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Vandyousefi S, Oettingen G, Wittleder S, Moin T, Sweat V, Aguilar AD, Ruan A, Angelotti G, Wong L, Orstad SL, Illengberger N, Nicholson A, Lim S, Cansler R, Portelli D, Sherman S, Jay MR. Protocol for a prospective, randomized, controlled trial of Mental Contrasting with Implementation Intentions (MCII) to enhance the effectiveness of VA's MOVE! weight management program: WOOP (Wish, Outcome, Obstacle, Plan) VA. Contemp Clin Trials 2024; 141:107523. [PMID: 38608752 DOI: 10.1016/j.cct.2024.107523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 03/31/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024]
Abstract
INTRODUCTION Intensive weight management programs are effective but often have low enrollment and high attrition. Lack of motivation is a key psychological barrier to enrollment, engagement, and weight loss. Mental Contrasting with Implementation Intentions (MCII) is a unique imagery technique that increases motivation for behavior change. We describe our study protocol to assess the efficacy and implementation of MCII to enhance the effectiveness of VA's MOVE! or TeleMOVE! weight management programs using a procedure called "WOOP" (Wish, Outcome, Obstacle, Plan) for Veterans. We hypothesize that WOOP+MOVE! or TeleMOVE! (intervention) will lead to greater MOVE!/TeleMOVE! program engagment and consequently weight loss than MOVE!/TeleMOVE! alone (control). METHOD Veterans are randomized to either the intervention or control. Both arms receive the either MOVE! or TeleMOVE! weight management programs. The intervention group receives an hour long WOOP training while the control group receives patient education. Both groups receive telephone follow up calls at 3 days, 4 weeks, and 2 months post-baseline. Eligible participants are Veterans (ages 18-70 years) with either obesity (BMI ≥ 30 kg/m2) or overweight (BMI ≥ 25 kg/m2) and an obesity-associated co-morbidity. At baseline, 6 and 12 months, we assess weight, diet, physical activity in both groups. The primary outcome is mean percent weight change at 6 months. Secondary outcomes include changes in waist circumference, diet, physical activity, and dieting self-efficacy and engagement in regular physical activity. We assess implementation using the RE-AIM framework. CONCLUSION If WOOP VA is found to be efficacious, it will be an important tool to facilitate weight management and improve weight outcomes. CLINICAL TRIAL REGISTRATION NCT05014984.
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Affiliation(s)
- Sarvenaz Vandyousefi
- New York Harbor Veterans Health Affairs, NY, New York, United States of America; Department of Medicine, New York University Grossman School of Medicine, NY, New York, United States of America
| | - Gabriele Oettingen
- Department of Psychology, New York University, NY, New York, United States of America
| | - Sandra Wittleder
- New York Harbor Veterans Health Affairs, NY, New York, United States of America; Department of Medicine, New York University Grossman School of Medicine, NY, New York, United States of America
| | - Tannaz Moin
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America; Department of Medicine, David Geffen School of Medicine, The University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Victoria Sweat
- New York Harbor Veterans Health Affairs, NY, New York, United States of America; Department of Medicine, New York University Grossman School of Medicine, NY, New York, United States of America
| | - Adrian D Aguilar
- New York Harbor Veterans Health Affairs, NY, New York, United States of America; Department of Medicine, New York University Grossman School of Medicine, NY, New York, United States of America
| | - Andrea Ruan
- New York Harbor Veterans Health Affairs, NY, New York, United States of America; Department of Medicine, New York University Grossman School of Medicine, NY, New York, United States of America
| | - Gina Angelotti
- New York Harbor Veterans Health Affairs, NY, New York, United States of America; Department of Medicine, New York University Grossman School of Medicine, NY, New York, United States of America
| | - Laura Wong
- New York Harbor Veterans Health Affairs, NY, New York, United States of America; Department of Medicine, New York University Grossman School of Medicine, NY, New York, United States of America
| | - Stephanie L Orstad
- Department of Medicine, New York University Grossman School of Medicine, NY, New York, United States of America
| | - Nicholas Illengberger
- Department of Population Health, New York University Grossman School of Medicine, NY, New York, United States of America
| | - Andrew Nicholson
- Department of Population Health, New York University Grossman School of Medicine, NY, New York, United States of America
| | - Sahnah Lim
- Department of Population Health, New York University Grossman School of Medicine, NY, New York, United States of America
| | - Rachel Cansler
- New York Harbor Veterans Health Affairs, NY, New York, United States of America; Department of Medicine, New York University Grossman School of Medicine, NY, New York, United States of America
| | - Dilara Portelli
- New York Harbor Veterans Health Affairs, NY, New York, United States of America; Department of Medicine, New York University Grossman School of Medicine, NY, New York, United States of America
| | - Scott Sherman
- New York Harbor Veterans Health Affairs, NY, New York, United States of America; Department of Medicine, New York University Grossman School of Medicine, NY, New York, United States of America; Department of Population Health, New York University Grossman School of Medicine, NY, New York, United States of America
| | - Melanie R Jay
- New York Harbor Veterans Health Affairs, NY, New York, United States of America; Department of Medicine, New York University Grossman School of Medicine, NY, New York, United States of America; Department of Population Health, New York University Grossman School of Medicine, NY, New York, United States of America.
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Loeb TB, Gholami M, Ramm K, Shedd K, Soetenga S, Jackson NJ, Chung UYR, Duru OK, Mangione CM, Hamilton AB, Moin T. Multilevel perceptions of the virtual delivery of the University of California Diabetes Prevention Program on RE-AIM domains due to COVID-19 mandates. Front Public Health 2024; 12:1327429. [PMID: 38525342 PMCID: PMC10959089 DOI: 10.3389/fpubh.2024.1327429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/23/2024] [Indexed: 03/26/2024] Open
Abstract
Background The University of California's Diabetes Prevention Program (UC DPP) Initiative was implemented across all 10 UC campuses in 2018. The COVID-19 pandemic and accompanying mandates required swift changes to program delivery, including pivoting from in-person to virtual delivery (i.e., Zoom). Our goal was to assess multilevel constituent perceptions of the use of a virtual platform to deliver UC DPP due to COVID-19 mandates. Methods We conducted qualitative interviews with 68 UC DPP participants, coordinators, and leaders to examine the use of virtual platform delivery on the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) of UC DPP. Transcripts were analyzed using rapid qualitative analysis and emergent themes were categorized using domains corresponding to RE-AIM framework. Results Among UC DPP participants (n = 42), virtual delivery primarily impacted perceptions of UC DPP effectiveness and implementation. Some participants perceived program effectiveness to be negatively impacted, given their preference for in-person sessions, which they felt provided more engagement, peer support, and accountability. Implementation challenges included problems with virtual format (e.g., "Zoom fatigue"); however, several benefits were also noted (e.g., increased flexibility, maintenance of DPP connections during campus closures). UC DPP coordinators (n = 18) perceived virtual delivery as positively impacting UC DPP reach, since virtual platforms provided access for some who could not participate in-person, and negatively impacting effectiveness due to reduced engagement and lower peer support. UC leaders (n = 8) perceived that use of the virtual format had a positive impact on reach (e.g., increased availability, accessibility) and negatively impacted effectiveness (e.g., less intensive interactions on a virtual platform). Across constituent levels, the use of a virtual platform had little to no impact on perceptions of adoption and maintenance of UC DPP. Conclusion Perceptions of the reach, effectiveness, and implementation of UC DPP using a virtual platform varied across constituents, although all groups noted a potential negative impact on overall program effectiveness. Unanticipated program adaptations, including virtual delivery, present potential benefits as well as perceived drawbacks, primarily across the effectiveness domain. Understanding differential constituent perceptions of the impact of virtual delivery can help maximize RE-AIM and inform future UC DPP delivery strategies.
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Affiliation(s)
- Tamra Burns Loeb
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Maryam Gholami
- Altman Clinical and Translational Research Institute (ACTRI), University of California, San Diego, San Diego, CA, United States
| | - Kate Ramm
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Kelly Shedd
- UCI Health, University of California, Irvine, Irvine, CA, United States
| | - Samantha Soetenga
- UCLA Campus Recreation, University of California, Los Angeles, Los Angeles, CA, United States
| | - Nicholas J. Jackson
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Un Young Rebecca Chung
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - O. Kenrik Duru
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Carol M. Mangione
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
| | - Alison B. Hamilton
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Tannaz Moin
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA, United States
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States
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Gholami M, Jackson NJ, Loeb T, Chung UYR, Ramm K, Shedd K, Soetenga S, Elashoff D, Hamilton AB, Mangione CM, Duru OK, Moin T. Twelve-Month Reach and Effectiveness of a University-Based Diabetes Prevention Initiative. Am J Prev Med 2024; 66:299-306. [PMID: 37741423 PMCID: PMC10842474 DOI: 10.1016/j.amepre.2023.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 09/25/2023]
Abstract
INTRODUCTION The University of California (UC) implemented the Diabetes Prevention Program (DPP) to address diabetes and obesity risk. This project examined the reach and effectiveness of this university-based DPP delivery approach. METHODS This project compared 12-month weight change among three groups of UC beneficiaries with overweight/obesity: (1) those who received invitation letters and enrolled in UC DPP, (2) those mailed invitation letters but did not enroll, and (3) those who were not mailed letters and did not enroll (controls). Using 2012-2022 EHR, administrative and DPP cohort data, an interrupted time series was conducted in 2022-2023 to compare group differences in rate of weight change. RESULTS Among 6,231 beneficiaries (132 UC DPP aware enrollees, 1,750 DPP aware non-enrollees, 4,349 controls), UC DPP enrollees were older (mean age 49), mostly women (76%), and more diverse (33% Asian, 8% Black, 20% Hispanic, 4% Multi/Other). Over 12 months of follow-up, UC DPP enrollee postenrollment rate of weight loss was -0.68 lbs./month. UC DPP enrollees had significantly greater weight change from pre- to post-enrollment than DPP aware non-enrollees (adjusted Δ-1.02 vs. Δ-0.07 lbs./month, difference= -0.95, p<0.001). Weight change among all participants who received letters with/without DPP enrollment was similar to controls. CONCLUSIONS UC DPP reached a diverse group and was effective for weight loss at 12-month follow-up. However, UC DPP invitation letters to raise prediabetes and DPP awareness were not associated with significant weight change in the absence of DPP enrollment. University-based approaches to DPP delivery are effective and may enhance reach of DPP among at-risk adults.
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Affiliation(s)
- Maryam Gholami
- Altman Clinical and Translational Research Institute, University of California, San Diego, California
| | - Nicholas J Jackson
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Tamra Loeb
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Un Young Rebecca Chung
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Kate Ramm
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Kelly Shedd
- Human Resources, University of California, Irvine, California
| | - Samantha Soetenga
- Campus Recreation, University of California, Los Angeles, California
| | - David Elashoff
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Alison B Hamilton
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California; VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Carol M Mangione
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California; Fielding School of Public Health, University of California, Los Angeles, California
| | - O Kenrik Duru
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Tannaz Moin
- Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, California; VA Greater Los Angeles Healthcare System, Los Angeles, California.
