Multi-Stakeholder Determinants of Medicare Diabetes Prevention Program Implementation and Participation

医疗保险糖尿病预防计划实施和参与的多利益相关者决定因素

基本信息

批准号：
10578862
负责人：
MELANIE T WARZISKI TURK
金额：
$ 42.6万
依托单位：
DUQUESNE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-07-01 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10578862
关键词：
Address Adoption Adult Affect American Awareness COVID-19 pandemic Cardiovascular Diseases Cardiovascular system Centers for Disease Control and Prevention (U.S.)Characteristics Community Healthcare Complex Consolidated Framework for Implementation Research Credentialing Data Date of birth Development Diabetes Mellitus Disease Elderly Elements Eligibility Determination Enrollment Ensure Environment Evidence based intervention Exposure to Future Goals Health Personnel Implementation readiness Individual Infrastructure Interdisciplinary Study Intervention Interview Investigation Life Style Link Medical Care Costs Medicare Methods Non-Insulin-Dependent Diabetes Mellitus Nursing Students Online Systems Outcome Participant Persons Pharmacy Students Physicians Prediabetes syndrome Prevention program Process Provider Public Health Research Risk SET Domain Sampling Site Social Security Number Surveys Telephone United States Centers for Medicare and Medicaid Services Universities behavior change beneficiary burden of illness comorbidity contextual factors cost diabetes prevention program disability burden disorder prevention evidence base experience health care service organization human old age (65+)implementation barriers implementation evaluation implementation facilitation implementation intervention implementation process implementation research implementation strategy improved lifestyle intervention meetings member mortality preservation prevent programs recruit success theories tool undergraduate student

项目摘要

PROJECT SUMMARY/ABSTRACT Nearly half of US adults age ≥ 65 (> 24 million) have prediabetes, which is often a precursor to type 2 diabetes mellitus (T2DM) and associated cardiovascular (CV) diseases and mortality. To address this public health burden, the Centers for Medicare and Medicaid Services enacted coverage of the Medicare Diabetes Prevention Program (MDPP) in 2018. Based on the National Diabetes Prevention Program (NDPP), the MDPP is an evidence-based (EB) lifestyle intervention that holds great promise, but is often unavailable and greatly underutilized. Reasons for lack of access and use remain unidentified, leaving a critical need to determine the individual, organizational, and contextual factors among program suppliers, older adults, and healthcare providers that are affecting MDPP availability and use. The objective for this R15 REAP application is to determine the diverse factors, processes, facilitators, and barriers affecting MDPP implementation and use, while providing an opportunity to stimulate research at Duquesne University. Without identifying these factors, implementation strategies to reduce barriers and promote facilitators of the MDPP cannot be readily enacted. We will pursue three specific aims using the Consolidated Framework for Implementation Research (CFIR) to guide a multi-level, convergent mixed methods investigation of the MDPP. Aim 1: Identify perceived facilitators and barriers to implementation and use of the MDPP in a national sample of program suppliers and older adults. We will conduct ~15 web-based or phone interviews with each stakeholder group: MDPP suppliers, NDPP suppliers, MDPP participants, and eligible non-participants. We will also administer an established survey to 64 MDPP and 64 NDPP suppliers to assess the Inner Setting of the CFIR. Aim 2: Determine current practices and recruitment strategies MDPP suppliers use to raise awareness of the MDPP and enroll older adults. We will first administer the Program Adoption and Implementation Strategies elements of a web-based survey to a national sample of 80 MDPP suppliers, and identify the strategies yielding the highest enrollment of older adults. Aim 3: Determine the individual and organizational factors promoting or inhibiting referral of eligible older adults to the MDPP among a national sample of healthcare providers. We will administer a web- based version of the Healthcare Provider Prediabetes Survey to 200 physicians and advanced practice providers; we will also interview a subsample of providers (~30) to gather in-depth qualitative data. Data from Aims 1, 2, and 3 will be triangulated, or integrated, using the CFIR as the guiding framework. Results of the proposed research are essential to inform the development of implementation interventions for multiple stakeholder groups, to scale the MDPP to a level that meaningfully reduces the burden of T2DM and CV disease. The MDPP is the first Medicare-covered disease prevention program, but coverage is not yet permanent. Ensuring success of the MDPP will preserve this benefit for millions of at-risk older adults and help drive payor coverage for other prevention programs in the future. Our team’s long-term goal is to reduce the burden of lifestyle-driven CV disease by facilitating implementation of EB interventions.

项目概要/摘要近一半 65 岁以上的美国成年人（> 2400 万）患有糖尿病前期，这通常是 2 型糖尿病的先兆糖尿病 (T2DM) 和相关心血管 (CV) 疾病和死亡率。负担，医疗保险和医疗补助服务中心颁布了医疗保险糖尿病保险 2018 年预防计划 (MDPP)。根据国家糖尿病预防计划 (NDPP)，MDPP 是一种基于证据的 (EB) 生活方式干预措施，前景广阔，但往往无法实现，而且影响很大缺乏访问和使用的原因仍不清楚，因此迫切需要确定项目提供者、老年人和医疗保健之间的个人、组织和背景因素影响 MDPP 可用性和使用的提供商此 R15 REAP 应用程序的目标是确定影响 MDPP 实施和使用的各种因素、流程、促进因素和障碍，在没有确定这些因素的情况下，提供了刺激杜肯大学研究的机会，减少 MDPP 障碍和促进促进者的实施战略不可能轻易颁布。我们将利用实施研究综合框架（CFIR）来实现三个具体目标指导 MDPP 的多层次、聚合混合方法调查目标 1：确定感知的促进者。以及在计划供应商和较老国家样本中实施和使用 MDPP 的障碍我们将对每个利益相关者群体进行约 15 次网络访谈或电话访谈：MDPP 供应商、我们还将管理既定的 NDPP 供应商、MDPP 参与者和符合条件的非参与者。对 64 家 MDPP 和 64 家 NDPP 供应商进行了调查，以评估 CFIR 的内部背景目标 2：确定当前情况。 MDPP 供应商用来提高 MDPP 意识并招收老年人的做法和招聘策略我们将首先管理基于网络的计划采用和实施策略要素。对 80 个 MDPP 供应商进行全国抽样调查，并确定获得最高入学率的策略目标 3：确定促进或抑制老年人转诊的个人和组织因素。我们将在全国医疗保健提供者样本中管理符合 MDPP 资格的老年人。基于医疗保健提供者糖尿病前期调查的 200 名医生版本和高级实践供应商；我们还将采访供应商的子样本（~30），以收集深入的定性数据。目标 1、2 和 3 将使用 CFIR 作为指导结果进行三角测量或整合。拟议的研究对于为多种实施干预措施的制定提供信息至关重要利益相关者团体，将 MDPP 扩大到能够有效减轻 T2DM 和 CV 负担的水平 MDPP 是第一个医疗保险承保的疾病预防计划，但尚未承保。确保 MDPP 的成功将为数百万高危老年人保留这一福利并提供帮助。推动未来其他预防计划的付款人覆盖。我们团队的长期目标是减少通过促进 EB 干预措施的实施，减轻生活方式驱动的心血管疾病的负担。