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: 10669641
• 负责人: Rosette J Chakkalakal
• 金额: $ 37.08万
• 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/10669641
• 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; Eligibility Determination; Employee; Employee Health; 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; Policy Analysis; Population; Prevention; 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; compare effectiveness; cost; diabetes prevention program; evaluation/testing; evidence base; financial incentive; implementation outcomes; implementation strategy; improved; prevent; primary outcome; programs; skills; telehealth; virtual assessment; virtual group

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.

项目摘要 现在，有60多名雇主和保险提供了疾病控制与预防中心（CDC） 国家糖尿病预防计划（DPP）作为基于证据的体重管理计划 雇员。 Health Plus，范德比尔特健康与健康的工作场所健康部，开始提供 2014年的DPP是范德比尔特大学（VU）和范德比尔特（Vanderbilt）的大约25,000名员工的好处 大学医学中心（VUMC）。 DPP的目标是让参与者减少其基线体重的5％ 在为期一年的计划结束时。从2014年至2017年，健康加上DPP（HP-DPP）的比例 实现这一目标的参与者超过了国家民进党指标（HP-DPP参与者为43.6％，而35.5％ DPP参与者的全国）和该计划获得了CDC糖尿病的完全认可状态 预防识别计划。然而，比较潜在和实际参与HP-DPP的建议 许多可能从这个高效计划中受益的员工没有参与其中。程序范围是 由于不便，时间，时间通常都受到工作现场计划和DPP的限制 局限性，激励措施不足和保密问题。从HP-DPP参与者收集的反馈 从2014年至2017年，有必要在VU/VUMC主校区亲自见面参加 在此间隔期间，程序是触及其范围的关键障碍。但是，该程序的小组结构是 注意是支持和动机的关键来源。提高高效HP-DPP的范围 HP-DPP维持其小组结构的好处，引入了视频限制（VTC）组 （远程医疗）2018年的参与选项。尽管CDC认可将远程医疗用作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 实现减肥的平台。没有研究比较VTC和面对面的减肥结果 VTC组仅通过在线互动参与的DPP组。医疗保险和 医疗补助服务（CMS）最近决定不利用远程医疗平台来偿还DPP 交付，无需进一步测试和评估虚拟DPP。那是指导使用的研究 远程医疗作为DPP实施策略在地方和国家一级均具有相关性。这个项目将 根据RE-AIM的覆盖范围，有效性和实施维度评估HP-DPP 通过（1）比较HP-DPP之前的覆盖范围，有效性和实施 引入VTC参与选项，（2）比较VTC与VTC的有效性和实施 面对面的HP-DPP组在“之后”期间，（3）探索覆盖范围差异的原因， HP-DPP的有效性和/或与包括VTC参与的HP-DPP的实施 使用深入访谈的选项。这项评估的结果将直接为扩展覆盖范围而努力 以及DPP内部和超越工程的公共卫生影响。