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Duru OK, Mangione CM, Turk N, Chon J, Fu J, Cheng G, Cheng F, Moss A, Frosch D, Jeffers KS, Castellon-Lopez Y, Tseng CH, Maranon R, Norris KC, Moin T. The Effectiveness of Shared Decision-making for Diabetes Prevention: 24- and 36-Month Results From the Prediabetes Informed Decision and Education (PRIDE) Trial. Diabetes Care 2023; 46:2218-2222. [PMID: 37770039 PMCID: PMC10698217 DOI: 10.2337/dc23-0829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/11/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE We conducted a cluster-randomized, shared decision-making (SDM) trial offering lifestyle change, metformin, or both options, to adults at risk for diabetes in a primary care network (n = 20 practices). RESEARCH DESIGN AND METHODS We used propensity score matching to identify control patients and used electronic health record data to compare weight loss at 24 and 36 months of follow-up and diabetes incidence at 36 months of follow-up. RESULTS In adjusted post hoc analyses, SDM participants (n = 489) maintained modestly greater 24-month weight loss of -3.1 lb and 36-month weight loss of -2.7 lb versus controls (n = 1,430, both comparisons P < 0.001). SDM participants who chose both lifestyle change and metformin sustained weight loss at 36 months of -4.1 lb (P < 0.001 vs. controls). We found no differences in incident diabetes (15% of SDM participants, 14% of control participants; P = 0.64). CONCLUSIONS This is one of the first studies to demonstrate weight loss maintenance up to 36 months after diabetes prevention SDM.
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Affiliation(s)
- O. Kenrik Duru
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Carol M. Mangione
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, Los Angeles, CA
| | - Norman Turk
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Janet Chon
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Jeffery Fu
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Grace Cheng
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Felicia Cheng
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Amanda Moss
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | | | - Kia Skrine Jeffers
- School of Nursing, University of California, Los Angeles, Los Angeles, Los Angeles, CA
| | | | - Chi-Hong Tseng
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Richard Maranon
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Keith C. Norris
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Tannaz Moin
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
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Golovaty I, Bergman M, Moin T. Response to the letter to the editor: "Two decade of diabetes prevention efforts: A call to innovate and revitalize our approach to lifestyle change". Diabetes Res Clin Pract 2023; 201:110681. [PMID: 37105399 DOI: 10.1016/j.diabres.2023.110681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Ilya Golovaty
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA; General Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA.
| | - Michael Bergman
- Division of Endocrinology and Metabolism, Department of Medicine and of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Tannaz Moin
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; VA Greater Los Angeles Health System and HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, CA, USA
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Golovaty I, Ritchie ND, Tuomilehto J, Mohan V, Ali MK, Gregg EW, Bergman M, Moin T. Two decades of diabetes prevention efforts: A call to innovate and revitalize our approach to lifestyle change. Diabetes Res Clin Pract 2023; 198:110195. [PMID: 36470316 PMCID: PMC10079599 DOI: 10.1016/j.diabres.2022.110195] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/07/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
The impact of global diabetes prevention efforts has been modest despite the promise of landmark diabetes prevention trials nearly twenty years ago. While national and regional initiatives show potential, challenges remain to adapt large-scale strategies in the real-world that fits individuals and their communities. Additionally, the sedentary lifestyle changes during the COVID-19 pandemic and guidelines that now call for earlier screening (e.g., US Preventative Task Force) will increase the pool of eligible adults worldwide. Thus, a more adaptable, person-centered approach that expands the current toolkit is urgently needed to innovate and revitalize our approach to diabetes prevention. This review identifies key priorities to optimize the population-level delivery of diabetes prevention based on a consensus-based evaluation of the current evidence among experts in global translational programs; key priorities identified include (1) participant eligibility, (2) intervention intensity, (3) delivery components, (4) behavioral economics, (5) technology, and (6) the role of pharmacotherapy. We offer a conceptual framework for a broader, person-centered approach to better address an individual's risk, readiness, barriers, and digital competency.
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Affiliation(s)
- Ilya Golovaty
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, WA, USA; General Medicine Service, VA Puget Sound Health Care System, Seattle, WA, USA.
| | - Natalie D Ritchie
- Office of Research, Denver Health and Hospital Authority, Denver, CO. Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO. University of Colorado College of Nursing, Aurora, CO, USA
| | - Jaakko Tuomilehto
- Public Health Promotion Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Public Health, University of Helsinki, Helsinki, Finland; Saudi Diabetes Research Group, King Abdulaziz University Jeddah, Saudi Arabia; Department of International Health, National School of Public Health, Instituto de Salud Carlos III. Madrid, Spain
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Chairman, Dr. Mohan's Diabetes Specialties Centre, Chennai, India
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA; Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Michael Bergman
- Division of Endocrinology and Metabolism, Department of Medicine and of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Tannaz Moin
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA; VA Greater Los Angeles Health System and HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, CA, USA
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Quinton JK, Jackson N, Mangione CM, Moin T, Vasilyev A, O'Shea DL, Duru OK. Differential Impact of a Plan-Led Standardized Complex Care Management Intervention on Subgroups of High-Cost High-Need Medicaid Patients. Popul Health Manag 2023; 26:100-106. [PMID: 37071688 PMCID: PMC10125392 DOI: 10.1089/pop.2022.0271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
Interventions to better coordinate care for high-need high-cost (HNHC) Medicaid patients frequently fail to demonstrate changes in hospitalizations or emergency department (ED) use. Many of these interventions are modeled after practice-level complex care management (CCM) programs. The authors hypothesized that a national CCM program may be effective for some subgroups of HNHC patients, and the overall null effect may obfuscate subgroup-level impact. They used a previously published typology defining 6 subgroups of high-cost Medicaid patients and evaluated program impact by subgroup. The analysis used an individual-level interrupted time series with a comparison group. Intervention subjects were high-cost adult Medicaid patients who enrolled in 1 of 2 national CCM programs implemented by UnitedHealthcare (UHC) (n = 39,687). The comparators were patients who met CCM program criteria but were ineligible due to current enrollment in another UHC/Optum led program (N = 26,359). The intervention was a CCM program developed by UHC/Optum to provide "whole person care" delivering standardized interventions to address medical, behavioral, and social needs for HNHC Medicaid patients, and the outcome was probability of hospitalization or ED use in a given month, estimated at 12 months postenrollment. A reduction in risk of ED utilization for 4 of 6 subgroups was found. A reduction in risk of hospitalization for 1 of 6 subgroups was also found. The authors conclude that standardized health plan led CCM programs demonstrate effectiveness for certain subgroups of HNHC patients in Medicaid. This effectiveness is principally in reducing ED risk and may extend to the risk of hospitalization for a small number of patients.
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Affiliation(s)
- Jacob K. Quinton
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, California, USA
- CMS Innovation Center, Centers for Medicare and Medicaid Services, Baltimore, Maryland, USA
| | - Nicholas Jackson
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, California, USA
| | - Carol M. Mangione
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, California, USA
| | - Tannaz Moin
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, California, USA
| | - Arseniy Vasilyev
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, California, USA
| | | | - O. Kenrik Duru
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, California, USA
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Hamilton AB, Finley EP, Bean-Mayberry B, Lang A, Haskell SG, Moin T, Farmer MM. Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER) 2.0 QUERI: study protocol for a cluster-randomized hybrid type 3 effectiveness-implementation trial. Implement Sci Commun 2023; 4:23. [PMID: 36890587 PMCID: PMC9994412 DOI: 10.1186/s43058-022-00389-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/22/2022] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Women Veterans are the fastest-growing segment of Veterans Health Administration (VA) users. The VA has invested heavily in delivering care for women Veterans that is effective, comprehensive, and gender-tailored. However, gender disparities persist in cardiovascular (CV) and diabetes risk factor control, and the rate of perinatal depression among women Veterans is higher than that among civilian women. Challenges such as distance, rurality, negative perception of VA, discrimination (e.g., toward sexual and/or gender minority individuals), and harassment on VA grounds can further impede women's regular use of VA care. Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER) 2.0 builds on work to date by expanding access to evidence-based, telehealth preventive and mental health services for women Veterans with high-priority health conditions in rural and urban-isolation areas. METHODS EMPOWER 2.0 will evaluate two implementation strategies, Replicating Effective Practices (REP) and Evidence-Based Quality Improvement (EBQI), in supporting the implementation and sustainment of three evidence-based interventions (Virtual Diabetes Prevention Program; Telephone Lifestyle Coaching Program; and Reach Out, Stay Strong Essentials) focused on preventive and mental health care for women Veterans. We will conduct a mixed-methods implementation evaluation using a cluster-randomized hybrid type 3 effectiveness-implementation trial design to compare the effectiveness of REP and EBQI on improved access to and rates of engagement in telehealth preventive lifestyle and mental health services. Other outcomes of interest include (a) VA performance metrics for telehealth care delivery and related clinical outcomes; (b) progression along the Stages of Implementation Completion; (c) adaptation, sensemaking, and experiences of implementation among multilevel stakeholders; and (d) cost and return on investment. We will also generate implementation playbooks for program partners to support scale-up and spread of these and future evidence-based women's health programs and policies. DISCUSSION EMPOWER 2.0 provides a model for mixed-methods hybrid type 3 effectiveness-implementation trial design incorporating evaluation of performance metrics, implementation progress, stakeholder experience, and cost and return on investment, with the ultimate goal of improving access to evidence-based preventive and mental telehealth services for women Veterans with high-priority health conditions. TRIAL REGISTRATION ClinicalTrials.gov, NCT05050266 . Registered on 20 September 2021.
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Affiliation(s)
- Alison B Hamilton
- Veterans Affairs Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | - Erin P Finley
- Veterans Affairs Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Departments of Medicine and Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, TX, USA
| | - Bevanne Bean-Mayberry
- Veterans Affairs Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Division of General Internal Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Ariel Lang
- VA San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Sally G Haskell
- VA HSR&D Pain Research, Informatics, Multi-morbidities, and Education Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine, Yale School of Medicine, Yale University, New Haven, CT, USA
| | - Tannaz Moin
- Veterans Affairs Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Division of General Internal Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Division of Endocrinology, Diabetes & Metabolism, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Melissa M Farmer
- Veterans Affairs Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Gupta D, Wilhalme H, Sauder G, Moin T. Cognitive screening among older adults with diabetes across diverse clinic settings. Diabetes Res Clin Pract 2023; 196:110184. [PMID: 36436551 DOI: 10.1016/j.diabres.2022.110184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022]
Abstract
AIMS Diabetes increases risk of cognitive dysfunction and dementia, which can make it harder to manage diabetes. We aimed to examine cognitive screening for older adults with diabetes in 1) endocrine (Endo), 2) geriatric (Geri) and 3) multidisciplinary endocrine-geriatric (Geri-Endo), to study differences between these settings and to elucidate risk factors of cognitive dysfunction. METHODS We performed cognitive screening for subsets of patients ≥ age 65 with diabetes in one large healthcare system. We compared results and differences from the three clinic types and used adjusted multivariate logistic regression models to predict risk of cognitive dysfunction. RESULTS Among 198 patients screened, those in Geri-Endo (N = 86) and Geri (N = 32) were more likely to have lower Mini-Cog scores, higher prevalence of hypertension and cardiovascular (CV) events. Endo and Geri-Endo patients had longer durations of diabetes, higher incidence of hypoglycemia, and were more likely to use insulin. Age > 75 years (p = 0.0105), previous CV events (p = 0.0006) and body mass index < 30 (p = 0.0115) were significantly associated with lower Mini-Cog scores. CONCLUSIONS Our study shows that cognitive screening can help identify at risk older adults with diabetes. Thus, yearly screening should be part of routine diabetes care.
