PDF(Pubmed)
Abstract：
BACKGROUND: Diabetes is a costly epidemic in the United States associated with both health and economic consequences. These consequences can be mitigated by participation in structured lifestyle change programs such as the National Diabetes Prevention Program (DPP) led by the Centers for Disease Control and Prevention. Mississippi consistently has among the highest rates of diabetes and prediabetes nationally. Implementing the National DPP through large health care systems can increase reach and accessibility for populations at the highest risk for diabetes. Translational research on the National DPP in Mississippi has not been studied.
OBJECTIVE: This study aims to evaluate the implementation and impact of the National DPP delivered using telehealth modalities at the University of Mississippi Medical Center in Jackson, Mississippi.
METHODS: An effectiveness-implementation hybrid type III research design is proposed. The study design is guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework and the Practical, Robust Implementation and Sustainability Model. Participants are being recruited via provider referral, and the DPP is being delivered by trained lifestyle coaches. Study participants include adult (≥18 years) patients eligible for the DPP with at least 1 encounter at 1 of 3 ambulatory clinic specialties (lifestyle medicine, family medicine, and internal medicine) between January 2019 and December 2023. The National DPP eligibility criteria include a BMI ≥25 kg/m2 and hemoglobin A1c between 5.7% and 6.4%. The University of Mississippi Medical Center criteria include Medicare or Medicaid beneficiaries. The University of Mississippi Medical Center\'s a priori implementation plan was developed using the Consolidated Framework for Implementation Research and includes 23 discrete strategies. The primary aim will use an embedded mixed method process analysis to identify and mitigate challenges to implementation. The secondary aim will use a nonrandomized quasi-experimental design to assess the comparative effectiveness of the DPP on health care expenditures. A propensity score matching method will be implemented to compare case subjects to control subjects. The primary outcomes include patient referrals, participant enrollment, retention, engagement, the incidence of diabetes, and health care resource use and costs.
RESULTS: At baseline, of the 26,151 patients across 3 ambulatory clinic specialties, 1010 (3.9%) had prediabetes and were eligible for the National DPP. Of the 1010 patients, more than half (n=562, 55.6%) were aged 65 years or older, 79.5% (n=803) were Medicare beneficiaries, 65.9% (n=666) were female, and 70.8% (n=715) were obese.
CONCLUSIONS: This is the first translational study of the National DPP in Mississippi. The findings will inform implementation strategies impacting the uptake and sustainability of the National DPP delivered in an academic medical setting using distance learning and telehealth modalities.
BACKGROUND: ClinicalTrials.gov NCT04822480; https://clinicaltrials.gov/study/NCT03622580.
UNASSIGNED: DERR1-10.2196/50183.
OBJECTIVE: This study aims to evaluate the implementation and impact of the National DPP delivered using telehealth modalities at the University of Mississippi Medical Center in Jackson, Mississippi.
METHODS: An effectiveness-implementation hybrid type III research design is proposed. The study design is guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework and the Practical, Robust Implementation and Sustainability Model. Participants are being recruited via provider referral, and the DPP is being delivered by trained lifestyle coaches. Study participants include adult (≥18 years) patients eligible for the DPP with at least 1 encounter at 1 of 3 ambulatory clinic specialties (lifestyle medicine, family medicine, and internal medicine) between January 2019 and December 2023. The National DPP eligibility criteria include a BMI ≥25 kg/m2 and hemoglobin A1c between 5.7% and 6.4%. The University of Mississippi Medical Center criteria include Medicare or Medicaid beneficiaries. The University of Mississippi Medical Center\'s a priori implementation plan was developed using the Consolidated Framework for Implementation Research and includes 23 discrete strategies. The primary aim will use an embedded mixed method process analysis to identify and mitigate challenges to implementation. The secondary aim will use a nonrandomized quasi-experimental design to assess the comparative effectiveness of the DPP on health care expenditures. A propensity score matching method will be implemented to compare case subjects to control subjects. The primary outcomes include patient referrals, participant enrollment, retention, engagement, the incidence of diabetes, and health care resource use and costs.
RESULTS: At baseline, of the 26,151 patients across 3 ambulatory clinic specialties, 1010 (3.9%) had prediabetes and were eligible for the National DPP. Of the 1010 patients, more than half (n=562, 55.6%) were aged 65 years or older, 79.5% (n=803) were Medicare beneficiaries, 65.9% (n=666) were female, and 70.8% (n=715) were obese.
CONCLUSIONS: This is the first translational study of the National DPP in Mississippi. The findings will inform implementation strategies impacting the uptake and sustainability of the National DPP delivered in an academic medical setting using distance learning and telehealth modalities.
