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

测试远程医疗：评估使用远程医疗来增加基于雇主的糖尿病预防计划的人群影响

• 批准号: 10254280
• 负责人: Rosette J Chakkalakal
• 金额: $ 15.14万
• 依托单位: VANDERBILT UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-15 至 2022-05-10
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10254280
• 关键词: Academic Medical Centers; Address; Adult; Affect; Award; Behavioral; Body Weight decreased; Cellular Phone; Centers for Disease Control and Prevention (U.S.); Communication; Computers; Data; Diabetes prevention; Dimensions; Effectiveness; Employee; Enrollment; Evaluation; Evaluation Research; Feedback; Goals; Group Structure; Health; Health Promotion; Healthcare; Incentives; Insurance Carriers; Interview; Location; Methods; Modality; Modeling; Motivation; Obesity; Outcome; Participant; Persons; Policies; Population; Productivity; Program Evaluation; Public Health; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Research; Social support; Source; Subgroup; Tablets; Teleconferences; Testing; Time; United States Centers for Medicare and Medicaid Services; Universities; Weight; Weight maintenance regimen; Wellness Program; Workplace; base; compare effectiveness; cost; diabetes prevention program; evaluation/testing; evidence base; financial incentive; implementation outcomes; implementation strategy; improved; prevent; primary outcome; programs; skills; telehealth; virtual

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.

项目摘要 超过60个雇主和保险公司现在提供疾病控制和预防中心（CDC） 国家糖尿病预防计划（DPP）作为一个基于证据的体重管理计划， 员工健康加，工作场所健康部门的范德比尔特健康和健康，开始提供 DPP在2014年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 大学医学中心（VUMC）。DPP的目标是让参与者减掉5%的基线体重 在为期一年的项目结束之前。2014-2017年，健康加DPP（HP-DPP） 达到这一目标的参与者超过了国家DPP指标（43.6%的HP-DPP参与者对35.5%的 全国DPP参与者），该计划获得了CDC糖尿病中心的充分认可 预防识别方案。然而，对潜在和实际参与HP-DPP的情况进行比较表明， 许多可能从这个高效的计划中受益的员工并没有参与其中。 由于地点、时间不方便，工作场所健康计划和DPP通常受到限制 限制、激励不足和保密问题。从HP-DPP参与者收集的反馈 从2014年至2017年建议需要在VU/VUMC主校区亲自参加 该计划是其在此期间达到的关键障碍。然而，该方案的组结构是 被认为是支持和激励的关键来源。提高高效HP-DPP的覆盖范围，同时 为了保持小组结构的优势，惠普-DPP引入了视频电话会议（VTC）小组 （远程医疗）参与选项。虽然疾病预防控制中心赞同使用远程保健作为一个民进党 实施战略，很少有研究比较了远程保健和亲自交付的有效性 实现减肥的平台。没有研究比较了VTC和面对面的减肥结果 职业训练局组别只透过网上互动参与的DPP组别。医疗保险中心和 医疗补助服务（CMS）最近决定不报销利用远程医疗平台进行计划的DPP 交付，而无需进一步测试和评估虚拟DPP。因此，需要研究来指导使用 远程保健作为一项DPP执行战略，在地方和国家两级都具有相关性。该项目将 从RE-AIM的覆盖范围、有效性和实施维度对HP-DPP进行评估 （1）比较HP-DPP之前与之后的范围、有效性和实施情况， （2）比较职业训练局与 在人的HP-DPP组在“之后”的时期，和（3）探索差异的原因， 与纳入职训局参与有关的HP-DPP的成效和/或实施情况 选择使用深度访谈。这项评估的结果将直接为扩大覆盖面的努力提供信息。 以及DPP在工作场所内外的公共卫生影响。