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Affiliation(s)
- Deepashree Gupta
- Division of Endocrinology, Diabetes & Metabolism, David Geffen School of Medicine at University of California- Los Angeles (UCLA), United States.
| | - Holly Wilhalme
- Statistics Core, Department of Medicine, David Geffen School of Medicine at UCLA, United States
| | - Gabriela Sauder
- Community Practice Network, Department of Family Medicine at UCLA, United States
| | - Tannaz Moin
- Division of Endocrinology, Diabetes & Metabolism, David Geffen School of Medicine at University of California- Los Angeles (UCLA), United States; HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, United States
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10
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Madievsky R, Vu A, Cheng F, Chon J, Turk N, Krueger A, Krong J, Maranon R, Liu S, Han CS, Norris KC, Mangione C, Page J, Thomas S, Duru OK, Moin T. A randomized controlled trial of a shared decision making intervention for diabetes prevention for women with a history of gestational diabetes mellitus: The Gestational diabetes Risk Attenuation for New Diabetes (GRAND study). Contemp Clin Trials 2023; 124:107007. [PMID: 36384219 PMCID: PMC10642368 DOI: 10.1016/j.cct.2022.107007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/14/2022] [Accepted: 11/10/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is a risk factor for the development of type 2 diabetes. Metformin and lifestyle change through a Diabetes Prevention Program (DPP) are equally effective in preventing diabetes in patients with a GDM history, so women can choose a strategy based on their preferences. This study aims to test whether shared decision making (SDM) can help women with a history of GDM increase adoption of evidence-based strategies and lose weight to lower their risk of incident diabetes in real-world settings. METHODS This pragmatic randomized controlled trial (RCT) will test the effectiveness of SDM for diabetes prevention among 310 overweight/obese women with a history of GDM and prediabetes from two large health care systems (n = 155 from UCLA Health and n = 155 from Intermountain Healthcare). The primary outcome is the proportion of participants who lose ≥5% body weight at 12 months. Secondary outcomes include uptake of DPP and/or metformin and other patient-reported outcomes such as patient activation and health-related quality of life. Rates of GDM in a subsequent pregnancy will be an exploratory outcome. A descriptive analysis of costs related to SDM implementation will also be conducted. CONCLUSION This is the first RCT to examine the effectiveness of SDM on weight loss, lifestyle change and/or metformin use, and other patient-reported outcomes in participants with a GDM history at risk of developing diabetes. TRIAL REGISTRATION ClinicalTrials.gov, NCT03766256. Registered on 6 December 2018.
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Affiliation(s)
- Ruth Madievsky
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Amanda Vu
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Felicia Cheng
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Janet Chon
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Norman Turk
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Ashley Krueger
- Healthcare Delivery Institute, Office of Research, Intermountain Healthcare, 5026 S. State St, Murray, UT 84107, USA.
| | - Jacob Krong
- Healthcare Delivery Institute, Office of Research, Intermountain Healthcare, 5026 S. State St, Murray, UT 84107, USA.
| | - Richard Maranon
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Sandra Liu
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Christina S Han
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of California, 200 Medical Plaza, Suite 430, Los Angeles, CA 90095, USA.
| | - Keith C Norris
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, David Geffen School of Medicine at UCLA, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Carol Mangione
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, David Geffen School of Medicine at UCLA, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA; Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, USA.
| | - Jessica Page
- Department of Maternal-Fetal Medicine, Intermountain Healthcare. Department of Maternal-Fetal Medicine, University of Utah Health, 8th Ave & C St E, Salt Lake City, UT 84143, USA.
| | - Samuel Thomas
- Department of Internal Medicine, Intermountain Healthcare, 5121 Cottonwood St, Murray, UT 84017, USA.
| | - O Kenrik Duru
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, David Geffen School of Medicine at UCLA, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA.
| | - Tannaz Moin
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, 1100 Glendon Ave STE 850, Los Angeles, CA 90024, USA; HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA; Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, UCLA, Los Angeles, CA 90024, USA.
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11
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Narain KDC, Turk N, Duru OK, Moin T, Ho S, Mangione CM. The diabetes health plan and medication adherence among individuals with low incomes. Health Serv Res 2022; 57 Suppl 2:214-221. [PMID: 35466402 PMCID: PMC9660410 DOI: 10.1111/1475-6773.13992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To test the impact of the Diabetes Health Plan (DHP), a diabetes-specific insurance plan that lowers out-of-pocket costs for diabetes-related medications and clinical visits, on adherence to oral hypoglycemic medications among low-income adults with Type 2 Diabetes (T2DM). DATA SOURCES AND STUDY SETTING Cohort of adults (18-64) with T2DM, an annual household income <USD 30,000, and who were continuously enrolled in an employer-sponsored UnitedHealthcare plan for at least two years between 2009 and 2014. STUDY DESIGN We employed a linear regression Difference-In-Differences (DID) approach with a matched comparison group. To assess for differential DHP effects across adherent versus non-adherent patients, we ran a Difference-in-Difference-in-Differences (DDD) analysis by including an interaction term that included indicators for DHP exposure status and time, and low versus high baseline medication adherence. DATA COLLECTION The analytic data set is limited to employer groups that purchased the DHP and standard benefit plans from UnitedHealthcare, had internal pharmacy contracts; complete pharmacy claims data, and sufficient medical claims and lab data to identify employees and their dependents with T2DM. PRINCIPAL FINDINGS Our DID analysis did not show improved medication adherence associated with employer DHP adoption. However, the DDD model suggested a difference between DHP-exposed and comparison beneficiaries when comparing the relative effect on individuals who were adherent versus non-adherent at baseline, as suggested by the significant three-way interaction term (10.2,p = 0.028). This effect was driven by the 8.2 percentage point increase in medication adherence for the DHP subsample that was non-adherent at baseline. CONCLUSIONS The DHP may benefit low-income patients with low baseline medication adherence. Value-based insurance design may be an important strategy for mitigating income disparities in T2DM outcomes.
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Affiliation(s)
- Kimberly Danae Cauley Narain
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of MedicineUniversity of CaliforniaLos AngelesCaliforniaUSA,Center for Health AdvancementFielding School of Public Health, University of California Los AngelesLos AngelesCaliforniaUSA,Center for the Study of RacismSocial Justice, and Health Los AngelesLos AngelesCaliforniaUSA
| | - Norman Turk
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of MedicineUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - O. Kenrik Duru
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of MedicineUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Tannaz Moin
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of MedicineUniversity of CaliforniaLos AngelesCaliforniaUSA,HSR&D Center for the Study of Healthcare Innovation, Implementation & PolicyVA Greater Los Angeles Healthcare SystemLos AngelesCaliforniaUSA
| | - Sam Ho
- UnitedHealthcareMinnetonkaMinnesotaUSA
| | - Carol M. Mangione
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of MedicineUniversity of CaliforniaLos AngelesCaliforniaUSA,Fielding School of Public HealthUniversity of CaliforniaLos AngelesCaliforniaUSA
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12
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Narain KDC, Turk N, Duru OK, Moin T, Mangione CM. The Diabetes Health Plan and Healthcare Utilization Among Beneficiaries with Low Incomes. J Gen Intern Med 2022; 38:1672-1680. [PMID: 36385412 DOI: 10.1007/s11606-022-07903-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The socioeconomic status (SES) gradient in hospital and emergency room utilization among adults with type 2 diabetes (T2DM) is partially driven by cost-related non-adherence. OBJECTIVE To test the impact of the Diabetes Health Plan (DHP), a diabetes-specific health plan incorporating value-based insurance design principles on healthcare utilization among low-income adults with T2DM. DESIGN To examine the impact of the DHP on healthcare utilization, we employed a difference-in-differences (DID) study design with a propensity-matched comparison group. We modeled count and dichotomous outcomes using Poisson and logit models, respectively. PARTICIPANTS Cohort of adults (18-64) with T2DM, with an annual household income <$ 30,000, and who were continuously enrolled in an employer-sponsored UnitedHealthcare plan for at least 2 years between 2009 and 2014. INTERVENTIONS The DHP reduces or eliminates out-of-pocket costs for disease management visits, diabetes-related medicines, and diabetes self-monitoring supplies. The DHP also provides access to diabetes-specific telephone case management as well as other online resources. MAIN MEASURES Number of disease management visits (N = 1732), any emergency room utilization (N = 1758), and any hospitalization (N = 1733), within the year. KEY RESULTS DID models predicting disease management visits suggested that DHP-exposed beneficiaries had 1.7 fewer in-person disease management visits per year (- 1.70 [95% CI: - 2.19, - 1.20], p < 0.001), on average, than comparison beneficiaries. Models for emergency room (0.00 [95% CI: - 0.06, 0.06], p = 0.966) and hospital utilization (- 0.03 [95% CI: - 0.08, - 0.01], p = 0.164) did not demonstrate statistically significant changes associated with DHP exposure. CONCLUSIONS While no relationship between DHP exposure and high-cost utilization was observed in the short term, fewer in-person disease management visits were observed. Future studies are needed to determine the clinical implications of these findings.
