Effectiveness of a National Health Care Community Partnership to Prevent Diabetes

目前，超过6000万美国人患有前驱糖尿病，据估计，这些人中几乎有四分之一可能在未来5至7年内发展为糖尿病。糖尿病预防计划（DPP）表明，强化的生活方式干预导致适度的体重减轻和增加体力活动可以延迟或预防糖尿病前期成人2型糖尿病的发展。不幸的是，DPP生活方式干预最初并不是为公共卫生规模的交付而设计的，而且自从DPP的结果在9年前首次发布以来，这种干预的成本和强度已经推迟了这种方法的被动传播。然而，我们在印第安纳州大学的小组最近的研究表明，由受过训练的基督教青年会员工提供基于小组的适应DPP生活方式干预，可以实现类似于DPP的体重减轻和行为改变，但成本仅为DPP的1/8。现在，通过联合健康集团（UHG）和美国基督教青年会（YMCA）的新伙伴关系，正在积极努力扩大这种模式在全国范围内提供DPP。在这次令人兴奋的合作中，UHG将为雇主团体和其他医疗保健购买者提供新的行政服务，帮助识别患有糖尿病前期的成年人，接触这些高风险人群，并协助他们参加基督教青年会的团体DPP干预计划。然后，UHG将管理一个价值驱动的支付系统，以基督教青年会为基础，参与和减肥的水平实现了每个高风险的人谁是登记。虽然这不足以作为在人口规模上解决糖尿病预防和控制问题的唯一手段，但这种新的伙伴关系创造了一个令人兴奋的机会，可以通过涉及大型商业健康支付者和领先社区组织的努力，评估在全国范围内提供DPP的可推广方式的可行性和可持续性。在UnitedHealth Group和YMCA的大力支持下，我们建议为美国多个地区的数万名高风险成年人评估这些努力的范围、实施、成本、有效性和维护情况。我们亦会收集有关体重管理及长期疾病预防服务的诱因及收费资料。通过这些努力，我们希望更多地了解影响这一新计划的覆盖面和有效性的因素，因为不同UHG市场的支付结构各不相同，我们还希望确定交付模式或福利结构随着时间的推移如何变化可能有助于提高更多雇主群体的覆盖面，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种合作预防策略具有成本效益和可持续性，这些结果将对及时传播全国范围内预防2型糖尿病的重要新组成部分至关重要，这些新组成部分目前已经有6000多万美国人患有糖尿病前期。

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.