Effectiveness of a National Health Care Community Partnership to Prevent Diabetes

项目摘要：目前，超过6000万美国人患有前驱糖尿病，据估计，其中近四分之一的人可能在未来5至7年内患上糖尿病。糖尿病预防计划（DPP）表明，密集的生活方式干预导致适度的体重减轻和增加体力活动可以延迟或预防2型糖尿病的发展。不幸的是，DPP生活方式干预最初并不是为公共卫生规模而设计的，而且自从DPP的结果在大约9年前首次公布以来，这种干预的成本和强度推迟了这种方法的任何被动传播。然而，我们在印第安纳大学的小组最近的研究表明，由受过培训的YMCA员工提供的以群体为基础的DPP生活方式干预适应，可以实现与DPP相似的体重减轻和行为改变，但成本仅为DPP的1/8。现在，通过联合健康集团（UHG）和美国基督教青年会（YMCA）的新伙伴关系，正在积极努力将这一模式推广到全国。在这次令人兴奋的合作中，UHG将为雇主团体和其他健康购买者提供新的行政服务，帮助识别患有糖尿病前期的成年人，接触这些高风险人群，并帮助他们参加基督教青年会以团体为基础的DPP干预计划。然后，UHG将管理一个以价值为导向的支付系统，该支付系统将基于每个参加活动的高风险人士的参与程度和减肥效果。虽然这并不足以作为在人口规模上解决糖尿病预防和控制问题的唯一手段，但这种新的伙伴关系创造了一个令人兴奋的机会，可以通过涉及大型商业卫生支付方和领先社区组织的努力，评估在全国范围内实施DPP的推广方式的可行性和可持续性。在联合健康集团（UnitedHealth Group）和基督教青年会（YMCA）的大力支持下，我们提供了对多个行政数据源的广泛和持续访问，我们建议对美国多个地区数万名高风险成年人的范围、实施、成本、有效性和维护进行评估。通过对大型雇主的全国调查，我们还将收集有关体重管理和慢性病预防服务的奖励和报酬的信息。通过这些努力，我们希望更多地了解影响这个新项目覆盖面和有效性的因素，因为不同UHG市场的支付结构不同，我们还希望确定交付模式或福利结构的变化如何随着时间的推移有助于扩大对更多雇主群体的影响，并提高更多个人的参与度和减肥成功率。如果我们的评估发现这种合作预防策略具有成本效益和可持续性，这些结果将对及时传播全国性努力的重要新组成部分至关重要，以预防超过6000万已经患有前驱糖尿病的美国人中的2型糖尿病。

DESCRIPTION (provided by applicant): Project Abstract Today over 60 million Americans have prediabetes, and it is estimated that almost one quarter of these individuals could develop diabetes within the next 5 to 7 years. The Diabetes Prevention Program (DPP) demonstrated that an intensive lifestyle intervention resulting in modest weight loss and increased physical activity can delay or prevent the development of type 2 diabetes for adults with prediabetes. Unfortunately, the DPP lifestyle intervention was not initially designed for delivery on a public health scale, and the costs and intensity of this intervention have delayed any passive dissemination of this approach since the DPP's results were first released some 9 years ago. However, recent studies by our group at Indiana University have demonstrated that delivery of a group-based adaptation of the DPP lifestyle intervention by trained YMCA employees can achieve weight loss and behavioral changes similar to the DPP but for only about 1/8 the cost. Now, through a new partnership involving UnitedHealth Group (UHG) and the YMCA of USA, efforts are actively underway to scale this model for DPP delivery nationally. In this exciting collaboration, UHG will provide a new administrative service for employer groups and other health purchasers that will help to identify adults with pre-diabetes, reach out to these high risk persons, and assist them in enrolling in the YMCA's group-based DPP intervention program. UHG will then manage a system of value-driven payments to the YMCA, based on levels of participation and weight loss achieved by each high risk person who is enrolled. Although this will not suffice as the only means for addressing the prevention and control of diabetes on a population scale, this new partnership creates an exciting opportunity to evaluate the feasibility and sustainability of a generalizable way for delivering the DPP nationally through efforts that involve a large commercial health payer and a leading community organization. With the strong support of both UnitedHealth Group and the YMCA to provide extensive and ongoing access to several administrative data sources, we propose to evaluate the reach, implementation, costs, effectiveness, and maintenance of these efforts for tens of thousands of high risk adults in multiple regions throughout the U.S. Through a national survey of large employers, we will also collect information regarding incentives and payment for weight management and chronic disease prevention services. Through these efforts, we hope to understand more about the factors that impact reach and effectiveness of this new program as the structure of payment varies across different UHG markets, and we also hope to identify how changes in the delivery model or benefit structure over time might help to enhance reach to more employer groups and to improve participation and weight loss success for more individuals. Should our evaluation find this partnered prevention strategy to be cost- effective and sustainable, these results will be pivotal to the timely dissemination of an important new component of nationwide efforts to prevent type 2 diabetes among over 60 million Americans who already have prediabetes today.