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Affiliation(s)
- Kimberly Danae Cauley Narain
- Division of General Internal Medicine and Health Services Research (GIM/HSR), Department of Medicine, David Geffen School of Medicine, University of California, 1100 Glendon Ave., Suite 850, Los Angeles, CA, 90024, USA. .,Center for Health Advancement, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA.
| | - Norman Turk
- Division of General Internal Medicine and Health Services Research (GIM/HSR), Department of Medicine, David Geffen School of Medicine, University of California, 1100 Glendon Ave., Suite 850, Los Angeles, CA, 90024, USA
| | - O Kenrik Duru
- Division of General Internal Medicine and Health Services Research (GIM/HSR), Department of Medicine, David Geffen School of Medicine, University of California, 1100 Glendon Ave., Suite 850, Los Angeles, CA, 90024, USA
| | - Tannaz Moin
- Division of General Internal Medicine and Health Services Research (GIM/HSR), Department of Medicine, David Geffen School of Medicine, University of California, 1100 Glendon Ave., Suite 850, Los Angeles, CA, 90024, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Carol M Mangione
- Division of General Internal Medicine and Health Services Research (GIM/HSR), Department of Medicine, David Geffen School of Medicine, University of California, 1100 Glendon Ave., Suite 850, Los Angeles, CA, 90024, USA.,Fielding School of Public Health, University of California, Los Angeles, CA, USA
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13
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Saju R, Castellon-Lopez Y, Turk N, Moin T, Mangione CM, Norris KC, Vu A, Maranon R, Fu J, Cheng F, Duru OK. Differences in Weight Loss by Race and Ethnicity in the PRIDE Trial: a Qualitative Analysis of Participant Perspectives. J Gen Intern Med 2022; 37:3715-3722. [PMID: 35469358 PMCID: PMC9037581 DOI: 10.1007/s11606-022-07521-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/28/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many Diabetes Prevention Program (DPP) translation efforts have been less effective for underresourced populations. In the cluster-randomized Prediabetes Informed Decision and Education (PRIDE) trial, which evaluated a shared decision-making (SDM) intervention for diabetes prevention, Hispanic and non-Hispanic Black participants lost less weight than non-Hispanic White participants at 12-month follow-up. OBJECTIVE To explore perspectives about weight loss from PRIDE participants of different racial and ethnic groups. PARTICIPANTS Sample of participants with prediabetes who were randomized to the PRIDE intervention arm (n=24). APPROACH We conducted semi-structured interviews within three groups stratified by DPP participation and % weight loss at 12 months: (DPP+/WL+, enrolled in DPP and lost >5% weight; DPP+/WL-, enrolled in DPP and lost <3% weight; DPP-/WL-, did not enroll in DPP and lost <3% weight). Each group was further subdivided on race and ethnicity (non-Hispanic Black (NHB), non-Hispanic White (NHW), Hispanic). Interviews were conducted on Zoom and transcripts were coded and analyzed with Dedoose. KEY RESULTS Compared to NHW participants, Hispanic and NHB participants more often endorsed weight loss barriers of limited time to make lifestyle changes due to long work and commute hours, inconvenient DPP class locations and offerings, and limited disposable income for extra weight loss activities. Conversely, facilitators of weight loss regardless of race and ethnicity included retirement or having flexible work schedules; being able to identify convenient DPP classes; having a strong, positive support system; and purchasing supplementary resources to support lifestyle change (e.g., gym memberships, one-on-one activity classes). CONCLUSIONS We found that NHB and Hispanic SDM participants report certain barriers to weight loss more commonly than NHW participants, particularly barriers related to limited disposable income and/or time constraints. Our findings suggest that increased lifestyle change support and flexible program delivery options may be needed to ensure equity in DPP reach, participant engagement, and outcomes.
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Affiliation(s)
- Rintu Saju
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Yelba Castellon-Lopez
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Family Medicine, University of California, Los Angeles, CA, USA
| | - Norman Turk
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - Tannaz Moin
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
- VA Greater Los Angeles Health System and HSR&D Center for Study of Healthcare Innovation, Implementation & Policy, University of California, Los Angeles, CA, USA
- Division of Endocrinology, Diabetes & Metabolism, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Carol M Mangione
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Keith C Norris
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - Amanda Vu
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - Richard Maranon
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - Jeffery Fu
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - Felicia Cheng
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA
| | - O Kenrik Duru
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
- Department of Medicine, Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, CA, USA.
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14
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Huang CX, Turk N, Ettner SL, Mangione CM, Moin T, O’Shea D, Luchs R, Chan C, Duru OK. Does the diabetes health plan have a differential impact on medication adherence among beneficiaries with fewer financial resources? J Manag Care Spec Pharm 2022; 28:948-957. [PMID: 36001105 PMCID: PMC10372993 DOI: 10.18553/jmcp.2022.28.9.948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND: The Diabetes Health Plan (DHP), a value-based insurance plan that reduces cost sharing, was previously shown to modestly increase employer-level medication adherence. It is unclear how the DHP might impact individuals with different incomes. OBJECTIVE: To examine the impact of the DHP on individual-level medication adherence, by income level. METHODS: This is a retrospective, quasiexperimental study. An employer-level propensity score match was done to identify suitable control employers, followed by individual-level propensity score weighing. These weights were applied to difference-in-difference models examining the effect of the DHP and the effect of income on changes in adherence to metformin, statins, and angiotensin-converting enzymes/angiotensin receptor blockers. The weights were then applied to a differences-in-differences-in-differences model to estimate the differential impact of DHP status on changes in adherence by income group. RESULTS: The study population included 2,065 beneficiaries with DHP and 17,704 matched controls. There were no significant differences in changes to adherence for any medications between beneficiaries enrolled in the DHP vs standard plans. However, adherence to all medications was higher among those with incomes greater than $75,000 (year 1: metformin: +7.3 percentage points; statin +4.3 percentage points; angiotensin-converting enzymes/angiotensin receptor blockers: +6.2 percentage points; P < 0.01) compared with those with incomes less than $50,000. The differences-in-differences-in-differences term examining the impact of income on the DHP effect was not significant for any comparisons. CONCLUSIONS: We did not find significant associations between the DHP and changes in individual-level medication adherence, even for low-income beneficiaries. New strategies to improve consumer engagement may be needed to translate value-based insurance designs into changes in patient behavior. DISCLOSURES: Drs Ettner and Moin received grants from the Centers for Disease Control and Prevention and National Institute of Diabetes and Digestive and Kidney Diseases (Principal Investigator: Carol Mangione). Mr Luchs received support for attending meetings and/or travel (minimal-mileage and hotel on 2 occasions). Mr Chan has an employee benefit to purchase stock for UnitedHealth Group.
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Affiliation(s)
- Cher X Huang
- Department of Internal Medicine, Massachusetts General Hospital, Boston
| | - Norman Turk
- Department of Medicine, University of California, Los Angeles
| | - Susan L Ettner
- Fielding School of Public Health, University of California, Los Angeles
| | - Carol M Mangione
- Department of Medicine, University of California, Los Angeles
- Fielding School of Public Health, University of California, Los Angeles
| | - Tannaz Moin
- Department of Medicine, University of California, Los Angeles
| | | | | | | | - O Kenrik Duru
- Department of Medicine, University of California, Los Angeles
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Alva ML, Chakkalakal RJ, Moin T, Galaviz KI. The Diabetes Prevention Gap And Opportunities To Increase Participation In Effective Interventions. Health Aff (Millwood) 2022; 41:971-979. [PMID: 35759735 PMCID: PMC10112939 DOI: 10.1377/hlthaff.2022.00259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
To understand the current state of prediabetes burden and treatment in the US, we examined recent trends in prediabetes prevalence, testing, and access to preventive resources. We estimated 13.5 percent prevalence of diagnosed prediabetes in the overall US adult population, using national survey data. Although prediabetes prevalence increased by 4.8 percentage points from 2010 to 2020, access to preventive resources remained low. The most effective intervention for diabetes prevention, known as the National Diabetes Prevention Program, remained woefully undersupplied and underused. There are only 2,098 National Diabetes Prevention Program-recognized providers nationally, and only 3 percent of adults with prediabetes have participated in the program. We suggest three actions to augment prevention efforts: increase payment for prevention interventions to avoid supply distortions, improve data integration and patient follow-up, and extend coverage and broaden access for preventive interventions. These actions, which would require policy-level changes, could lower the barriers to prevention.
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Affiliation(s)
- Maria L Alva
- Maria L. Alva , Georgetown University, Washington, D.C
| | | | - Tannaz Moin
- Tannaz Moin, University of California Los Angeles, Irvine, California
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Everett EM, Copeland TP, Moin T, Wisk LE. Insulin Pump-related Inpatient Admissions in a National Sample of Youth With Type 1 Diabetes. J Clin Endocrinol Metab 2022; 107:e2381-e2387. [PMID: 35196382 PMCID: PMC9113825 DOI: 10.1210/clinem/dgac047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Insulin pump use in type 1 diabetes management has significantly increased in recent years, but we have few data on its impact on inpatient admissions for acute diabetes complications. METHODS We used the 2006, 2009, 2012, and 2019 Kids' Inpatient Database to identify all-cause type 1 diabetes hospital admissions in those with and without documented insulin pump use and insulin pump failure. We described differences in (1) prevalence of acute diabetes complications, (2) severity of illness during hospitalization and disposition after discharge, and (3) length of stay (LOS) and inpatient costs. RESULTS We identified 228 474 all-cause admissions. Insulin pump use was documented in 7% of admissions, of which 20% were due to pump failure. The prevalence of diabetic ketoacidosis (DKA) was 47% in pump nonusers, 39% in pump users, and 60% in those with pump failure. Admissions for hyperglycemia without DKA, hypoglycemia, sepsis, and soft tissue infections were rare and similar across all groups. Admissions with pump failure had a higher proportion of admissions classified as major severity of illness (14.7%) but had the lowest LOS (1.60 days, 95% CI 1.55-1.65) and healthcare costs ($13 078, 95% CI $12 549-$13 608). CONCLUSIONS Despite the increased prevalence of insulin pump in the United States, a minority of pediatric admissions documented insulin pump use, which may represent undercoding. DKA admission rates were lower among insulin pump users compared to pump nonusers. Improved accuracy in coding practices and other approaches to identify insulin pump users in administrative data are needed, as are interventions to mitigate risk for DKA.
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Affiliation(s)
- Estelle M Everett
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Timothy P Copeland
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Tannaz Moin
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Lauren E Wisk
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA
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Williams J, Sachdev N, Kirley K, Moin T, Duru OK, Brunisholz KD, Sill K, Joy E, Aquino GC, Brown AR, O'Connell C, Rea B, Craig-Buckholtz H, Witherspoon PW, Bruett C. Implementation of Diabetes Prevention in Health Care Organizations: Best Practice Recommendations. Popul Health Manag 2022; 25:31-38. [PMID: 34161148 PMCID: PMC8861908 DOI: 10.1089/pop.2021.0044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Approximately 1 in 3 American adults has prediabetes, a condition characterized by blood glucose levels that are above normal, not in the type 2 diabetes ranges, and that increases the risk of developing type 2 diabetes. Evidence-based treatments can be used to prevent or delay type 2 diabetes in adults with prediabetes. The American Medical Association (AMA) has collaborated with health care organizations across the country to build sustainable diabetes prevention strategies. In 2017, the AMA formed the Diabetes Prevention Best Practices Workgroup (DPBP) with representatives from 6 health care organizations actively implementing diabetes prevention. Each organization had a unique strategy, but all included the National Diabetes Prevention Program lifestyle change program as a core evidence-based intervention. DPBP established the goal of disseminating best practices to guide other health care organizations in implementing diabetes prevention and identifying and managing patients with prediabetes. Workgroup members recognized similarities in some of their basic steps and considerations and synthesized their practices to develop best practice recommendations for 3 strategy maturity phases. Recommendations for each maturity phase are classified into 6 categories: (1) organizational support; (2) workforce and funding; (3) promotion and dissemination; (4) clinical integration and support; (5) evaluation and outcomes; (6) and program. As the burden of chronic disease grows, prevention must be prioritized and integrated into health care. These maturity phases and best practice recommendations can be used by any health care organization committed to diabetes prevention. Further research is suggested to assess the impact and adoption of diabetes prevention best practices.
