Health and Economic Impacts of Coverage Requirements and Health System-Community Coordination for Diabetes Prevention

覆盖要求和卫生系统社区协调对糖尿病预防的健康和经济影响

• 批准号: 9924263
• 负责人: Ronald T. Ackermann
• 金额: $ 50.57万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-21 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9924263
• 关键词: Adoption; Adult; Advisory Committees; Affordable Care Act; American; American Medical Association; Caring; Case Study; Centers for Disease Control and Prevention (U.S.); Clinical; Collaborations; Communities; Community Health Systems; Cost Sharing; Data Sources; Detection; Development; Diabetes prevention; Diagnosis; Effectiveness; Engineering; Evaluation; Exposure to; Future; Geographic Locations; Goals; Health; Health Care Costs; Health Personnel; Health system; Institutes; Interruption; Intervention; Knowledge; Life Style; Maintenance; Medicare/Medicaid; Methods; Natural experiment; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Overweight; Patients; Policies; Prediabetes syndrome; Prevalence; Prevention; Preventive service; Public Health; Public Health Practice; Recommendation; Recording of previous events; Research; Research Design; Research Methodology; Research Personnel; Resources; Series; Services; Source; Statutes and Laws; Structure; Time; adult obesity; aged; base; cardiovascular risk factor; clinical practice; community intervention; cost; design; diabetes prevention program; disability; economic impact; experience; experimental study; glucose metabolism; health care service utilization; health data; health economics; health plan; healthcare community; high risk; improved; intervention program; lifestyle intervention; multidisciplinary; patient subsets; payment; prevent; preventable death; programs; randomized trial; rate of change; screening; service coordination; service intervention

Project Summary Currently, 86 million Americans have prediabetes, but 9 in 10 of them remain unaware. Randomized trials have demonstrated that more than half of all new cases of type 2 diabetes can be prevented or delayed when high risk adults are offered resource-intensive lifestyle intervention programs, such as the Diabetes Prevention Program (DPP). While numerous organizations have engaged in efforts to expand screening and subsequent access to interventions for adults with prediabetes, those services are far from routine in clinical and public health practice. However, implementation efforts in this arena are expected to accelerate rapidly during the next 3 years as several forthcoming policies will catalyze efforts to identify and intervene upon prediabetes. The US Preventive Services Task Force (USPSTF) recently issued a grade B recommendation that all overweight or obese adults with cardiovascular risk conditions (including prediabetes) be offered intensive lifestyle interventions, specifically referencing the DPP as a case example. This recommendation, together with Affordable Care Act (ACA) legislation requiring commercial and public payers to provide coverage of USPSTF A and B recommendations, has led payers to begin structuring coverage policies that will include a mix of clinical and community intervention services. In parallel, key stakeholders such as YMCA of the USA and the American Medical Association (AMA) have engineered a series of strategic regional initiatives to strengthen healthcare-community linkages for the screening and diagnosis of prediabetes, as well as the coordination of referrals to community-based interventions, and the billing and payment for delivery of those interventions. In close collaboration with these stakeholders, we propose this natural experiment, employing a mix of qualitative and quantitative research methods, and leveraging available data from the Health Care Cost Institute (HCCI), OptumHealth Care Solutions, and other accessible sources to evaluate the reach, implementation, effectiveness, and costs of these interrelated policies likely to impact the prevention of type 2 diabetes for potentially several million Americans over the next 5 to 10 years. Our proposal aims to: (1) evaluate and compare the impacts of large-scale, regional healthcare-community linkages on changing rates of prediabetes screening, diagnosis, and National DPP intervention attendance following enactment of USPSTF recommendations for those services; (2) describe implementation features and elicit barriers and facilitators of implementation, replication, and future scaling of large-scale regional initiatives; and (3) compare the effects of exposure to the YMCA’s DPP on healthcare costs and utilization for different subgroups of patients with prediabetes. This evaluation will provide critical information about whether particular strategies should be discontinued, refined, or replicated on a larger scale to achieve maximal impact over the coming decade.

项目摘要 目前，8600万美国人患有前驱糖尿病，但其中十分之九的人仍然不知道。随机试验 研究表明，超过一半的2型糖尿病新发病例可以预防或延迟， 风险成年人提供资源密集型的生活方式干预计划，如糖尿病预防 程序（DPP）。虽然许多组织都在努力扩大筛查和随后的 尽管这些服务在临床和公众中远非常规， 健康实践。然而，预计在2010年期间，这一竞技场的执行工作将迅速加速。 未来3年，一些即将出台的政策将促进识别和干预前驱糖尿病的努力。 美国预防服务工作组（USPSTF）最近发布了一项B级建议， 患有心血管风险疾病（包括前驱糖尿病）的超重或肥胖成年人应接受强化治疗， 生活方式干预，特别是指DPP作为一个案例。这项建议连同 《平价医疗法案》（ACA）立法要求商业和公共支付者提供USPSTF的保险 A和B的建议，导致支付人开始结构覆盖政策，将包括混合 临床和社区干预服务。与此同时，美国基督教青年会和 美国医学协会（AMA）制定了一系列战略性区域倡议，以加强 在糖尿病前期的筛查和诊断方面建立保健-社区联系， 社区干预措施的转诊，以及这些干预措施的收费和付款。在 与这些利益相关者密切合作，我们提出了这个自然的实验，采用了定性的组合， 和定量研究方法，并利用卫生保健成本研究所（HCCI）的可用数据， OptumHealth Care Solutions和其他可访问的资源，以评估覆盖范围，实施， 这些相互关联的政策可能会影响2型糖尿病的预防， 在未来的5到10年里，可能会有数百万美国人。我们的建议旨在：（1）评估和 比较大规模区域卫生保健-社区联系对糖尿病前期发病率变化的影响 USPSTF颁布后的筛查、诊断和国家DPP干预出勤率 （2）描述实施特点，并找出实施的障碍和促进因素; 大规模区域倡议的实施、复制和未来的扩展;（3）比较 暴露于YMCA的DPP对不同亚组患者的医疗保健成本和利用的影响 糖尿病前期这项评估将提供关键信息，说明是否应 在未来十年内，停止、改进或大规模复制这些技术，以实现最大的影响。