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.

项目摘要/摘要美国近一半的成年人≥65岁（> 2400万）患有糖尿病，这通常是2型糖尿病的前体 Mellitus（T2DM）和相关的心血管疾病和死亡率。解决这个公共卫生伯恩（Burnen），医疗保险和医疗补助服务中心制定了医疗保险糖尿病的覆盖范围 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，具有巨大的希望，但通常不可用，而且很大未充分利用。缺乏访问和使用的原因仍然不明身份，留下了确定的迫切需求计划供应商，老年人和医疗保健的个人，组织和背景因素影响MDPP可用性和使用的提供商。此R15收获应用的目的是确定影响MDPP实施和使用的不同因素，过程，促进者和障碍，同时提供了刺激杜肯大学研究的机会。没有确定这些因素，不能轻易制定减少障碍和促进MDPP的促进者的实施策略。我们将使用合并框架进行实施研究（CFIR）实现三个具体目标指导MDPP的多层次收敛混合方法研究。目标1：确定感知的促进者以及在国家计划供应商和年龄较大的国家样本中实施和使用MDPP的障碍成年人。我们将对每个利益相关者组进行约15个基于网络或电话的访谈：MDPP供应商， NDPP供应商，MDPP参与者和合格的非参与者。我们还将管理一个已建立的对64 MDPP和64个NDPP供应商进行调查，以评估CFIR的内部设置。目标2：确定电流 MDPP供应商使用的实践和招聘策略用于提高MDPP的认识并注册较老的成年人。我们将首先管理基于Web的计划采用和实施策略要素向全国80个MDPP供应商进行调查，并确定策略的入学率最高老年人。目标3：确定促进或抑制推荐的个人和组织因素全国医疗保健提供者样本中的MDPP有资格的老年人。我们将管理一个网络基于医疗保健提供者前糖尿病的基于200医师和高级实践的版本提供者；我们还将采访提供者的子样本（〜30），以收集深入的定性数据。来自 AIM 1、2和3将使用CFIR作为指导框架进行三角剖分或集成。结果拟议的研究对于告知多个的实施干预措施至关重要利益相关者组，将MDPP扩展到有意义地减少T2DM和CV燃烧的水平疾病。 MDPP是第一个被医疗保险覆盖的疾病预防计划，但覆盖范围尚未永恒的。确保MDPP的成功将为数百万高风险的老年人保留这一收益，并提供帮助将来其他预防计划的驱动器付款人覆盖范围。我们团队的长期目标是减少通过支持实施EB干预措施，以生活方式驱动的简历疾病负担。