A Multi-Level Evaluation of California's New Medicaid Coverage for the Diabetes Prevention Program

对加州糖尿病预防计划新医疗补助覆盖范围的多层次评估

• 批准号: 10581381
• 负责人: OBIDIUGWU KENRIK, DURU
• 金额: $ 14.93万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-27 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10581381
• 关键词: Accounting; Address; Adult; Affect; Age; American; Amputation; Asian Americans; Award; Biometry; Black race; Blindness; Body Weight Changes; COVID-19; COVID-19 pandemic; California; Cardiovascular Diseases; Centers for Disease Control and Prevention (U.S.); Characteristics; Data; Development Plans; Diabetes Mellitus; Diabetes prevention; Economic Burden; Economics; Epidemiologic Methods; Evaluation; Exercise; Foundations; Funding; Goals; Health; Health Care Costs; Health Disparities Research; Health Insurance; Health system; Incidence; Insurance Coverage; Interruption; Intervention; Kidney Failure; Latino; Longitudinal cohort; Los Angeles; Low income; Lower Extremity; Medicaid; Medical; Mentored Research Scientist Development Award; Mentorship; Methods; Minority; Minority Groups; National Institute of Diabetes and Digestive and Kidney Diseases; Natural experiment; Non-Insulin-Dependent Diabetes Mellitus; Outcome; Outcome Study; Patients; Persons; Population; Prediabetes syndrome; Prevalence; Preventive healthcare; Quasi-experiment; Research; Research Methodology; Research Personnel; Resources; Retrospective cohort; Risk; Risk Factors; Risk Marker; Series; Shelter facility; Testing; Time; Training; Translational Research; United States; United States National Institutes of Health; Universities; Weight; Weight Gain; beneficiary; career; career development; demographics; design; diabetes prevention program; diabetes risk; disparity reduction; effectiveness evaluation; ethnic minority; experience; health care service; health disparity; high risk population; large datasets; pandemic disease; parent grant; patient population; programs; racial minority; rate of change; screening; skills; social; social health determinants; trend; uptake

PROJECT SUMMARY/ABSTRACT Type 2 diabetes (T2DM) is a leading cause of cardiovascular disease, blindness, lower extremity amputations and kidney failure in the United States, and disproportionately affects minority and low-income Americans. The Diabetes Prevention Program (DPP) effectively helps adults with prediabetes delay their progression to T2DM. However, the CDC-supported national DPP expansion has had low uptake among racial and ethnic minority and low-income adults, who are disproportionally affected by T2DM. In 2019, California legislators passed Senate Bill 97, which expanded the DPP to include Medi-Cal (California-specific Medicaid) beneficiaries. The parent grant (R18DK122372) aims to evaluate the effectiveness of this expansion on diabetes risk markers (e.g., weight change) by utilizing a large longitudinal cohort of Medi-Cal adults from Kaiser Permanente Northern California (KPNC) and the University of California, Los Angeles (UCLA), two large health systems with diverse patient populations. The results of the parent grant's main outcomes however may be modified by the coronavirus disease 2019 (COVID-19) pandemic. The mandated shelter-in-place orders, economic shut downs and pandemic-related restrictions have resulted in a decrease in exercise and increased weight gain, along with a decrease in utilization of preventive health care services. However, it is unclear the extent to which these changes disproportionally affected Medi-Cal beneficiaries, who have been hard hit by the pandemic. Leveraging three years of longitudinal data (1/1/19-12/31/21), the primary objective of this diversity supplement is to assess the extent to which the COVID-19 pandemic exacerbated disparities in T2DM prevention and outcomes between the Medi-Cal and commercially-insured populations. The career development plan for this diversity supplement will provide the candidate with high-quality mentorship from experts in T2DM prevention, health disparities, biostatistics and evaluation of natural experiments. Aligned with this plan and using the R18 parent grant retrospective cohort, the research goals of the proposed diversity supplement are to: 1) examine differential rates of T2DM screening among California adults following the COVID-19 pandemic, by insurance status (Medi-Cal vs. commercial) and demographics; 2) examine differential changes in T2DM risk factors (exercise and weight) among California adults following the COVID- 19 pandemic, by insurance status (Medi-Cal vs. commercial) and demographics; and 3) accounting for changes in screening rates, examine differential changes in T2DM incidence rate among California adults following the COVID-19 pandemic, by insurance status (Medi-Cal vs. commercial) and demographics. Understanding how Medi-Cal beneficiaries were disproportionally affected is important for allocating limited resources (including DPP) and targeted interventions. Furthermore, the mentorship, career development and scientific skills gained during this diversity supplement will advance the candidate towards independence working at the intersection of T2DM prevention and health disparities, with a focus on minority populations.

项目摘要/摘要 2型糖尿病（T2DM）是心血管疾病，失明，下肢截肢的主要原因 在美国，肾衰竭会影响少数群体和低收入美国人。这 糖尿病预防计划（DPP）有效地帮助糖尿病前期的成年人延迟其发展为T2DM。 但是，疾病预防控制中心支持的国家DPP扩展的种族和少数民族的吸收率很低 和低收入成年人，受T2DM影响不成比例。 2019年，加利福尼亚州立法者通过了 参议院第97号法案，该法案将DPP扩大到包括Medi-Cal（加利福尼亚州特定医疗补助）受益人。这 家长赠款（R18DK122372）旨在评估这种扩张对糖尿病风险标志的有效性 （例如，体重变化）通过利用来自Kaiser Permanente的大型Medi-Cal成年人的纵向队列 北加州（KPNC）和加利福尼亚大学洛杉矶分校（UCLA），两个大型卫生系统 患者人数多样化。但是，父母赠款的主要结果的结果可能会通过 2019年冠状病毒病（Covid-19）大流行。实地命令，经济关闭 跌倒和与大流行有关的限制导致运动减少和体重增加， 随着预防保健服务的利用降低。但是，目前尚不清楚 这些变化对中的基础受益者的影响不成比例，他们受到了 大流行。利用三年的纵向数据（1/1/19-12/31/21），这是该多样性的主要目标 补充是评估Covid-19-19大流行加剧T2DM的差异的程度 预防和商业保险人群之间的预防和结果。职业 这种多样性补充的发展计划将为候选人提供高质量的指导 T2DM预防，健康差异，生物统计学和自然实验评估的专家。与 该计划并使用R18父母赠款回顾群体，拟议多样性的研究目标 补充是：1）检查加利福尼亚成年人对T2DM筛查的差异率 COVID-19-19大流行，按保险状况（Medi-Cal与商业）和人口统计数据； 2）检查 加利福尼亚州成年人的T2DM风险因素（运动和体重）的差异变化 - 19大流行，按保险状况（Medi-Cal vs.商业）和人口统计数据； 3）会计 筛选率的变化，检查加利福尼亚成年人T2DM发病率的差异变化 遵循共同的19日大流行，按保险状态（Medi-Cal与商业）和人口统计数据进行。 了解Medi-Cal受益人如何受到过分影响对于分配有限很重要 资源（包括DPP）和有针对性的干预措施。此外，指导，职业发展和 在这种多样性补充期间获得的科学技能将使候选人迈向独立 在T2DM预防和健康差异的交集中工作，重点是少数群体。