Multi-Stakeholder Determinants of Medicare Diabetes Prevention Program Implementation and Participation

项目摘要/摘要 近一半年龄在≥65岁(2,400万)的美国成年人患有糖尿病前期，这通常是2型糖尿病的先兆 糖尿病(T2 DM)及相关的心血管(CV)疾病和死亡率。为了解决这个公共卫生问题 负担，医疗保险和医疗补助服务中心颁布了联邦医疗保险糖尿病保险 2018年的预防计划(MDPP)。基于国家糖尿病预防计划(NDPP)，MDPP 是一种以证据为基础的(EB)生活方式干预，前景看好，但往往无法获得，而且 没有得到充分利用。缺乏访问和使用的原因仍未确定，迫切需要确定 计划供应商、老年人和医疗保健中的个人、组织和背景因素 影响MDPP可用性和使用的提供商。此R15 REAP应用程序的目标是 确定影响MDPP实施和使用的各种因素、流程、促进者和障碍； 同时提供了一个机会，以刺激杜肯大学的研究。在没有确定这些因素的情况下， 减少障碍和促进千年发展方案的促进者的执行战略不能轻易颁布。 我们将利用实施研究综合框架(CFIR)实现三个具体目标 指导MDPP的多层次、趋同的混合方法研究。目标1：确定感知的促进者 以及在全国方案供应商和较老的抽样中实施和使用MDPP的障碍 成年人。我们将对每个利益相关者群体进行约15次网络或电话采访：MDPP供应商、 NDPP供应商、MDPP参与者和符合条件的非参与者。我们还将管理一个既定的 对MDPP和NDPP供应商进行调查，以评估CFIR的内部设置。目标2：确定电流 MDPP供应商用来提高对MDPP的认识和招募老年人的做法和招聘策略 成年人。我们将首先管理基于Web的计划采用和实施战略要素 对全国80家MDPP供应商进行抽样调查，并确定哪些战略可产生最高的 上了年纪的人。目标3：确定促进或抑制转诊的个人和组织因素 在全国医疗保健提供者的样本中，有资格参加MDPP的老年人。我们将管理一个网络- 面向200名医生和高级实践的医疗保健提供者糖尿病前期调查的基础版本 供应商；我们还将采访供应商的一个子样本(约30个)，以收集深入的定性数据。数据来自 将使用CFIR作为指导框架，对目标1、目标2和目标3进行三角划分或整合。评选结果 拟议的研究对于制定多项执行干预措施至关重要 利益相关者团体，将MDPP扩展到有意义地减轻T2 DM和CV负担的水平 疾病。MDPP是第一个医疗保险覆盖的疾病预防计划，但覆盖范围还没有 永久的。确保MDPP的成功将为数百万高危老年人保留这一好处，并帮助 推动未来其他预防计划的支付者覆盖面。我们团队的长期目标是减少 通过促进EB干预措施的实施，减轻生活方式驱动的心血管疾病的负担。

PROJECT SUMMARY/ABSTRACT Nearly half of US adults age ≥ 65 (> 24 million) have prediabetes, which is often a precursor to type 2 diabetes mellitus (T2DM) and associated cardiovascular (CV) diseases and mortality. To address this public health burden, the Centers for Medicare and Medicaid Services enacted coverage of the Medicare Diabetes Prevention Program (MDPP) in 2018. Based on the National Diabetes Prevention Program (NDPP), the MDPP is an evidence-based (EB) lifestyle intervention that holds great promise, but is often unavailable and greatly underutilized. Reasons for lack of access and use remain unidentified, leaving a critical need to determine the individual, organizational, and contextual factors among program suppliers, older adults, and healthcare providers that are affecting MDPP availability and use. The objective for this R15 REAP application is to determine the diverse factors, processes, facilitators, and barriers affecting MDPP implementation and use, while providing an opportunity to stimulate research at Duquesne University. Without identifying these factors, implementation strategies to reduce barriers and promote facilitators of the MDPP cannot be readily enacted. We will pursue three specific aims using the Consolidated Framework for Implementation Research (CFIR) to guide a multi-level, convergent mixed methods investigation of the MDPP. Aim 1: Identify perceived facilitators and barriers to implementation and use of the MDPP in a national sample of program suppliers and older adults. We will conduct ~15 web-based or phone interviews with each stakeholder group: MDPP suppliers, NDPP suppliers, MDPP participants, and eligible non-participants. We will also administer an established survey to 64 MDPP and 64 NDPP suppliers to assess the Inner Setting of the CFIR. Aim 2: Determine current practices and recruitment strategies MDPP suppliers use to raise awareness of the MDPP and enroll older adults. We will first administer the Program Adoption and Implementation Strategies elements of a web-based survey to a national sample of 80 MDPP suppliers, and identify the strategies yielding the highest enrollment of older adults. Aim 3: Determine the individual and organizational factors promoting or inhibiting referral of eligible older adults to the MDPP among a national sample of healthcare providers. We will administer a web- based version of the Healthcare Provider Prediabetes Survey to 200 physicians and advanced practice providers; we will also interview a subsample of providers (~30) to gather in-depth qualitative data. Data from Aims 1, 2, and 3 will be triangulated, or integrated, using the CFIR as the guiding framework. Results of the proposed research are essential to inform the development of implementation interventions for multiple stakeholder groups, to scale the MDPP to a level that meaningfully reduces the burden of T2DM and CV disease. The MDPP is the first Medicare-covered disease prevention program, but coverage is not yet permanent. Ensuring success of the MDPP will preserve this benefit for millions of at-risk older adults and help drive payor coverage for other prevention programs in the future. Our team’s long-term goal is to reduce the burden of lifestyle-driven CV disease by facilitating implementation of EB interventions.