Design and Pilot Test of A Prediabetes Digital Patient Activation Tool

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PROJECT SUMMARY/ABSTRACT Prediabetes is a significant public health problem affecting 88 million U.S. adults and increases the risk of developing diabetes with a 5-year risk of up to 50%. The NIDDK has prioritized examining behavioral approaches to preventing type 2 diabetes. This application seeks to address this priority by developing a prediabetes digital activation tool to increase patient activation, which is a key driver of positive health outcomes. Patient activation encourages empowering patients to be knowledgeable and activated, and a collaborative partner in managing his or her health. However, in clinical practice, primary care clinicians (PCP) often do not have the time or training to use objective tools to assess their patient’s activation, which may lead them to making recommendations that may not get followed or not making any recommendations at all. This barrier likely contributes to the low rates of referral and participation in the Diabetes Prevention Program (DPP), a yearlong lifestyle program shown to decrease one’s risk of developing diabetes. Our overarching goal is to increase the percentage of patients engaging in diabetes prevention activities to reduce the incidence of diabetes. To address this need, we propose the following interrelated Specific Aims: 1) To develop a prediabetes digital patient activation tool (DPAT) that evaluates a patient’s activation level, generates for the clinician a visit goal related to prediabetes, questions to guide the visit toward that goal, and a list of resources that support moving the patient from a lower to higher stage of activation, and 2) To conduct a conduct a pilot group-randomized controlled trial of DPAT vs. usual care to assess the primary outcome of increased patient activation, followed by interviews of a subset of participants and PCPs to evaluate acceptability and feasibility of DPAT. The target population includes adults with prediabetes and BMI ≥25kg/m2 who have an electronic health record patient portal account. We hypothesize that patients who use this tool will have an increase in activation levels, report greater satisfaction level and experience, and ultimately, be more likely to be enroll and participate in the DPP compared to participants in the usual care group. Data from this pilot study would provide preliminary data to test the effectiveness of this digital patient activation tool on patient activation and DPP enrollment in a larger randomized controlled trial across a health system.