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

项目总结/摘要 近一半年龄≥ 65岁的美国成年人（> 2400万）患有前驱糖尿病，这通常是2型糖尿病的前兆 糖尿病（T2 DM）和相关心血管（CV）疾病和死亡率。为了解决这个公共卫生问题 为了减轻负担，医疗保险和医疗补助服务中心颁布了医疗保险糖尿病保险 2018年的预防计划（MDPP）。根据国家糖尿病预防计划（NDPP），MDPP 是一种循证（EB）的生活方式干预，具有很大的希望，但往往是不可用的， 利用不足。无法获得和使用的原因仍未查明，因此迫切需要确定 计划提供者、老年人和医疗保健之间的个人、组织和背景因素 影响MDPP可用性和使用的提供商。此R15 REAP应用程序的目标是 确定影响MDPP实施和使用的各种因素、过程、促进因素和障碍， 同时也为迪克讷大学的研究提供了机会。如果不确定这些因素， 减少千年发展目标方案障碍和促进促进者的实施战略不能轻易颁布。 我们将利用实施研究综合框架实现三个具体目标， 引导MDPP的多层次、融合的混合方法调查。目标1：识别感知的促进者 以及在计划供应商和较老的国家样本中实施和使用MDPP的障碍 成年人了我们将对每个利益相关者群体进行约15次基于网络或电话的访谈：MDPP供应商， NDPP供应商、MDPP参与者和合格的非参与者。我们亦会管理一个既有的 对64家MDPP和64家NDPP供应商进行调查，以评估CFIR的内部设置。目标2：确定电流 MDPP供应商用于提高MDPP意识和招募老年人的做法和招募策略 成年人了我们将首先管理基于网络的 对全国80家MDPP供应商进行抽样调查，并确定注册率最高的策略， 老年人目标3：确定促进或抑制转诊的个人和组织因素 在医疗保健提供者的全国样本中，有资格参加MDPP的老年人。我们将管理一个网络- 基于版本的医疗保健提供者糖尿病前期调查，200名医生和先进的实践 提供者;我们还将采访提供者的子样本（约30），以收集深入的定性数据。数据从 目标1、2和3将以CFIR为指导框架进行三角测量或整合。结果 拟议的研究对于为多种实施干预措施的制定提供信息至关重要。 利益相关者团体，将MDPP扩展到有意义地降低T2 DM和CV负担的水平 疾病MDPP是第一个医疗保险覆盖的疾病预防计划，但覆盖范围尚未扩大。 永久的确保MDPP的成功将为数百万处于风险中的老年人保留这一益处， 推动未来其他预防计划的支付者覆盖率。我们团队的长期目标是减少 通过促进EB干预措施的实施，减轻生活方式驱动的CV疾病负担。

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.