Louisiana Experiment to Address Diabetes: Zero-Dollar Copayment (LEAD-ZDC) for Improving Disease Management

路易斯安那州解决糖尿病问题的实验：零美元共付额 (LEAD-ZDC) 改善疾病管理

• 批准号: 10097610
• 负责人: LIZHENG SHI
• 金额: $ 44.99万
• 依托单位: TULANE UNIVERSITY OF LOUISIANA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-30 至 2025-09-29
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10097610
• 关键词: Louisiana; Experiment; Address; Diabetes; Zero

Abstract Type 2 diabetes mellitus (T2DM) remains a major public health concern in the United States, especially in Louisiana where mortality from diabetes complications and cardiovascular disease (CVD) is high due to poor diabetes management. Medication treatment non-adherence is prevalent and costly in diabetes management where Cost-Related Non-adherence (CRN) with medication therapies has to be addressed as part of the social determinants of health. We propose a Louisiana Natural Experiment Center (LNEC) that includes academic/research institutions, payers, community non-profit organizations and community/patient partners, and health systems to improve care for diabetes and reduce risk factors and complications. The LNEC will be enhanced by the infrastructure of Research Action for Health Network (REACHnet). The LNEC's Louisiana Experiment to Address Diabetes: Zero-Dollar Copayment (LEAD-ZDC) project will examine the policy intervention of lowering out-of-pocket cost by ZDC for select medications (antidiabetics, antihypertensives, and statins) among fully insured Blue Cross and Blue Shield of Louisiana (BCBSLA) members with T2DM. The hypothesis is that the ZDC program will improve medication adherence and ultimately improve health outcomes. The overall goal is to study how ZDC may reduce CRN, overall medication non-adherence, health care utilization, and diabetes complications. The three specific aims will be evaluated according to the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. The first aim is to evaluate how health impacts of the ZDC program improve the primary effectiveness measure: medication adherence with ZDC list of antidiabetics and multiple secondary effectiveness measures such as overall medication adherence, adherence with medications for risk factors (antihypertensives and statins), diabetes control, complications, health care utilization, and patient-reported outcomes. The second aim is to evaluate the barriers (e.g. racial/ethnic and rural/urban disparities) and facilitators related to the ZDC program in Louisiana. The third aim is to estimate the cost-effectiveness of the ZDC program from health system and social perspectives using modelling techniques. Patient and stakeholder engagement will be implemented as a cornerstone of the LEAD-ZDC project, which will explore the barriers at patient, provider, health system, and community levels, to inform, engage and empower patients, and to partner with and support T2DM patients to achieve better health outcomes. The proposed study will generate urgently needed data on effective, practical, and sustainable programs for eliminating health disparities and reducing diabetes-related disease burden. The study findings will assist (1) patients with better access to needed medications, and (2) providers and payers with improved understanding of how to address barriers to adherence so that they may better work with patients to make medications affordable and improve diabetes outcomes. Further dissemination and scale-up efforts will create large returns for more diverse health systems and payers in the United States.

抽象的 2型糖尿病（T2DM）仍然是美国的主要公共卫生问题 路易斯安那州的糖尿病并发症和心血管疾病（CVD）的死亡率很高，因此 糖尿病管理。在糖尿病管理中，不遵守药物治疗是普遍且昂贵的 与成本相关的不遵守（CRN）与药物疗法必须作为社会的一部分来解决 健康的决定因素。我们提出了一个路易斯安那州自然实验中心（LNEC），其中包括 学术/研究机构，付款人，社区非营利组织和社区/患者合作伙伴， 以及改善糖尿病护理并减少危险因素和并发症的卫生系统。 LNEC将 通过卫生网络研究行动（REACHNET）的基础设施增强。 LNEC的路易斯安那州 解决糖尿病的实验：零美元共付额（LEAD-ZDC）项目将检查该政策 降低ZDC的自付费用的干预措施（抗糖尿病，抗高血压和抗糖尿病） 他汀类药物）在带有T2DM的路易斯安那州（BCBSLA）成员的蓝十字和蓝盾中。这 假设是ZDC计划将改善药物依从性并最终改善健康状况 结果。总体目标是研究ZDC如何减少CRN，总体药物不遵守，健康 护理利用和糖尿病并发症。这三个特定目标将根据覆盖范围进行评估 有效，采用，实施和维护（RE-AIM）框架。第一个目的是评估 ZDC计划的健康影响如何改善主要有效性措施：药物依从性 ZDC抗糖尿病和多种次要有效性措施（例如总体药物） 依从性，遵守药物对危险因素（抗高血压和他汀类药物），糖尿病的控制， 并发症，医疗保健利用和患者报告的结果。第二个目的是评估 与路易斯安那州ZDC计划有关的障碍（例如种族/种族和农村/城市差异）和促进者。 第三个目的是估算卫生系统和社会ZDC计划的成本效益 使用建模技术的观点。患者和利益相关者的参与将作为一个 Lead-ZDC项目的基石，该项目将探索患者，提供商，卫生系统和 社区级别，告知，吸引和赋予患者权力，并与T2DM患者合作并支持 取得更好的健康结果。拟议的研究将迫切需要有关有效，实用的数据 以及可持续的计划，以消除健康差异和减轻与糖尿病有关的疾病负担。这 研究发现将帮助（1）更好地使用所需药物的患者，以及（2）提供者和付款人 随着如何解决如何解决遵守障碍，他们可以更好地与之合作 患者使药物负担得起并改善糖尿病预后。进一步传播和扩大规模 努力将为美国更多样化的卫生系统和付款人创造巨大的回报。