Putting Telehealth to the Test: An Evaluation of the Use of Telehealth to Increase the Population-Level Impact of an Employer-Based Diabetes Prevention Program

项目总结 现在有60多家雇主和保险公司为疾病控制和预防中心(CDC)提供 国家糖尿病预防计划(DPP)作为以证据为基础的体重管理计划 员工。Vanderbilt Health and Wellness的工作场所健康部门Health Plus开始提供 作为范德比尔特大学(VU)和范德比尔特约25,000名员工的福利，2014年的DPP 大学医学中心(VUMC)。民进党的目标是让参与者减掉5%的基线体重 到为期一年的计划结束时。2014-2017年，健康加DPP(HP-DPP)的比例 实现这一目标的参与者超过了国家DPP指标(HP-DPP参与者的43.6%对35.5% 全国DPP参与者)，该计划获得了疾病预防控制中心糖尿病患者的完全认可 预防识别计划。然而，对HP-DPP潜在参与度和实际参与度的比较表明 许多可能从这一高效计划中受益的员工并没有参与其中。计划范围是 由于不方便的地点、时间和时间，工作场所健康计划和DPP通常都受到限制 限制、激励不足和保密问题。从HP-DPP参与者那里收集的反馈 2014-2017年建议需要亲自在VU/VUMC主校区会面才能参加 在这段时间里，该计划是其覆盖范围的关键障碍。然而，该计划的小组结构是 被认为是支持和激励的关键来源。为了提高高效HP-DPP的覆盖范围，同时 为了保持其小组结构的优势，HP-DPP引入了一个视频电话会议(VTC)小组 2018年的(远程医疗)参与选项。尽管疾控中心支持使用远程医疗作为DPP 实施策略，很少有研究比较远程医疗和面对面交付的有效性 实现减肥的平台。还没有研究比较VTC和面对面减肥的结果 职业训练局小组仅通过在线互动参与的DPP小组。医疗保险和医疗保险中心 医疗补助服务(CMS)最近决定不向使用远程医疗平台的DPP报销计划 在不进一步测试和评估虚拟DPP的情况下交付。因此，有必要进行研究以指导使用 远程保健作为一项民进党执行战略，在地方和国家两级都具有相关性。这个项目将 根据RE-AIM的覆盖范围、有效性和实施维度对HP-DPP进行评估 模型通过(1)比较HP-DPP实施前后的覆盖范围、有效性和实施情况 引入职训局参与方案；(2)比较职训局与 面对面的HP-DPP群体，以及(3)探索REACH差异的原因， 与纳入职训局参与相关的HP-DPP的有效性和/或实施 使用深度访谈的选项。这项评估的结果将直接为扩大覆盖范围的努力提供信息 以及工作场所内外的DPP对公共健康的影响。

PROJECT SUMMARY More than 60 employers and insurers now offer the Centers for Disease Control and Prevention (CDC) National Diabetes Prevention Program (DPP) as an evidence-based weight management program for employees. Health Plus, the workplace wellness division of Vanderbilt Health and Wellness, began offering the DPP in 2014 as a benefit to the approximately 25,000 employees of Vanderbilt University (VU) and Vanderbilt University Medical Center (VUMC). The goal of the DPP is for participants to lose 5% of their baseline weight by the end of the year-long program. From 2014-2017, the proportion of Health Plus DPP (HP-DPP) participants achieving this goal exceeded National DPP metrics (43.6% of HP-DPP participants versus 35.5% of DPP participants nationwide) and the program earned full recognition status from the CDC Diabetes Prevention Recognition Program. Yet comparisons of potential and actual participation in the HP-DPP suggest many employees likely to benefit from this highly effective program are not participating in it. Program reach is often limited for both worksite wellness programs and DPPs because of inconvenient locations, time limitations, insufficient incentives, and confidentiality concerns. Feedback collected from HP-DPP participants from 2014-2017 suggests the need to meet in person on the VU/VUMC main campus to participate in the program was a key barrier to its reach during this interval. However, the group structure of the program was noted to be a key source of support and motivation. To improve the reach of the highly effective HP-DPP while maintaining the benefits of its group structure, the HP-DPP introduced a video-teleconference (VTC) group (telehealth) participation option in 2018. Although the CDC endorses the use of telehealth as a DPP implementation strategy, few studies have compared the effectiveness of telehealth and in-person delivery platforms for achieving weight loss. No studies have compared weight loss outcomes for VTC and in-person DPP groups in which the VTC group participates solely via online interactions. The Centers for Medicare and Medicaid Services (CMS) recently decided not to reimburse DPPs utilizing a telehealth platform for program delivery without further testing and evaluation of virtual DPPs. Thus, the need for research to guide the use of telehealth as a DPP implementation strategy is relevant at both a local and national level. This project will evaluate the HP-DPP in terms of the reach, effectiveness, and implementation dimensions of the RE-AIM model by (1) comparing the reach, effectiveness, and implementation of the HP-DPP before versus after the introduction of the VTC participation option, (2) comparing the effectiveness and implementation of VTC versus in-person HP-DPP groups in the “after” period, and (3) exploring reasons for differences in the reach, effectiveness, and/or implementation of the HP-DPP that are associated with inclusion of the VTC participation option using in-depth interviews. The results of this evaluation will directly inform efforts to extend the reach and public health impact of DPPs both within and beyond worksites.