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Affiliation(s)
- Janet Williams
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA.,Address correspondence to: Janet Williams, MA, Improving Health Outcomes, American Medical Association, 330 N. Wabash Avenue, Chicago, IL 60611, USA
| | - Neha Sachdev
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA.,David Geffen School of Medicine, UCLA and VA, Los Angeles, California, USA
| | - Kate Kirley
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA.,David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Tannaz Moin
- David Geffen School of Medicine, UCLA and VA, Los Angeles, California, USA
| | - O. Kenrik Duru
- David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | | | - Kelly Sill
- Improving Health Outcomes, American Medical Association, Chicago, Illinois, USA
| | - Elizabeth Joy
- Wellness and Nutrition, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Gina C. Aquino
- Henry Ford Macomb Hospital, Clinton Township, Michigan, USA
| | - Ameldia R. Brown
- Faith and Community Health, Henry Ford Health System, Clinton Township, Michigan, USA
| | | | - Brenda Rea
- Department of Family Medicine and Preventive Medicine, Loma Linda University Health, Redlands, California, USA
| | - Holly Craig-Buckholtz
- Diabetes and Outpatient Wound Care Services, Loma Linda University Medical Center, Loma Linda, California, USA
| | | | - Cindy Bruett
- Diabetes Prevention Program, Community Health & Well-Being, Trinity Health, Livonia, Michigan, USA
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18
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Vu A, Turk N, Duru OK, Mangione CM, Panchal H, Amaya S, Castellon-Lopez Y, Norris K, Moin T. Association of Type 2 Diabetes Risk Perception With Interest in Diabetes Prevention Strategies Among Women With a History of Gestational Diabetes. Diabetes Spectr 2022; 35:335-343. [PMID: 36072816 PMCID: PMC9396721 DOI: 10.2337/ds21-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The aims of this study were to identify predictors of perception of type 2 diabetes risk in women with a history of gestational diabetes mellitus (GDM) and to determine factors associated with interest in evidence-based strategies for type 2 diabetes prevention. RESEARCH DESIGN AND METHODS We surveyed women with a history of GDM who had not progressed to type 2 diabetes from a large academic medical center. We used multivariate logistic regression to assess predictors of high levels of perception of type 2 diabetes risk. We also tested associations between risk perception and interest in a lifestyle change program and/or metformin therapy. RESULTS In our diverse sample of 264 women, 28% were unaware that GDM is a risk factor for incident type 2 diabetes after pregnancy, and 48% believed their personal risk of type 2 diabetes was low. In multivariate analyses, family history of diabetes (odds ratio [OR] 2.2, 95% CI 1.2-4.4) and knowledge of GDM as a risk factor for incident type 2 diabetes (OR 4.5, 95% CI 2.1-9.8) were significant predictors of greater perception of type 2 diabetes risk. Women with higher risk perception were more likely to express interest in a lifestyle change program compared with women with lower risk perception (OR 2.4, 95% CI 1.3-4.5). CONCLUSION Although some women are aware that GDM is a risk factor for incident type 2 diabetes, many still perceive their own risk of developing type 2 diabetes as low. Higher risk perception predicted interest in an evidence-based diabetes prevention program, highlighting the importance of personalized risk assessment and communication about risk for women who have had GDM.
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Affiliation(s)
- Amanda Vu
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, Los Angeles, Los Angeles, CA
- Corresponding author: Amanda Vu,
| | - Norman Turk
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - O. Kenrik Duru
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, Los Angeles, Los Angeles, CA
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Carol M. Mangione
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, Los Angeles, Los Angeles, CA
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA
| | - Hemali Panchal
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Sarah Amaya
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, Los Angeles, Los Angeles, CA
| | - Yelba Castellon-Lopez
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Keith Norris
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, Los Angeles, Los Angeles, CA
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Tannaz Moin
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
- Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Health System, Los Angeles, CA
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19
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Gholami M, Jackson NJ, Chung UYR, Duru OK, Shedd K, Soetenga S, Loeb T, Elashoff D, Hamilton AB, Mangione CM, Slusser W, Moin T. Evaluation of the University of California Diabetes Prevention Program (UC DPP) Initiative. BMC Public Health 2021; 21:1775. [PMID: 34592981 PMCID: PMC8482560 DOI: 10.1186/s12889-021-11731-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2022] Open
Abstract
Background Type 2 diabetes can negatively impact long term health outcomes, healthcare costs and quality of life. However, intensive lifestyle interventions, including the Diabetes Prevention Program (DPP), can significantly lower risk of incident type 2 diabetes among overweight adults with prediabetes. Unfortunately, the majority of adults in the US who are at risk of developing diabetes do not engage in DPP-based lifestyle change programs. Increased adoption of evidence-based obesity and diabetes prevention interventions, such as the DPP, may help large employers reduce health risks and improve health outcomes among employees. In 2018, the University of California Office of thePresident (UCOP) implemented the UC DPP Initiative, a novel, multi-component program to address diabetes and obesity prevention across the UC system. Methods The goal of our study is to conduct a multifaceted evaluation of the UC DPP Initiative using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Our evaluation will integrate unique and diverse UC data sources, including electronic health record (EHR) data, administrative claims, campus-based DPP cohort data, qualitative interviews and site visits. Our primary outcome of interest is the mean percent weight change among three groups of overweight/obese UC beneficiaries at risk for diabetes at 12-month follow-up. Secondary outcomes include mean percent weight change at 24-month follow-up, barriers and facilitators associated with implementatio, as well as the degree of program adoption and maintenance. Discussion Our study will help inform diabetes and obesity prevention efforts across the UC system. Findings from this evaluation will also be highly applicable to universities and large employers, as well as community organizers, healthcare organizations and insurers implementing the DPP and/or other health promotion interventions.
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Affiliation(s)
| | - Nicholas J Jackson
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - Un Young Rebecca Chung
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - O Kenrik Duru
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - Kelly Shedd
- Campus Recreation, University of California, Los Angeles, Los Angeles, CA, USA
| | - Samantha Soetenga
- Campus Recreation, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tamara Loeb
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - David Elashoff
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - Alison B Hamilton
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Carol M Mangione
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - Wendelin Slusser
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA
| | - Tannaz Moin
- David Geffen School of Medicine at the University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, USA. .,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
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20
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Affiliation(s)
- Edward W Gregg
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
| | - Tannaz Moin
- Divisions of Endocrinology, Diabetes & Metabolism and General Internal Medicine & Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
- Health Services Research and Development Service Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
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21
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Haibach JP, Hoerster KD, Dorflinger L, McAndrew LM, Cassidy DG, Goodrich DE, Bormann JE, Lowery J, Asch SM, Raffa SD, Moin T, Peterson AL, Goldstein MG, Neal-Walden T, Talcott GW, Hunter CL, Knight SJ. Research translation for military and veteran health: research, practice, policy. Transl Behav Med 2021; 11:631-641. [PMID: 32043529 DOI: 10.1093/tbm/ibz195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Military service presents unique challenges and opportunities for health care and public health. In the USA, there are over 2 million military servicemembers, 20 million veterans, and millions more military and veteran family members. Military servicemembers and eligible family members, many veterans, and retirees receive health care through the two largest learning health care systems in the USA, managed and delivered through the Departments of Defense (DoD), Veterans Affairs (VA), and contracted health care organizations. Through a network of collaborative relationships, DoD, VA, and partnering health care and research organizations (university, corporate, community, and government) accelerate research translation into best practices and policy across the USA and beyond. This article outlines military and veteran health research translation as summarized from a collaborative workshop led by experts across health care research, practice, and administration in DoD, VA, the National Institutes of Health, and affiliated universities. Key themes and recommendations for research translation are outlined in areas of: (a) stakeholder engagement and collaboration; (b) implementation science methods; and (c) funding along the translation continuum. Overall, the ability to rapidly translate research into clinical practice and policy for positive health outcomes requires collaborative relationships among many stakeholders. This includes servicemembers, veterans, and their families along with researchers, health care clinicians, and administrators, as well as policymakers and the broader population.
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Affiliation(s)
- Jeffrey P Haibach
- U.S. Department of Veterans Affairs, Washington, DC, USA.,Veteran Consulting and Research Corp., Rochester, NY, USA
| | - Katherine D Hoerster
- Research and Development Service, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | | | - Lisa M McAndrew
- War Related Illness and Injury Study Center, VA New Jersey Health care System, East Orange, NJ, USA.,Department of Educational and Counseling Psychology, University at Albany, Albany, NY, USA
| | | | - David E Goodrich
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Jill E Bormann
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA, USA.,Hahn School of Nursing and Health Science/Beyster Institute for Nursing Research, University of San Diego, San Diego, CA, USA
| | - Julie Lowery
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Steven M Asch
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Division of Primary Care and Population Health, Stanford University, Stanford, CA, USA
| | - Susan D Raffa
- VA National Center for Health Promotion and Disease Prevention, Durham, NC, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Tannaz Moin
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Alan L Peterson
- Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX, USA.,Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center, San Antonio, TX, USA
| | - Michael G Goldstein
- VA National Center for Health Promotion and Disease Prevention, Durham, NC, USA
| | - Tracy Neal-Walden
- Steven A. Cohen Military Family Clinic at Easterseals, Silver Spring, MD, USA
| | - Gerald W Talcott
- Center for Addiction and Prevention Research, University of Virginia, Charlottesville, VA, USA
| | - Christopher L Hunter
- Primary Care and Clinical Patient Engagement/Experience, Military Affairs, Clinical Support Division, Defense Health Agency, Falls Church, VA, USA
| | - Sara J Knight
- VA Salt Lake City Health care System, Salt Lake City, UT, USA.,Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
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22
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Abstract
BACKGROUND AND OBJECTIVES Diabetic ketoacidosis (DKA) rates in the United States are rising. Prior studies suggest higher rates in younger populations, but no studies have evaluated national trends in pediatric populations and differences by subgroups. As such, we sought to examine national trends in pediatric DKA. METHODS We used the 2006, 2009, 2012, and 2016 Kids' Inpatient Database to identify pediatric DKA admissions among a nationally representative sample of admissions of youth ≤20 years old. We estimate DKA admission per 10 000 admissions and per 10 000 population, charges, length of stay (LOS), and trends over time among all hospitalizations and by demographic subgroups. Regression models were used to evaluate differences in DKA rates within subgroups overtime. RESULTS Between 2006 and 2016, there were 149 535 admissions for DKA. Unadjusted DKA rate per admission increased from 120.5 (95% CI, 115.9-125.2) in 2006 to 217.7 (95% CI, 208.3-227.5) in 2016. The mean charge per admission increased from $14 548 (95% CI, $13 971-$15 125) in 2006 to $20 997 (95% CI, $19 973-$22 022) in 2016, whereas mean LOS decreased from 2.51 (95% CI, 2.45-2.57) to 2.28 (95% CI, 2.23-2.33) days. Higher DKA rates occurred among 18- to 20-year-old females, Black youth, without private insurance, with lower incomes, and from nonurban areas. Young adults, men, those without private insurance, and from nonurban areas had greater increases in DKA rates across time. CONCLUSIONS Pediatric DKA admissions have risen by 40% in the United States and vulnerable subgroups remain at highest risk. Further studies should characterize the challenges experienced by these groups to inform interventions to mitigate their DKA risk and to address the rising DKA rates nationally.
