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

项目摘要/摘要 2型糖尿病(T2 DM)是心血管疾病、失明、下肢截肢的主要原因 和肾衰竭在美国，并不成比例地影响少数族裔和低收入美国人。这个 糖尿病预防计划(DPP)有效地帮助患有糖尿病前期的成年人延缓进展为T2 DM。 然而，疾控中心支持的全国民进党扩张在种族和少数民族中的接受率很低 以及低收入成年人，他们不成比例地受到T2 DM的影响。2019年，加利福尼亚州立法者通过 参议院法案97，该法案扩大了DPP，将Medi-Cal(加州特有的医疗补助)受益人包括在内。这个 Parent Grant(R18DK122372)旨在评估这种扩展对糖尿病风险标记物的有效性 (例如，体重变化)通过利用来自Kaiser Permanente的大量Medi-Cal成人纵向队列 北加州大学(KPNC)和加州大学洛杉矶分校(UCLA)这两个大型医疗系统 有不同的患者群体。然而，父母赠款的主要结果可能会被修改 冠状病毒病2019年(新冠肺炎)大流行。强制要求的原地避难所命令，经济关闭 减重和大流行相关的限制导致运动量减少，体重增加， 同时，预防性保健服务的使用率也在下降。然而，目前还不清楚在多大程度上 这些变化不成比例地影响了Medi-Cal受益人，他们受到了 大流行。利用三年的纵向数据(1/1/19-12/31/21)，这种多样性的主要目标 补充内容是评估新冠肺炎大流行在多大程度上加剧了T2 DM的差异 中东和商业保险人群之间的预防和结果。职业生涯 这一多样性补充的发展计划将为候选人提供高质量的指导 T2 DM预防、健康差距、生物统计学和自然实验评估方面的专家。与以下各项保持一致 本计划并采用R18父母资助回溯队列，提出多样性的研究目标 补充内容是：1)检查加州成年人中T2 DM筛查的不同比率 新冠肺炎大流行，按保险状况(中东和商业)和人口统计数据；2)检查 COVID后加州成年人中T2 DM危险因素(运动和体重)的差异变化- 19大流行，按保险状况(Medi-Cal与商业)和人口结构分列；以及3)占 筛查率的变化，检查加州成年人中T2 DM发病率的差异变化 新冠肺炎大流行后，按保险状况(中东和加勒比地区与商业)和人口结构分列。 了解Medi-Cal受益者如何受到不成比例的影响对于分配有限的 资源(包括民进党)和有针对性的干预。此外，导师、职业发展和 在这种多样性补充中获得的科学技能将使候选人走向独立 在T2 DM预防和健康差距的交叉点工作，重点是少数群体。

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.