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

评估综合卫生系统中糖尿病预防计划的实施情况

基本信息

批准号：
9980394
负责人：
Stephanie Lenay Fitzpatrick
金额：
$ 45.58万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-07-01 至 2022-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9980394
关键词：
Address Adoption Adult Age Assessment tool Behavior Therapy Behavioral Blood Glucose Body Weight decreased Clinical Clinical Trials Communities Control Groups Cost Effectiveness Analysis Cost Savings Data Diabetes Mellitus Dietary Assessment Dietary intake Effectiveness Elderly Electronic Health Record Enrollment Funding Future Glycosylated hemoglobin A Health Policy Health Status Incidence Individual Integrated Health Care Systems Internet Interview Knowledge Lead Learning Life Stress Maintenance Measures Medicare Mental Depression Methods Motivation Nature Non-Insulin-Dependent Diabetes Mellitus Obesity Patients Persons Physical activity Physical activity scale Policies Population Prediabetes syndrome Preparation Primary Health Care Program Effectiveness Program Evaluation Psychosocial Factor Public Health Publishing Qualitative Evaluations Quality of life Quantitative Evaluations Randomized Sample Size Services Social support Surveys Target Populations Telephone Time Translating United States Centers for Medicare and Medicaid Services Weight Weight maintenance regimen arm base beneficiary clinically significant comparative cost effectiveness cost effective diabetes prevention program evidence base health plan high risk lifestyle intervention member population health prevent programs psychosocial recruit response retention rate satisfaction translational study treatment arm treatment as usual treatment comparison uptake

项目摘要

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.

项目摘要/摘要：超过三分之一的60岁成年人患有肥胖症和50％有糖尿病。糖尿病预防计划（DPP）临床试验证明了行为生活方式干预可以降低2型糖尿病的发生率，并导致临床重量显着损失，特别是在老年人中。几项研究研究了如何将DPP转化为社区 - 基于基于的设置和初级保健，但这些受到小样本量的限制，缺乏对照小组，老年人很少。需要更大，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，基督教青年会证明了DPP可以成功交付给具有糖尿病前期的医疗保险受益人，并导致临床上显着的体重减轻和成本储蓄。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）计划涵盖针对Medicare受益人的12个月DPP计划。但是，以所需的规模实施此程序尚不清楚。虽然Medicare将为面对面的DPP提供资金或在线上，需要确定两种格式的覆盖范围和有效性。此外，我们对影响计划参与的行为和社会心理因素的了解有限在这个小组中。我们建议在Kaiser Permanente Northwest严格评估Medicare DPP的实施（KPNW），一个大型的综合医疗保健系统，以确定交付的可行性和有效性 DPP面对面或在线。 KPNW将在2017年实施12个月的Medicare DPP，并将随机化 6000名受益人患有2型糖尿病的高风险至四个治疗组之一：1）DPP亲自面对面； 2）DPP 在线的; 3）DPP面对面或在线之间的患者选择；或4）通常的护理。我们将检查计划范围（比较有关招聘和保留率以及会议出勤率的面对面和在线格式），比较临床措施的治疗臂（从电子健康中提取的重量和HBA1C 记录），并检查与程序有效性和参与相关的因素。我们也会比较饮食摄入量变化的四个治疗臂和六和12的体育锻炼分钟几个月，以及抑郁，生活质量，压力，社会支持和动力的措施基线和六个月。将进行定性访谈以探索与计划注册，满意度和继续参与。最后，我们将比较成本效益 DPP面对面的DPP，DPP在线和DPP选择。简而言之，这项务实的研究将决定最好的，大多数为高风险的医疗保险人群提供这些服务的具有成本效益的方法。

项目成果

期刊论文数量（3）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Challenges with implementing the Diabetes Prevention Program for Medicare beneficiaries in an integrated health system.

DOI：
10.37765/ajmc.2021.88784
发表时间：
2021-11-01
期刊：
The American journal of managed care
影响因子：
0
作者：
Gruß I;Firemark A;Papajorgji-Taylor D;Fitzpatrick SL
通讯作者：
Fitzpatrick SL

Evaluating the Implementation of Digital and In-Person Diabetes Prevention Program in a Large, Integrated Health System: Natural Experiment Study Design.

DOI：
10.7812/tpp/21.056
发表时间：
2021-12-13
期刊：
The Permanente journal
影响因子：
0
作者：
Fitzpatrick, Stephanie L;Mayhew, Meghan;Fortmann, Stephen P
通讯作者：
Fortmann, Stephen P

Costs and Cost-Effectiveness of Implementing a Digital Diabetes Prevention Program in a Large, Integrated Health System.

在大型综合卫生系统中实施数字糖尿病预防计划的成本和成本效益。

DOI：
10.7812/tpp/22.029
发表时间：
2022
期刊：
The Permanente journal
影响因子：
0
作者：
Smith,DavidH;O'Keeffe-Rosetti,Maureen;Fitzpatrick,StephanieL;Mayhew,Meghan;Firemark,AlisonJ;Gruß,Inga;Nyongesa,DenisB;Smith,Ning;Dickerson,JohnF;Stevens,VictorJ;Vollmer,WilliamM;Fortmann,StephenP
通讯作者：
Fortmann,StephenP