Assessing Barriers and Facilitators for Participating Structured Lifestyle Intervention and its Real-world Effectiveness and Cost-Effectiveness among US Veterans

评估美国退伍军人参与结构化生活方式干预的障碍和促进因素及其现实世界的有效性和成本效益

• 批准号: 10554732
• 负责人: LAWRENCE S PHILLIPS
• 金额: $ 57万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10554732
• 关键词: Assessing; Barriers; Facilitators; Participating; Structured

Project Summary The US Diabetes Prevention Program (DPP) has shown that a structured lifestyle intervention (SLI) can prevent or delay progression to type 2 diabetes (T2D). In 2010, Congress authorized CDC to establish and manage DPP-like SLI programs nationwide through the National DPP (NDPP), and these programs soon expanded to Medicare in 2016. However, the enrollment and completion rates of existing NDPPs were significantly lower than observed in the original DPP study, especially in minority groups. Barriers and facilitators that determine the individuals’ NDPP enrollment and completion remain unclear. Also, studies assessing the long-term effectiveness of NDPP in reducing cardiovascular disease (CVD) risk factors and incident T2D were lacking. The cost-effectiveness of NDPP in the overall enrollees and enrollee subgroups was also unknown. Filling these knowledge gaps is critical to improving the implementation of NDPP. The Veterans Health Administration (VA) MOVE! program is the largest DPP-like SLI program in the US. The program was initiated in 2005 with a curriculum developed based on the original US DPP trial and CDC’s NDPP curriculum. We have already established a large longitudinal cohort of MOVE! program enrollees (N=50,000) with electronic health records (EHR) and linked insurance claims data and the MOVE! program providers' data with a follow-up length of up to 15 years. Through this unique data source, combined with one of the most advanced diabetes microsimulation models in the US --the BRAVO diabetes model, developed by our group, we will identify barriers and facilitators to the enrollment and completion of the MOVE! program, and evaluate its long-term effectiveness and cost-effectiveness. The specific aims of the proposed study are: 1) Aim 1: Assess barriers and facilitators of enrollment and completion of MOVE! program; 2) Aim 2: Assess the long-term effectiveness of the MOVE! program; 3) Aim 3: Evaluate the long-term economic impact and cost-effectiveness of the MOVE! program. By achieving all three aims, we will be able to identify the most effective and cost-effective strategy to implement and expand the NDPP in the US. The proposed research is significant because it will fill the critical knowledge gaps in implementing the NDPP in the US. The Veteran population is a unique population and a vital piece to this nationwide NDPP research network. This study is innovative because our large SLI cohort with EHR-claims-linked data will allow us to apply cutting-edge ML methods and simulation models to tackle a series of challenging research questions.

项目概要 美国糖尿病预防计划 (DPP) 表明，结构化生活方式干预 (SLI) 可以 预防或延缓进展为 2 型糖尿病 (T2D) 2010 年，国会授权 CDC 建立和预防 2 型糖尿病 (T2D)。 通过国家民进党 (NDPP) 在全国范围内管理类似民进党的 SLI 计划，这些计划很快就会实现 2016 年扩展到医疗保险。然而，现有 NDPP 的入学率和完成率 低于最初 DPP 研究中观察到的情况，特别是在少数群体中。 决定个人 NDPP 入学和完成情况的促进者也仍不清楚。 评估 NDPP 在减少心血管疾病 (CVD) 危险因素方面的长期有效性，以及 NDPP 在总体参与者和参与者亚组中缺乏成本效益。 填补这些知识空白对于改进 NDPP 的实施至关重要。 退伍军人健康管理局 (VA) MOVE! 计划是美国最大的类似 DPP 的 SLI 计划。 该计划于 2005 年启动，课程根据美国 DPP 的原始试验和 CDC 的 NDPP 课程。我们已经建立了一个庞大的 MOVE 计划参与者纵向队列。 (N=50,000) 具有电子健康记录 (EHR) 和链接的保险索赔数据以及 MOVE! 通过这一独特的数据源，结合一个跟踪时间长达 15 年的提供商数据。 美国最先进的糖尿病微模拟模型——BRAVO糖尿病模型，由 我们的团队，我们将确定注册和完成 MOVE! 计划的障碍和促进因素，以及 评估其长期有效性和成本效益。 拟议研究的具体目标是： 1) 目标 1：评估入学的障碍和促进因素 并完成 MOVE! 计划；2) 目标 2：评估 MOVE! 的长期有效性 计划；3) 目标 3：评估 MOVE! 的长期经济影响和成本效益 通过实现所有三个目标，我们将能够确定最有效和最具成本效益的策略。 在美国实施和扩大 NDPP。 拟议的研究意义重大，因为它将填补实施 NDPP 的关键知识空白 在美国，退伍军人群体是一个独特的群体，也是全国 NDPP 研究的重要组成部分。 这项研究具有创新性，因为我们拥有 EHR 索赔相关数据的大型 SLI 队列将使我们能够 应用尖端的机器学习方法和模拟模型来解决一系列具有挑战性的研究问题。