Evaluating the implementation of the diabetes prevention program in an integrated health system

项目总结/摘要：超过三分之一的60岁以上的成年人患有肥胖症，50%的 有前驱糖尿病。糖尿病预防计划（DPP）的临床试验表明， 生活方式干预可以降低2型糖尿病的发病率，并导致临床显着的体重 尤其是老年人。几项研究探讨了如何将DPP转化为社区- 基础设施和初级保健，但这些都受到样本量小，缺乏控制， 只有极少数的老年人。需要更大规模、更高质量的务实研究来确定如何 将这些发现转化为实践。最近，基督教青年会证明，民进党可以成功地 提供给患有前驱糖尿病的医疗保险受益人，并导致临床显著的体重减轻和成本 积蓄根据这些发现，从2018年1月开始，医疗保险和医疗补助服务中心 (CMS)计划为医疗保险受益人提供为期12个月的DPP计划。然而， 目前尚不清楚该方案能否按所需规模实施。虽然医疗保险将资助DPP亲自或 在网上，需要确定这两种形式在老年人中的覆盖面和有效性。我们还 对影响项目参与的行为和心理社会因素了解有限 在这个组里。 我们建议严格评估Kaiser Permanente Northwest的Medicare DPP实施情况 （KPNW），一个大型的综合医疗保健系统，以确定提供的可行性和有效性 个人或在线DPP。KPNW将于2017年实施为期12个月的Medicare DPP，并将随机 6000名2型糖尿病高风险受益人接受以下四个治疗组之一：1）DPP亲自治疗; 2）DPP 在线; 3）患者在DPP亲自或在线之间的选择;或4）家庭护理。我们将检查项目覆盖范围 （比较面对面和在线形式的征聘和保留率以及会议出席率）， 比较治疗组的临床指标（从电子健康数据库中提取的体重和HbA 1c） 记录），并检查与计划有效性和参与度相关的因素。我们还将 比较四个治疗组在6岁和12岁时饮食摄入量和体力活动分钟数的变化 月，以及抑郁，生活质量，压力，社会支持和动机的措施， 基线和六个月时。将进行定性访谈，以探讨与以下因素相关的因素： 计划注册、满意度和持续参与。最后，我们将比较成本效益 民进党人，民进党在线，民进党的选择。简而言之，这项务实的研究将确定最好、最 为这些高风险的医疗保险人群提供这些服务的成本效益方法。

PROJECT SUMMARY/ABSTRACT: More than one-third of adults over age 60 have obesity and 50% have prediabetes. The Diabetes Prevention Program (DPP) clinical trial demonstrated that a behavioral lifestyle intervention could reduce the incidence of type 2 diabetes and lead to clinically significant weight loss, particularly among older adults. Several studies have examined how to translate DPP into community- based settings and primary care, but these have been limited by small sample sizes, absence of a control group, and very few older adults. Larger, higher-quality pragmatic studies are needed to determine how to translate these findings into practice. Recently, YMCA demonstrated that DPP could be successfully delivered to Medicare beneficiaries with prediabetes and lead to clinically significant weight loss and cost savings. Based on these findings, starting in January 2018 the Centers for Medicare & Medicaid Services (CMS) plans to cover a 12-month DPP program for Medicare beneficiaries. Yet, the feasibility of implementing this program at the required scale remains unclear. While Medicare will fund DPP in-person or online, the reach and effectiveness of either format among older adults needs to be determined. Further, we have limited knowledge about the behavioral and psychosocial factors that influence program engagement in this group. We propose to rigorously evaluate the implementation of Medicare DPP at Kaiser Permanente Northwest (KPNW), a large, integrated health care system, to determine the feasibility and effectiveness of delivering DPP in-person or online. KPNW will implement the 12-month Medicare DPP in 2017, and will randomize 6000 beneficiaries at high risk for type 2 diabetes to one of four treatment arms: 1) DPP in-person; 2) DPP online; 3) patient choice between DPP in-person or online; or 4) Usual care. We will examine program reach (comparing in-person and online formats on recruitment and retention rates and session attendance), compare treatment arms on clinical measures (weight and HbA1c extracted from the electronic health records), and examine factors associated with program effectiveness and engagement. We will also compare the four treatment arms on change in dietary intake and minutes of physical activity at six and 12 months, as well as on measures of depression, quality of life, stress, social support, and motivation at baseline and at six months. Qualitative interviews will be conducted to explore factors associated with program enrollment, satisfaction, and continued participation. Finally, we will compare the cost-effectiveness of DPP in-person, DPP online, and DPP choice. In short, this pragmatic study will determine the best, most cost-effective methods for delivering these services to this high risk Medicare population.