的电子队列 参加 DPP 和未参加 DPP 的倾向匹配对照。我们将包括所有 DPP 交付 两个系统中已经存在近十年的模型。评估有效性 现实世界的 DPP 交付，我们将检查有风险的成年人 5 年随访时的体重变化百分比 对于发生 2 型糖尿病，将完成 DPP 的患者与未参加的患者进行比较，以及 还将开始但未完成 DPP 的人与未注册的人（小学 结果）。次要结局将检查心血管危险因素的变化（例如血压、 烟草使用）、2 型糖尿病发病率和糖尿病相关医疗服务利用率以及 相关费用。为了评估实际 DPP 交付的成本效益，我们将估算每箱的成本 2 型糖尿病的预防和 5 年随访时获得的每质量调整生命年 (QALY) 的成本。我们 还将检查长期有效性和成本效益是否因多种因素而变化，包括 DPP 进入标准（例如，血液测试与风险测试）、项目实施模式、健康的社会决定因素、年龄 群体，或种族和民族。为了研究 DPP 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， 开展这项综合性多地点评估研究。这项研究的结果将为未来的加州大学提供信息 解决肥胖和 2 型糖尿病预防问题的系统和山间医疗保健策略 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.