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Affiliation(s)
- Estelle M Everett
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Correspondence: Estelle Everett, MD, MHS, David Geffen School of Medicine, University of California, Los Angeles, 1100 Glendon Ste 850, Los Angeles, CA 90024, United States.
| | - Timothy P Copeland
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Tannaz Moin
- Division of Endocrinology, Diabetes, & Metabolism, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Lauren E Wisk
- Division of General Internal Medicine & Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
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23
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Panchal H, Turk N, Moin T, Mangione CM, Vu A, Amaya S, Norris KC, Duru OK. Educational Attainment, Decision-Making Preferences, and Interest in Evidence-Based Diabetes Prevention among Women with a History of Gestational Diabetes Mellitus. Womens Health Rep (New Rochelle) 2021; 2:106-112. [PMID: 33937908 PMCID: PMC8082012 DOI: 10.1089/whr.2020.0116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/17/2021] [Indexed: 12/16/2022]
Abstract
Background: The Diabetes Prevention Program (DPP) showed that lifestyle change or metformin is equally efficacious in preventing diabetes in women who have had gestational diabetes mellitus (GDM). Few studies have investigated the relationship between education and willingness to engage in either intervention and between education and preferred decision-making style. Methods: Within a large health system, we surveyed insured women 18-64 years old with a history of GDM, identified through the electronic health record. We estimated preference for decision-making style and interest in DPP lifestyle change and/or metformin by educational level, using multivariate logistic regression models controlling for age, race, and ethnicity. Results: Our sample (n = 264) was 36% Latino, 29% Asian, 28% non-Latino white, and 5% African American, with a mean age of 37 years. In terms of education, 31% had a postgraduate degree, 41% were college graduates, and 29% did not graduate from college. In multivariate analyses, willingness to engage in either intervention did not vary by education. Women who did not graduate from college were more likely to leave medical decisions to their provider (p = 0.004) compared to women with a college or postgraduate degree. However, regardless of education, over 80% of women preferred to make medical decisions themselves or jointly with their provider. Conclusions: Most women prefer to play an active role in their own medical decisions and have an interest in both evidence-based diabetes prevention strategies. This suggests that shared decision-making is appropriate for many women with a history of GDM and different levels of educational attainment.
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Affiliation(s)
- Hemali Panchal
- Department of Internal Medicine, University of California, Davis, Sacramento, California, USA
| | - Norman Turk
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, California, USA
| | - Tannaz Moin
- Division of Endocrinology, Diabetes and Metabolism, University of California, Los Angeles, Los Angeles, California, USA.,HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Health System, Los Angeles, California, USA
| | - Carol M Mangione
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, California, USA
| | - Amanda Vu
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, California, USA
| | - Sarah Amaya
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, California, USA
| | - Keith C Norris
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, California, USA
| | - Obidiugwu Kenrik Duru
- Division of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, California, USA
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24
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Moin T, Martin JM, Mangione CM, Grotts J, Turk N, Norris KC, Tseng CH, Jeffers KS, Castellon-Lopez Y, Frosch DL, Duru OK. Choice of Intensive Lifestyle Change and/or Metformin after Shared Decision Making for Diabetes Prevention: Results from the Prediabetes Informed Decisions and Education (PRIDE) Study. Med Decis Making 2021; 41:607-613. [PMID: 33813948 DOI: 10.1177/0272989x211001279] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION While the Diabetes Prevention Program Study demonstrated that intensive lifestyle change and metformin both reduce type 2 diabetes incidence, there are little data on patient preferences in real-world, clinical settings. METHODS The Prediabetes Informed Decisions and Education (PRIDE) study was a cluster-randomized trial of shared decision making (SDM) for diabetes prevention. In PRIDE, pharmacists engaged patients with prediabetes in SDM using a decision aid with information about both evidence-based options. We recorded which diabetes prevention option(s) participants chose after the SDM visit. We also evaluated logistic regression models examining predictors of choosing intensive lifestyle change ± metformin, compared to metformin or usual care, and predictors of choosing metformin ± intensive lifestyle change, compared to intensive lifestyle change or usual care. RESULTS Among PRIDE participants (n = 515), 55% chose intensive lifestyle change, 8.5% chose metformin, 15% chose both options, and 21.6% declined both options. Women (odds ratio [OR] = 1.60, P = 0.023) had higher odds than men of choosing intensive lifestyle change. Patients >60 years old (OR = 0.50, P = 0.028) had lower odds than patients <50 years old of choosing metformin. Participants with higher body mass index (BMI) had higher odds of choosing intensive lifestyle change (OR = 1.07 per BMI unit increase, P = 0.005) v. other options and choosing metformin (OR = 1.06 per BMI unit increase, P = 0.008) v. other options. CONCLUSIONS Patients with prediabetes are making choices for diabetes prevention that generally align with recommendations and expected benefits from the published literature. Our results are important for policy makers and clinicians, as well as program planners developing systemwide approaches for diabetes prevention.
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Affiliation(s)
- Tannaz Moin
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,VA Greater Los Angeles Health System and HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, CA, USA
| | | | - Carol M Mangione
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,UCLA Fielding School of Public Health, Los Angeles, CA
| | - Jonathan Grotts
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Norman Turk
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Keith C Norris
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Chi-Hong Tseng
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Kia Skrine Jeffers
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | | | - Dominick L Frosch
- Palo Alto Medical Foundation for Health Care, Research and Education, Palo Alto, CA, USA
| | - O Kenrik Duru
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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25
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Abstract
PURPOSE OF REVIEW Type 2 diabetes (T2DM) is a major comorbidity of coronavirus disease 2019 (COVID-19) but less is known about COVID-19 and type 1 diabetes (T1DM). Thus, our goal was to review the literature on COVID and T1DM. RECENT FINDINGS We identified 21 reports focusing on COVID-19 infections among patients with preexisting T1DM (n = 7), incident T1DM presentations during the COVID-19 quarantine (n = 6), and outpatient management of T1DM during the COVID-19 quarantine (n = 8). These studies showed that patients with preexisting T1DM and COVID-19 infection often present with hyperglycemia and/or diabetic ketoacidosis (DKA). Although the risk of in-hospital mortality may be increased, hospitalization rates among patients with T1DM mirror that of the general population. The numbers of patients presenting with incident T1DM during COVID-19 quarantine have remained stable, but cases with severe DKA may have increased. COVID-19 quarantine has also impacted outpatient T1DM management and studies examining changes in glycemic control have shown mixed results. SUMMARY COVID-19 has important implications for patients with type 1 diabetes, but additional studies with larger numbers of patients and longer term follow-up are needed to confirm the early findings highlighted in this review.
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Affiliation(s)
- Diana J Chang
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, UCLA David Geffen School of Medicine
| | - Tannaz Moin
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, UCLA David Geffen School of Medicine
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Health System, Los Angeles, California, USA
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26
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Moin T, Steers N, Ettner SL, Duru K, Turk N, Chan C, Keckhafer AM, Luchs RH, Ho S, Mangione CM. Association of the Diabetes Health Plan with emergency room and inpatient hospital utilization: a Natural Experiment for Translation in Diabetes (NEXT-D) Study. BMJ Open Diabetes Res Care 2021; 9:9/1/e001802. [PMID: 33431601 PMCID: PMC7802657 DOI: 10.1136/bmjdrc-2020-001802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/16/2020] [Accepted: 12/14/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION To examine the association of a novel disease-specific health plan, known as the Diabetes Health Plan (DHP), with emergency room (ER) and hospital utilization among patients with diabetes and pre-diabetes. RESEARCH DESIGN AND METHODS Quasi-experimental design, with employer group as the unit of analysis, comparing changes in any ER and inpatient hospital utilization over a 3-year period. Inverse probability weighting was used to control for differences between employers purchasing DHP versus standard plans. Estimated differences in utilization are calculated as average treatment effects on the treated. We used employees and dependents from employer groups contracting with a large, national private insurer between 2009 and 2012. Eligibility and claims data from continuously covered employees and dependents with diabetes and pre-diabetes (n=74 058) were aggregated to the employer level. The analysis included 9 DHP employers (n=7004) and 183 control employers (n=67 054). RESULTS DHP purchase was associated with 2.4 and 1.8 percentage points absolute reduction in mean rates of any ER utilization, representing 13% and 10% relative reductions at 1 and 2 years post-DHP (p=0.012 and p=0.046, respectively). There was no significant association between DHP purchase and hospital utilization. CONCLUSION Employers purchasing diabetes-specific health benefit designs may experience lower rates of resource-intensive services such as ER utilization.
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Affiliation(s)
- Tannaz Moin
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Neil Steers
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Susan L Ettner
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Kenrik Duru
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Norman Turk
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Charles Chan
- United Healthcare Services, Minneapolis, Minnesota, USA
| | | | | | - Sam Ho
- United Healthcare Services, Minneapolis, Minnesota, USA
| | - Carol M Mangione
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
- Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
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Castellon-Lopez Y, Skrine Jeffers K, Duru OK, Moreno G, Moin T, Grotts J, Mangione CM, Norris KC, Hays RD. Psychometric Properties of the Altarum Consumer Engagement (ACE) Measure of Activation in Patients with Prediabetes. J Gen Intern Med 2020; 35:3159-3165. [PMID: 32162203 PMCID: PMC7661602 DOI: 10.1007/s11606-020-05727-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 02/10/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient activation is associated with better outcomes in chronic conditions. OBJECTIVE We evaluated the psychometric properties of the 12-item Altarum Consumer Engagement™ Measure (ACE-12) in patients with prediabetes. PARTICIPANTS ACE-12 was administered to patients in the Prediabetes Informed Decisions and Education Study. MAIN MEASURES We conducted an exploratory factor analysis followed by confirmatory factor analytic models. We evaluated item response categories using item characteristic curves. Construct validity was assessed by examining correlations of the ACE-12 scales with education, depressive symptoms, self-rated health, hemoglobin A1c, body mass index, and weight loss. KEY RESULTS Participants (n = 515) had a median age of 58; 56% were female; 17% Hispanic; 54% were non-White. The scree plot and Tucker and Lewis reliability coefficient (0.95) suggested three factors similar to the original scales. One item loaded on the navigation rather than the informed choice scale. Ordinal alpha coefficients for the original scales were commitment (0.75); informed choice (0.71); and navigation (0.54). ICCs indicated that one or more of the response categories for 5 of the 12 items were never most likely to be selected. Patients with lower education were less activated on the commitment (r = - 0.124, p = 0.004), choice (r = - 0.085, p = 0.009), and overall score (r = - 0.042, p = 0.011). Patients with depressive symptoms had lower commitment (r = - 0.313, p ≤ 0.001) and overall scores (r = - 0.172, p = 0.012). Patients with poorer health scored lower on the Commitment (r = - 0.308, p ≤ 0.001), Navigation (r = - 0.137, p ≤ 0.001), and overall score (r = - 0.279, p ≤ 0.001). CONCLUSION The analyses provide some support for the psychometric properties of the ACE-12 in prediabetic patients. Future research evaluating this tool among patients with other chronic conditions are needed to determine whether Q1 (I spend a lot of time learning about health) should remain in the informed choice or be included in the navigation scale. Additional items may be needed to yield acceptable reliability for the navigation scale.