BACKGROUND: ClinicalTrials.gov NCT04822480; https://clinicaltrials.gov/study/NCT03622580.
UNASSIGNED: DERR1-10.2196/50183.
摘要：
背景：糖尿病在美国是一种昂贵的流行病，与健康和经济后果有关。这些后果可以通过参与结构化的生活方式改变计划来减轻，例如由疾病控制和预防中心领导的国家糖尿病预防计划（DPP）。密西西比州一直是全国糖尿病和前驱糖尿病发病率最高的国家之一。通过大型医疗保健系统实施国家DPP可以增加糖尿病风险最高的人群的覆盖面和可及性。尚未对密西西比州国家民进党的转化研究进行研究。
目的：本研究旨在评估杰克逊的密西西比大学医学中心使用远程医疗模式提供的国家DPP的实施和影响。密西西比州。
方法：提出了一种有效性-实施混合的III型研究设计。研究设计由Reach指导，有效性,收养,实施,和维护框架和实践，稳健的实施和可持续性模型。参与者是通过提供者转介招募的，DPP由训练有素的生活方式教练提供。研究参与者包括符合DPP条件的成人（≥18岁）患者，在3个门诊诊所专业（生活方式医学，家庭医学,和内科）在2019年1月至2023年12月之间。国家DPP资格标准包括BMI≥25kg/m2和血红蛋白A1c在5.7％至6.4％之间。密西西比大学医学中心标准包括医疗保险或医疗补助受益人。密西西比大学医学中心的先验实施计划是使用实施研究综合框架制定的，包括23个离散策略。主要目标将使用嵌入式混合方法过程分析来识别和减轻实施挑战。次要目标将使用非随机准实验设计来评估DPP对医疗保健支出的比较有效性。将实施倾向评分匹配方法以将病例受试者与对照受试者进行比较。主要结果包括患者转诊，参与者注册，保留,订婚,糖尿病的发病率，以及医疗保健资源的使用和成本。
结果：在基线时，在3个门诊诊所的26151名患者中，1010（3.9％）患有糖尿病前期，符合国家DPP的资格。1010名患者中,超过一半(n=562，55.6%)年龄在65岁或以上，79.5%(n=803)是医疗保险受益人，65.9%(n=666)为女性，70.8%(n=715)为肥胖。
结论：这是密西西比州国家DPP的首次转化研究。研究结果将为实施策略提供信息，这些策略会影响在学术医学环境中使用远程学习和远程医疗模式交付的国家DPP的吸收和可持续性。
背景：ClinicalTrials.govNCT04822480;https://clinicaltrials.gov/study/NCT03622580。
■DERR1-10.2196/50183。
目的：本研究旨在评估杰克逊的密西西比大学医学中心使用远程医疗模式提供的国家DPP的实施和影响。密西西比州。
方法：提出了一种有效性-实施混合的III型研究设计。研究设计由Reach指导，有效性,收养,实施,和维护框架和实践，稳健的实施和可持续性模型。参与者是通过提供者转介招募的，DPP由训练有素的生活方式教练提供。研究参与者包括符合DPP条件的成人（≥18岁）患者，在3个门诊诊所专业（生活方式医学，家庭医学,和内科）在2019年1月至2023年12月之间。国家DPP资格标准包括BMI≥25kg/m2和血红蛋白A1c在5.7％至6.4％之间。密西西比大学医学中心标准包括医疗保险或医疗补助受益人。密西西比大学医学中心的先验实施计划是使用实施研究综合框架制定的，包括23个离散策略。主要目标将使用嵌入式混合方法过程分析来识别和减轻实施挑战。次要目标将使用非随机准实验设计来评估DPP对医疗保健支出的比较有效性。将实施倾向评分匹配方法以将病例受试者与对照受试者进行比较。主要结果包括患者转诊，参与者注册，保留,订婚,糖尿病的发病率，以及医疗保健资源的使用和成本。
结果：在基线时，在3个门诊诊所的26151名患者中，1010（3.9％）患有糖尿病前期，符合国家DPP的资格。1010名患者中,超过一半(n=562，55.6%)年龄在65岁或以上，79.5%(n=803)是医疗保险受益人，65.9%(n=666)为女性，70.8%(n=715)为肥胖。
结论：这是密西西比州国家DPP的首次转化研究。研究结果将为实施策略提供信息，这些策略会影响在学术医学环境中使用远程学习和远程医疗模式交付的国家DPP的吸收和可持续性。
背景：ClinicalTrials.govNCT04822480;https://clinicaltrials.gov/study/NCT03622580。
■DERR1-10.2196/50183。
