Effectiveness of a National Health Care Community Partnership to Prevent Diabetes

描述(由申请人提供)：项目摘要今天，超过6000万美国人患有糖尿病前期，据估计，其中近四分之一的人可能在未来5到7年内患上糖尿病。糖尿病预防计划(DPP)表明，密集的生活方式干预可以适度减肥和增加体力活动，可以延缓或预防患有糖尿病前期的成年人患2型糖尿病。不幸的是，民进党的生活方式干预最初并不是为公共卫生规模的服务而设计的，自从民进党在大约9年前首次发布结果以来，这种干预的成本和强度推迟了这种方法的任何被动传播。然而，我们在印第安纳大学的团队最近的研究表明，由训练有素的基督教青年会员工提供基于群体的DPP生活方式干预可以实现与DPP类似的减肥和行为改变，但成本仅为DPP的八分之一左右。现在，通过UnitedHealth Group(UHG)和美国基督教青年会的新合作伙伴关系，正在积极努力将这种模式推广到全国范围内的DPP交付。在这一激动人心的合作中，UHG将为雇主团体和其他健康购买者提供一项新的行政服务，帮助识别患有糖尿病前期的成年人，接触这些高危人群，并帮助他们登记参加基督教青年会以团体为基础的DPP干预计划。然后，UHG将根据每个登记的高风险人士的参与程度和体重减轻程度，管理一个向基督教青年会支付价值驱动的系统。虽然这不足以作为在人口规模上解决糖尿病预防和控制的唯一手段，但这一新的合作伙伴关系创造了一个令人兴奋的机会，通过涉及大型商业医疗保健付款人和领先的社区组织的努力，评估在全国范围内提供DPP的普遍方式的可行性和可持续性。在UnitedHealth Group和YMCA的大力支持下，我们建议评估这些努力的覆盖范围、实施、成本、有效性和维护，以帮助全美多个地区的数万名高危成年人。通过对大型雇主的全国性调查，我们还将收集有关体重控制和慢性病预防服务的激励和支付方面的信息。通过这些努力，我们希望更多地了解影响这一新计划覆盖范围和有效性的因素，因为不同UHG市场的支付结构不同，我们也希望确定随着时间的推移，交付模式或福利结构的变化如何有助于扩大对更多雇主群体的覆盖范围，并提高更多个人的参与和减肥成功率。如果我们的评估发现这一伙伴预防战略具有成本效益和可持续性，这些结果将对及时向6000多万目前已经患有前驱糖尿病的美国人传播全国预防2型糖尿病努力的重要新组成部分至关重要。

DESCRIPTION (provided by applicant): Project Abstract Today over 60 million Americans have prediabetes, and it is estimated that almost one quarter of these individuals could develop diabetes within the next 5 to 7 years. The Diabetes Prevention Program (DPP) demonstrated that an intensive lifestyle intervention resulting in modest weight loss and increased physical activity can delay or prevent the development of type 2 diabetes for adults with prediabetes. Unfortunately, the DPP lifestyle intervention was not initially designed for delivery on a public health scale, and the costs and intensity of this intervention have delayed any passive dissemination of this approach since the DPP's results were first released some 9 years ago. However, recent studies by our group at Indiana University have demonstrated that delivery of a group-based adaptation of the DPP lifestyle intervention by trained YMCA employees can achieve weight loss and behavioral changes similar to the DPP but for only about 1/8 the cost. Now, through a new partnership involving UnitedHealth Group (UHG) and the YMCA of USA, efforts are actively underway to scale this model for DPP delivery nationally. In this exciting collaboration, UHG will provide a new administrative service for employer groups and other health purchasers that will help to identify adults with pre-diabetes, reach out to these high risk persons, and assist them in enrolling in the YMCA's group-based DPP intervention program. UHG will then manage a system of value-driven payments to the YMCA, based on levels of participation and weight loss achieved by each high risk person who is enrolled. Although this will not suffice as the only means for addressing the prevention and control of diabetes on a population scale, this new partnership creates an exciting opportunity to evaluate the feasibility and sustainability of a generalizable way for delivering the DPP nationally through efforts that involve a large commercial health payer and a leading community organization. With the strong support of both UnitedHealth Group and the YMCA to provide extensive and ongoing access to several administrative data sources, we propose to evaluate the reach, implementation, costs, effectiveness, and maintenance of these efforts for tens of thousands of high risk adults in multiple regions throughout the U.S. Through a national survey of large employers, we will also collect information regarding incentives and payment for weight management and chronic disease prevention services. Through these efforts, we hope to understand more about the factors that impact reach and effectiveness of this new program as the structure of payment varies across different UHG markets, and we also hope to identify how changes in the delivery model or benefit structure over time might help to enhance reach to more employer groups and to improve participation and weight loss success for more individuals. Should our evaluation find this partnered prevention strategy to be cost- effective and sustainable, these results will be pivotal to the timely dissemination of an important new component of nationwide efforts to prevent type 2 diabetes among over 60 million Americans who already have prediabetes today.