VA Diabetes Prevention: Enhanced Implementation Evaluation

背景： 多项大规模随机对照试验表明，在血糖受损的人中 耐受性：40%到60%的2型糖尿病病例可以通过生活方式预防 强调饮食、锻炼和减肥的干预措施。尽管有强大的证据基础 支持可预防的是，糖尿病的发病率继续增加。在美国，近200万人 2010年，新诊断出2型糖尿病患者。退伍军人行动！没有专门针对那些 有糖尿病前期的退伍军人大多指退伍军人搬家！他们还没有确诊为 糖尿病患者不知道自己是否有糖尿病前期症状。除了少数例外，生活方式的改变 针对糖尿病前期患者并遵循糖尿病预防计划的干预措施 退伍军人糖尿病前期退伍军人不能参加课程。该项目将建立在两个前 现有项目，由我们的合作伙伴资助的VA糖尿病预防临床示范项目 弗吉尼亚州国家健康促进和疾病预防中心(NCP)和QUERI资助的RRP 标题：退伍军人糖尿病预防：糖尿病前期的流行病学和实施试点。 方法： 本SDP应用程序中提出的评估组件代表混合类型3混合方法 实施评估。本着这一目标，我们的研究团队通力合作 与NCP一起确定三个具体的以实施为重点的研究问题， 将通知全国在退伍军人事务部执行民进党。有三个截然不同的研究组成部分 与本研究计划的三个具体目标相对应：执行评估、 调解分析组件之间的差异，VA搬家！和退伍军人事务部DPP，还有一个成本- 效益/预算影响分析。退伍军人被转介到退伍军人事务部！在三个退伍军人中的一个 医疗中心将对糖尿病前期进行筛查。那些符合纳入标准的人将被分配 使用系统抽样，以VA DPP或VA MOVE！参与者将被跟踪一年 根据分配的任务评估减肥和会议出席率。参与者还将被邀请参加 完成两项调查，一项在基线调查，另一项在12个月的随访中。参与者的子集 将就定性数据进行访谈，以支持量化结果并为实施提供信息 分析。其他工作人员面谈将使用CFIR和RE-AIM实施进行编码 指导未来实施战略的框架。 客观化 1.测试实施战略，并确定实施退伍军人管理局的障碍和促进者 三个退伍军人医疗中心的DPP使用混合方法，该方法由CFIR和RE- AIM实施框架。 2.测试不同结构对减肥干预效果的中介作用 退伍军人行动！VA DPP包括群体凝聚力、干预强度、结果预期、目标 意识和承诺，以及自我调节技能。 3.在退伍军人事务部广泛实施退伍军人事务部DPP的成本效益和预算影响分析 从卫生系统的角度来看。

Background: Multiple large scale randomized controlled trials have shown that in people with impaired glucose tolerance, between 40 and 60% of cases of Type 2 diabetes can be prevented with lifestyles interventions that emphasize diet, exercise and weight loss. Despite the strong evidence base supporting preventability, the incidence of diabetes continues to increase. In the US, almost 2 million people were newly diagnosed with type 2 diabetes in 2010. VA MOVE! does not specifically target those with pre-diabetes and most veterans referred to VA MOVE! who don't already have a diagnosis of diabetes do not know if they are pre-diabetic or not. With a few exceptions, lifestyle modification interventions that target individuals with pre-diabetes and follow the Diabetes Prevention Program curriculum are not available to veterans with pre-diabetes in the VA. This project will build on two pre- existing projects, the VA Diabetes Prevention clinical demonstration project funded by our partners at VA National Center for Health Promotion and Disease Prevention (NCP) and the QUERI funded RRP titled: VA Diabetes Prevention: Epidemiology of Pre-Diabetes and Implementation Pilot. Methods: The evaluation components proposed in this SDP application represent a Hybrid Type 3 mixed methods implementation evaluation. Consistent with this goal, our research team has worked collaboratively with NCP to identify three specific implementation-focused research questions, the answers to which will inform national implementation of the DPP in the VA. There are three distinct research components corresponding to the three specific aims in this research plan: an implementation evaluation, a mediation analysis of components that differ between VA MOVE! and VA DPP, and a cost- effectiveness/budget impact analysis. Veterans who are referred to VA MOVE! at one of three VA medical centers will be screened for pre-diabetes. Those who meet inclusion criteria will be assigned using a systematic sampling to either VA DPP or VA MOVE! Participants will be tracked for 1 year following assignment to evaluate weight loss and session attendance. Participants will also be invited to complete two surveys, one at baseline and one at a 12 month follow-up visit. A subset of participants will be interviewed for qualitative data to support quantitative results and to inform the implementation analysis. Additional staff interviews will be coded using the CFIR and RE-AIM implementation framework to guide future implementation strategies. Objective 1. Test an implementation strategy and identify barriers and facilitators to implementation of the VA DPP at three VA medical centers using a mixed methods approach that is informed by the CFIR and RE- AIM implementation frameworks. 2. Test for mediation of intervention effect on weight loss by constructs that are addressed differently in VA MOVE! and the VA DPP including group cohesion, intervention intensity, outcome expectations, goal awareness and commitment, and self-regulation skills. 3. Conduct cost-effectiveness and budget impact analyses of implementing the VA DPP broadly in the VA from the perspective of the health system.