Assessing Barriers and Facilitators for Participating Structured Lifestyle Intervention and its Real-world Effectiveness and Cost-Effectiveness among US Veterans

项目摘要 美国糖尿病预防计划(DPP)表明，结构化生活方式干预(SLI)可以 预防或延缓进展为2型糖尿病(T2D)。2010年，国会授权疾控中心建立和 通过国家民进党(NDPP)在全国范围内管理类似DPP的SLI计划，并很快推出这些计划 2016年扩展到联邦医疗保险。然而，现有NDPP的入学率和完成率为 明显低于最初民进党研究中观察到的水平，特别是在少数民族群体中。障碍和 决定个人NDPP注册和完成情况的促进者仍不清楚。另外，研究 评估NDPP在降低心血管疾病(CVD)危险因素和 缺少事件T2D。NDPP在总体注册人数和注册人数分组中的成本-效果 也是未知的。填补这些知识空白对于改进NDPP的执行至关重要。 退伍军人健康管理局(VA)行动！该计划是美国最大的类似DPP的SLI计划。这个 该计划于2005年启动，课程基于最初的美国民进党试验和疾控中心的 NDPP课程。我们已经建立了一个庞大的纵向移动队列！计划参与者 (n=50,000)具有电子健康记录(EHR)和关联的保险索赔数据和Move！计划 提供商的数据具有长达15年的随访期。通过这个唯一的数据源，与一个 美国最先进的糖尿病微观模拟模型之一--Bravo糖尿病模型，由 我们的小组，我们会找出障碍和推动者来完成招生和搬家！计划，以及 评估其长期效果和成本效益。 拟议研究的具体目标是：1)目标1：评估入学的障碍和促进者 并完成搬家！计划；2)目标2：评估这一举措的长期效果！ 计划；3)目标3：评估此举的长期经济影响和成本效益！ 程序。通过实现所有这三个目标，我们将能够确定最有效和最具成本效益的战略 在美国实施和扩大NDPP。 拟议的研究具有重要意义，因为它将填补实施NDPP的关键知识空白 在美国。退伍军人是一个独特的群体，是这项全国性NDPP研究的重要组成部分 网络。这项研究具有创新性，因为我们的大型SLI队列和与EHR索赔相关的数据将使我们能够 应用尖端的ML方法和模拟模型来解决一系列具有挑战性的研究问题。

Project Summary The US Diabetes Prevention Program (DPP) has shown that a structured lifestyle intervention (SLI) can prevent or delay progression to type 2 diabetes (T2D). In 2010, Congress authorized CDC to establish and manage DPP-like SLI programs nationwide through the National DPP (NDPP), and these programs soon expanded to Medicare in 2016. However, the enrollment and completion rates of existing NDPPs were significantly lower than observed in the original DPP study, especially in minority groups. Barriers and facilitators that determine the individuals’ NDPP enrollment and completion remain unclear. Also, studies assessing the long-term effectiveness of NDPP in reducing cardiovascular disease (CVD) risk factors and incident T2D were lacking. The cost-effectiveness of NDPP in the overall enrollees and enrollee subgroups was also unknown. Filling these knowledge gaps is critical to improving the implementation of NDPP. The Veterans Health Administration (VA) MOVE! program is the largest DPP-like SLI program in the US. The program was initiated in 2005 with a curriculum developed based on the original US DPP trial and CDC’s NDPP curriculum. We have already established a large longitudinal cohort of MOVE! program enrollees (N=50,000) with electronic health records (EHR) and linked insurance claims data and the MOVE! program providers' data with a follow-up length of up to 15 years. Through this unique data source, combined with one of the most advanced diabetes microsimulation models in the US --the BRAVO diabetes model, developed by our group, we will identify barriers and facilitators to the enrollment and completion of the MOVE! program, and evaluate its long-term effectiveness and cost-effectiveness. The specific aims of the proposed study are: 1) Aim 1: Assess barriers and facilitators of enrollment and completion of MOVE! program; 2) Aim 2: Assess the long-term effectiveness of the MOVE! program; 3) Aim 3: Evaluate the long-term economic impact and cost-effectiveness of the MOVE! program. By achieving all three aims, we will be able to identify the most effective and cost-effective strategy to implement and expand the NDPP in the US. The proposed research is significant because it will fill the critical knowledge gaps in implementing the NDPP in the US. The Veteran population is a unique population and a vital piece to this nationwide NDPP research network. This study is innovative because our large SLI cohort with EHR-claims-linked data will allow us to apply cutting-edge ML methods and simulation models to tackle a series of challenging research questions.