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Affiliation(s)
- Yelba Castellon-Lopez
- Department of Family Medicine, University of California Los Angeles, 10880 Wilshire Blvd, Suite 1800, Los Angeles, CA, 90095, USA.
| | | | - O Kenrik Duru
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, Los Angeles, CA, USA
| | - Gerardo Moreno
- Department of Family Medicine, University of California Los Angeles, 10880 Wilshire Blvd, Suite 1800, Los Angeles, CA, 90095, USA
| | - Tannaz Moin
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, Los Angeles, CA, USA
- VA Greater Los Angeles Health System and HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, CA, USA
| | - Jonathan Grotts
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, Los Angeles, CA, USA
| | - Carol M Mangione
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, Los Angeles, CA, USA
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Keith C Norris
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, Los Angeles, CA, USA
| | - Ron D Hays
- Department of Medicine, Division of General Internal Medicine-Health Services Research, University of California, Los Angeles, CA, USA
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, CA, USA
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Lane KL, Moin T. AUTOIMMUNE DIABETES IN A PATIENT WITH HUMAN IMMUNODEFICIENCY VIRUS ON ANTI-RETROVIRAL THERAPY WITH LITERATURE REVIEW. AACE Clin Case Rep 2020; 6:e201-e206. [PMID: 32984521 DOI: 10.4158/accr-2019-0480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/08/2020] [Indexed: 12/28/2022] Open
Abstract
Objective Diabetes that develops in human immunodeficiency virus-infected individuals is typically classified as type 2 diabetes mellitus. Although less commonly reported, it has been shown that autoimmune diabetes can also develop in this population. Methods We present a case of a patient found to have autoimmune diabetes following initiation of anti-retroviral therapy. Results A 68-year-old, African American man with human immunodeficiency virus had a nadir CD4 count of 2 cells/μL, which improved with anti-retroviral therapy. He was subsequently diagnosed with type 2 diabetes mellitus but developed worsening glycemic control. Further investigation demonstrated an elevated glutamic acid decarboxylase antibody level >250 IU/mL and a declining C peptide level from 1.82 ng/mL to 0.56 ng/mL. He was ultimately diagnosed with autoimmune diabetes that was treated with insulin glargine and insulin aspart with improvement in his glycemic control. Conclusion Autoimmune diabetes in this case was attributed to immune reconstitution after anti-retroviral therapy led to recovery from a significantly low CD4 count. While this phenomenon has been described in previous case reports, our case was unique in that autoimmune diabetes affected an older African American man, a different demographic than previously reported. Although the true mechanism of this association remains unknown, the recognition of autoimmune diabetes is crucial as it greatly impacts diabetes management.
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Affiliation(s)
- Kyrstin L Lane
- Division of Endocrinology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California.,VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Tannaz Moin
- Division of Endocrinology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California.,Health Services Research and Development, Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, California
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29
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Duru OK, Harwood J, Moin T, Jackson N, Ettner S, Vasilyev A, Mosley DG, O’Shea DL, Ho S, Mangione CM. Evaluation of a National Care Coordination Program to Reduce Utilization Among High-cost, High-need Medicaid Beneficiaries With Diabetes. Med Care 2020; 58 Suppl 6 Suppl 1:S14-S21. [PMID: 32412949 PMCID: PMC10653047 DOI: 10.1097/mlr.0000000000001315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Medical, behavioral, and social determinants of health are each associated with high levels of emergency department (ED) visits and hospitalizations. OBJECTIVE The objective of this study was to evaluate a care coordination program designed to provide combined "whole-person care," integrating medical, behavioral, and social support for high-cost, high-need Medicaid beneficiaries by targeting access barriers and social determinants. RESEARCH DESIGN Individual-level interrupted time series with a comparator group, using person-month as the unit of analysis. SUBJECTS A total of 42,214 UnitedHealthcare Medicaid beneficiaries (194,834 person-months) age 21 years or above with diabetes, with Temporary Assistance to Needy Families, Medicaid expansion, Supplemental Security Income without Medicare, or dual Medicaid/Medicare. MEASURES Our outcome measures were any hospitalizations and any ED visits in a given month. Covariates of interest included an indicator for intervention versus comparator group and indicator and spline variables measuring changes in an outcome's time trend after program enrollment. RESULTS Overall, 6 of the 8 examined comparisons were not statistically significant. Among Supplemental Security Income beneficiaries, we observed a larger projected decrease in ED visit risk among the intervention sample versus the comparator sample at 12 months postenrollment (difference-in-difference: -6.6%; 95% confidence interval: -11.2%, -2.1%). Among expansion beneficiaries, we observed a greater decrease in hospitalization risk among the intervention sample versus the comparator sample at 12 months postenrollment (difference-in-difference: -5.8%; 95% confidence interval: -11.4%, -0.2%). CONCLUSION A care coordination program designed to reduce utilization among high-cost, high-need Medicaid beneficiaries was associated with fewer ED visits and hospitalizations for patients with diabetes in selected Medicaid programs but not others.
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Affiliation(s)
- O. Kenrik Duru
- David Geffen School of Medicine, UCLA, 1100 Glendon Ave Suite 850, Los Angeles, CA 90024
| | - Jessica Harwood
- David Geffen School of Medicine, UCLA, 1100 Glendon Ave Suite 850, Los Angeles, CA 90024
| | - Tannaz Moin
- David Geffen School of Medicine, UCLA, 1100 Glendon Ave Suite 850, Los Angeles, CA 90024
- VA Greater Los Angeles Healthcare System,11301 Wilshire Boulevard Los Angeles, CA 90073-1003
| | - Nick Jackson
- David Geffen School of Medicine, UCLA, 1100 Glendon Ave Suite 850, Los Angeles, CA 90024
| | - Susan Ettner
- David Geffen School of Medicine, UCLA, 1100 Glendon Ave Suite 850, Los Angeles, CA 90024
- UCLA Fielding School of Public Health, 650 Charles E. Young Dr. South, Los Angeles, CA 90095
| | - Arseniy Vasilyev
- David Geffen School of Medicine, UCLA, 1100 Glendon Ave Suite 850, Los Angeles, CA 90024
| | | | | | - Sam Ho
- UnitedHealthcare, Minnetonka, MN 55343
| | - Carol M. Mangione
- David Geffen School of Medicine, UCLA, 1100 Glendon Ave Suite 850, Los Angeles, CA 90024
- UCLA Fielding School of Public Health, 650 Charles E. Young Dr. South, Los Angeles, CA 90095
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Everett E, Copeland T, Moin T, Wisk L. SAT-LB119 Diabetic Ketoacidosis With PUMP Failure: Analysis of the 2006-2016 U.S. Kid Inpatient Database. J Endocr Soc 2020. [PMCID: PMC7209130 DOI: 10.1210/jendso/bvaa046.2177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background: Insulin pumps are valuable tools in diabetes management and their use has increased dramatically over the past decade. Unfortunately, insulin pump use has also been associated with diabetic ketoacidosis (DKA), relating to pump malfunctions that result in the disruption in insulin administration. Our objective was to examine the prevalence and characteristics of DKA admissions associated with pump failure among pediatric patients. Methods: We used the national Kids’ Inpatient Database to identify pediatric admissions with a primary diagnosis of DKA in years 2006, 2009, 2012, and 2016. We defined a DKA-pump failure admission as an admission with either a primary diagnosis of DKA plus a secondary diagnosis of pump failure/complication or conversely, a primary diagnosis of pump failure/complication with a secondary diagnosis of DKA. We used descriptive statistics and logistic regression to describe the annual trends and characteristics of children admitted for DKA with or without pump failure. Lastly, logistic regression was used to assess the impact of pump failure on length of stay and severity of illness during DKA admissions. Results: Our dataset included 166,583 DKA admissions, of which 2,291 (1.4%) were associated with a primary or secondary diagnosis of insulin pump failure. Between 2006 and 2016, the number of total DKA admissions increased by 58%. Admissions for DKA with pump failure increased from 387 to 665 admissions during this time. Among all children admitted with DKA, those with pump failure were primarily older (60% above age 12), mostly white (63%), female (57%), from urban areas (78%), and almost 2/3rds had private insurance (60%). Adjusted analyses revealed that compared to DKA admissions without pump failure, pump failure was associated with older age, white race, residing in a rural area, private insurance, and higher income. Pump failure admissions were more likely in western and southern hospitals, otherwise there were no significant differences with respect to hospital characteristics. Compared to DKA admissions without pump failure, DKA admissions associated with pump failure had a longer mean length of stay (2.6 vs 1.5 days) and were more likely to have a higher severity of illness category. Conclusion: In this national sample, DKA with pump failure was more often observed among white, privately insured and high income children; these patient characteristics likely reflect the population of youth with diabetes who are more likely prescribed pumps in the US. Admissions for DKA concurrent with insulin pump failure accounted for a minority of pediatric DKA admissions but these admissions were associated with longer lengths of stay and severity of illness. Pump failure has important implications for care and management of children with diabetes.
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Affiliation(s)
| | | | - Tannaz Moin
- University of California Los Angeles, Los Angeles, CA, USA
| | - Lauren Wisk
- University of California Los Angeles, Los Angeles, CA, USA
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31
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Moin T, Li J, Duru K, Ettner SL, Turk N, Chan C, Keckhafer AM, Luchs RH, Ho S, Mangione CM. Results from NEXT-D: the association of a pre-diabetes-specific health plan and rates of incident diabetes among a national sample of working-age adults. BMJ Open Diabetes Res Care 2020; 8:8/1/e001093. [PMID: 32312720 PMCID: PMC7199143 DOI: 10.1136/bmjdrc-2019-001093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/20/2020] [Accepted: 03/21/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Pre-diabetes affects one-third of adults in the USA and a subset will progress to type 2 diabetes. Our objective was to determine whether a disease-specific health plan, known as the Diabetes Health Plan (DHP), designed to improve care for persons with pre-diabetes and diabetes also led to lower rates of incident diabetes among adults with pre-diabetes. METHODS We examined eligibility and claims data from a large payer who offered the DHP to a national sample of employers. We included adult employees and dependents who were continuously covered by the DHP over a 4-year study window. The primary outcome was incident diabetes. We conducted propensity score matching at the employer level to find comparable control employer groups offering standard plans. Using an adjusted logistic regression model at the individual level, we tested the association between DHP employer group status and incident diabetes diagnosis during the 3 years of postbaseline follow-up. FINDINGS Our analysis included data from 11 965 continuously enrolled adults with pre-diabetes (n=1538 from nine employers offering DHP; n=10 427 from 105 control employers offering standard plans). DHP employees and covered dependents with pre-diabetes had an 8% lower absolute predicted probability of incident diabetes compared with individuals from employer groups offering standard benefit plans (29% predicted probability of incident diabetes for DHP vs 37% for controls, p<0.001). CONCLUSIONS A pre-diabetes-specific health benefit design was associated with lower rates of incident diabetes and represents an area of needed future study.
