Putting Telehealth to the Test: An Evaluation of the Use of Telehealth to Increase the Population-Level Impact of an Employer-Based Diabetes Prevention Program

测试远程医疗：评估使用远程医疗来增加基于雇主的糖尿病预防计划的人群影响

• 批准号: 10456167
• 负责人: Rosette J Chakkalakal
• 金额: $ 38.69万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-05-12 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10456167
• 关键词: Academic Medical Centers; Address; Adult; Affect; Award; Behavioral; Body Weight decreased; Cellular Phone; Centers for Disease Control and Prevention (U.S.); Communication; Computers; Data; Diabetes prevention; Dimensions; Effectiveness; Employee; Enrollment; Evaluation; Evaluation Research; Feedback; Goals; Group Structure; Health; Health Promotion; Healthcare; Incentives; Insurance Carriers; Interview; Location; Methods; Modality; Modeling; Motivation; Obesity; Outcome; Participant; Persons; Policies; Population; Productivity; Program Evaluation; Public Health; Reach Effectiveness Adoption Implementation and Maintenance; Research; Social support; Source; Subgroup; Tablets; Teleconferences; Testing; Time; United States Centers for Medicare and Medicaid Services; Universities; Weight; Weight maintenance regimen; Wellness Program; Workplace; base; compare effectiveness; cost; diabetes prevention program; evaluation/testing; evidence base; financial incentive; implementation outcomes; implementation strategy; improved; prevent; primary outcome; programs; skills; telehealth; virtual; virtual assessment

PROJECT SUMMARY More than 60 employers and insurers now offer the Centers for Disease Control and Prevention (CDC) National Diabetes Prevention Program (DPP) as an evidence-based weight management program for employees. Health Plus, the workplace wellness division of Vanderbilt Health and Wellness, began offering the DPP in 2014 as a benefit to the approximately 25,000 employees of Vanderbilt University (VU) and Vanderbilt University Medical Center (VUMC). The goal of the DPP is for participants to lose 5% of their baseline weight by the end of the year-long program. From 2014-2017, the proportion of Health Plus DPP (HP-DPP) participants achieving this goal exceeded National DPP metrics (43.6% of HP-DPP participants versus 35.5% of DPP participants nationwide) and the program earned full recognition status from the CDC Diabetes Prevention Recognition Program. Yet comparisons of potential and actual participation in the HP-DPP suggest many employees likely to benefit from this highly effective program are not participating in it. Program reach is often limited for both worksite wellness programs and DPPs because of inconvenient locations, time limitations, insufficient incentives, and confidentiality concerns. Feedback collected from HP-DPP participants from 2014-2017 suggests the need to meet in person on the VU/VUMC main campus to participate in the program was a key barrier to its reach during this interval. However, the group structure of the program was noted to be a key source of support and motivation. To improve the reach of the highly effective HP-DPP while maintaining the benefits of its group structure, the HP-DPP introduced a video-teleconference (VTC) group (telehealth) participation option in 2018. Although the CDC endorses the use of telehealth as a DPP implementation strategy, few studies have compared the effectiveness of telehealth and in-person delivery platforms for achieving weight loss. No studies have compared weight loss outcomes for VTC and in-person DPP groups in which the VTC group participates solely via online interactions. The Centers for Medicare and Medicaid Services (CMS) recently decided not to reimburse DPPs utilizing a telehealth platform for program delivery without further testing and evaluation of virtual DPPs. Thus, the need for research to guide the use of telehealth as a DPP implementation strategy is relevant at both a local and national level. This project will evaluate the HP-DPP in terms of the reach, effectiveness, and implementation dimensions of the RE-AIM model by (1) comparing the reach, effectiveness, and implementation of the HP-DPP before versus after the introduction of the VTC participation option, (2) comparing the effectiveness and implementation of VTC versus in-person HP-DPP groups in the “after” period, and (3) exploring reasons for differences in the reach, effectiveness, and/or implementation of the HP-DPP that are associated with inclusion of the VTC participation option using in-depth interviews. The results of this evaluation will directly inform efforts to extend the reach and public health impact of DPPs both within and beyond worksites.

项目概要 现在有 60 多家雇主和保险公司提供疾病控制和预防中心 (CDC) 服务 国家糖尿病预防计划 (DPP) 作为一项基于证据的体重管理计划 范德比尔特健康与保健公司的工作场所健康部门 Health Plus 开始为员工提供 2014 年 DPP 为范德比尔特大学 (VU) 和范德比尔特大学约 25,000 名员工提供福利 大学医学中心 (VUMC)。DPP 的目标是让参与者减掉基线体重的 5%。 到全年计划结束时，2014-2017 年 Health Plus DPP (HP-DPP) 的比例。 实现这一目标的参与者超过了国家 DPP 指标（HP-DPP 参与者为 43.6%，而 35.5% 全国 DPP 参与者），该计划获得了 CDC 糖尿病中心的充分认可 然而，对 HP-DPP 的潜在参与和实际参与的比较表明。 许多可能从这一高效计划中受益的员工并未参与该计划。 由于地点、时间不方便，工作场所健康计划和 DPP 往往受到限制 从 HP-DPP 参与者收集的反馈。 2014-2017 年建议需要亲自在 VU/VUMC 主校区见面以参加 在此期间，该计划是其影响力的一个主要障碍。 被认为是支持和动力的关键来源，同时提高高效 HP-DPP 的影响力。 为了保持其小组结构的优势，HP-DPP 引入了视频电话会议 (VTC) 小组 2018 年的（远程医疗）参与选项。尽管 CDC 认可使用远程医疗作为 DPP 实施策略，很少有研究比较远程医疗和面对面交付的有效性 没有研究比较 VTC 和现场减肥的效果。 VTC 小组仅通过在线互动参与 DPP 小组。 医疗补助服务 (CMS) 最近决定不向使用远程医疗平台计划的 DPP 进行报销 因此，需要进行研究来指导虚拟 DPP 的使用。 远程医疗作为 DPP 实施战略在地方和国家层面都具有相关性。 从 RE-AIM 的范围、有效性和实施维度评估 HP-DPP 通过 (1) 比较 HP-DPP 实施前后的范围、有效性和实施情况来建立模型 引入 VTC 参与选项，(2) 比较 VTC 与 VTC 的有效性和实施情况 “之后”时期的面对面 HP-DPP 小组，以及 (3) 探讨影响范围差异的原因， 与 VTC 参与相关的 HP-DPP 的有效性和/或实施 使用深度访谈的选项将直接影响扩大影响范围的努力。 以及 DPP 对工作场所内外的公共卫生影响。