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

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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.