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Affiliation(s)
- Tannaz Moin
- Department of Medicine, University of California, Los Angeles, California, USA
- HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Jinnan Li
- Department of Medicine, University of California, Los Angeles, California, USA
| | - Kenrik Duru
- Department of Medicine, University of California, Los Angeles, California, USA
| | - Susan L Ettner
- Department of Medicine, University of California, Los Angeles, California, USA
- Fielding School of Public Health, UCLA, Los Angeles, California, USA
| | - Norman Turk
- Department of Medicine, University of California, Los Angeles, California, USA
| | - Charles Chan
- United HealthCare Services, Minneapolis, Minnesota, USA
| | | | | | - Sam Ho
- United HealthCare Services, Minneapolis, Minnesota, USA
| | - Carol M Mangione
- Department of Medicine, University of California, Los Angeles, California, USA
- Fielding School of Public Health, UCLA, Los Angeles, California, USA
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32
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Dyer KE, Moreau JL, Finley E, Bean-Mayberry B, Farmer MM, Bernet D, Kress A, Lewis JL, Batuman FK, Haskell SG, Hamilton AB, Moin T. Tailoring an evidence-based lifestyle intervention to meet the needs of women Veterans with prediabetes. Women Health 2020; 60:748-762. [PMID: 31959089 DOI: 10.1080/03630242.2019.1710892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Prediabetes affects one-third of U.S. adults. Lifestyle change interventions, such as the Diabetes Prevention Program (DPP), can significantly lower type 2 diabetes risk, but little is known about how the DPP could be best adapted for women. This mixed-methods study assessed the impact of gender-tailoring and modality choice on DPP engagement among women Veterans with prediabetes. Participants were offered women-only groups and either in-person/peer-led or online modalities. Implementation outcomes were assessed using attendance logs, recruitment calls, and semi-structured interviews about patient preferences. Between June 2016 and March 2017, 119 women Veterans enrolled in the DPP (n = 51 in-person, n = 68 online). We conducted 22 interviews between August and September 2016 (n = 10 early-implementation) and March and July 2017 (n = 12 follow-up). Most interviewees preferred women-only groups, citing increased comfort, camaraderie, and mutual understanding of gender-specific barriers to lifestyle change. More women preferred online DPP, and those using this modality participated at higher rates. Most endorsed the importance of modality choice and were satisfied with their selection; however, selection was frequently based on participants' personal circumstances and access barriers and not on a "preferred choice" of two equally accessible options. Patient engagement and program reach can be expanded by tailoring the DPP for population-specific needs.
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Affiliation(s)
- Karen E Dyer
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
| | - Jessica L Moreau
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
| | - Erin Finley
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles, California, USA.,Veterans Evidence-based Research, Dissemination, and Implementation Center (VERDICT), South Texas Veterans Healthcare System , San Antonio, Texas, USA.,Departments of Medicine and Psychiatry, University of Texas Health Science Center , San Antonio, Texas, USA
| | - Bevanne Bean-Mayberry
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles, California, USA.,UCLA David Geffen School of Medicine , Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
| | - Melissa M Farmer
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
| | - Dorothy Bernet
- VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
| | - Arthur Kress
- VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
| | - Jackie L Lewis
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
| | - Fatma K Batuman
- UCLA David Geffen School of Medicine , Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
| | - Sally G Haskell
- Women's Health Services, Veterans Health Administration , Washington, District of Columbia, USA.,VA Connecticut Healthcare System , West Haven, Connecticut, USA.,Yale University School of Medicine , New Haven, Connecticut, USA
| | - Alison B Hamilton
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles, California, USA.,UCLA David Geffen School of Medicine , Los Angeles, California, USA
| | - Tannaz Moin
- VHA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles, California, USA.,UCLA David Geffen School of Medicine , Los Angeles, California, USA.,VA Greater Los Angeles Healthcare System , Los Angeles, California, USA
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Skrine Jeffers K, Castellon-Lopez Y, Grotts J, Mangione CM, Moin T, Tseng CH, Turk N, Frosch DL, Norris KC, Duke CC, Moreno G, Duru OK. Diabetes Prevention Program attendance is associated with improved patient activation: Results from the Prediabetes Informed Decisions and Education (PRIDE) study. Prev Med Rep 2019; 16:100961. [PMID: 31516814 PMCID: PMC6732720 DOI: 10.1016/j.pmedr.2019.100961] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 07/18/2019] [Accepted: 07/21/2019] [Indexed: 01/10/2023] Open
Abstract
The Diabetes Prevention Program (DPP) is a 12-month behavior change program designed to increase physical activity and improve dietary patterns among patients at risk for Type 2 diabetes, in order to facilitate modest weight loss and improve cardio-metabolic profiles. It is unknown whether baseline patient activation is related to increased DPP uptake, and whether DPP attendance leads to subsequent improvement in patient activation. We analyzed data from 352 adult participants in the Prediabetes Informed Decisions and Education (PRIDE) trial of shared decision-making (SDM) in diabetes prevention, collected from November 2015 through September 2017. PRIDE participants completed baseline and 4-month follow-up surveys, including the Altarum Consumer Engagement (ACE) Measure™ of patient activation. We tracked DPP attendance over 8 months using data from partnering DPP providers. In multivariate models, we measured whether self-reported baseline activation was associated with DPP "uptake" (1+ session attended) or DPP "attendance" (9+ sessions). We also examined whether DPP attendance was associated with change in activation at 4-months follow-up. We did not find an association between baseline activation and DPP uptake or attendance. However, we did find that DPP attendance was associated with an increase in the overall ACE score (6.68 points, 95% CI 1.97-11.39, p = 0.005) and increased activation in 2 of the 3 ACE subscales (Commitment and Informed Choice). Our finding of increased patient activation with DPP attendance suggests a mechanism for the improved health outcomes seen in DPP real-world translational studies. This work has important implications for diabetes prevention and other behavior change programs.
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Affiliation(s)
| | - Yelba Castellon-Lopez
- Department of Family Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States of America
| | - Jonathan Grotts
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States of America
| | - Carol M. Mangione
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States of America
- Jonathan and Karin Fielding School of Public Health, UCLA, Los Angeles, CA, United States of America
| | - Tannaz Moin
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States of America
- Veterans Affairs Greater Los Angeles Health System, Veterans Affairs Health Services Research and Development Service Center for the Study of Healthcare Innovation, Implementation & Policy, United States of America
| | - Chi-Hong Tseng
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States of America
| | - Norman Turk
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States of America
| | | | - Keith C. Norris
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States of America
| | | | - Gerardo Moreno
- Department of Family Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States of America
| | - O. Kenrik Duru
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, CA, United States of America
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Norris KC, Duru OK, Alicic RZ, Daratha KB, Nicholas SB, McPherson SM, Bell DS, Shen JI, Jones CR, Moin T, Waterman AD, Neumiller JJ, Vargas RB, Bui AAT, Mangione CM, Tuttle KR. Rationale and design of a multicenter Chronic Kidney Disease (CKD) and at-risk for CKD electronic health records-based registry: CURE-CKD. BMC Nephrol 2019; 20:416. [PMID: 31747918 PMCID: PMC6868861 DOI: 10.1186/s12882-019-1558-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 09/12/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a global public health problem, exhibiting sharp increases in incidence, prevalence, and attributable morbidity and mortality. There is a critical need to better understand the demographics, clinical characteristics, and key risk factors for CKD; and to develop platforms for testing novel interventions to improve modifiable risk factors, particularly for the CKD patients with a rapid decline in kidney function. METHODS We describe a novel collaboration between two large healthcare systems (Providence St. Joseph Health and University of California, Los Angeles Health) supported by leadership from both institutions, which was created to develop harmonized cohorts of patients with CKD or those at increased risk for CKD (hypertension/HTN, diabetes/DM, pre-diabetes) from electronic health record data. RESULTS The combined repository of candidate records included more than 3.3 million patients with at least a single qualifying measure for CKD and/or at-risk for CKD. The CURE-CKD registry includes over 2.6 million patients with and/or at-risk for CKD identified by stricter guide-line based criteria using a combination of administrative encounter codes, physical examinations, laboratory values and medication use. Notably, data based on race/ethnicity and geography in part, will enable robust analyses to study traditionally disadvantaged or marginalized patients not typically included in clinical trials. DISCUSSION CURE-CKD project is a unique multidisciplinary collaboration between nephrologists, endocrinologists, primary care physicians with health services research skills, health economists, and those with expertise in statistics, bio-informatics and machine learning. The CURE-CKD registry uses curated observations from real-world settings across two large healthcare systems and has great potential to provide important contributions for healthcare and for improving clinical outcomes in patients with and at-risk for CKD.
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Affiliation(s)
- Keith C Norris
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA.
- UCLA Department of Medicine, Division of General Internal Medicine, 1100 Glendon Ave. Suite 900, Los Angeles, CA, 90024, USA.
| | - O Kenrik Duru
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Radica Z Alicic
- Providence St. Joseph Health, Providence Medical Research Center, Spokane, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Kenn B Daratha
- Providence St. Joseph Health, Providence Medical Research Center, Spokane, Washington, USA
| | - Susanne B Nicholas
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Sterling M McPherson
- Providence St. Joseph Health, Providence Medical Research Center, Spokane, Washington, USA
- Washington State University Elson S. Floyd College of Medicine, Spokane, Washington, USA
| | - Douglas S Bell
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Jenny I Shen
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Cami R Jones
- Providence St. Joseph Health, Providence Medical Research Center, Spokane, Washington, USA
| | - Tannaz Moin
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
- VA Greater Los Angeles, Los Angeles, USA
| | - Amy D Waterman
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Joshua J Neumiller
- Washington State University College of Pharmacy and Pharmaceutical Sciences, Spokane, USA
| | - Roberto B Vargas
- Charles R. Drew University of Medicine and Science, Los Angeles, USA
- RAND Corporation, Santa Monica, CA, USA
| | - Alex A T Bui
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Carol M Mangione
- David Geffen School of Medicine at University of California, Los Angeles, CA, 90095, USA
| | - Katherine R Tuttle
- Providence St. Joseph Health, Providence Medical Research Center, Spokane, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
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AuYoung M, Moin T, Richardson CR, Damschroder LJ. The Diabetes Prevention Program for Underserved Populations: A Brief Review of Strategies in the Real World. Diabetes Spectr 2019; 32:312-317. [PMID: 31798288 PMCID: PMC6858084 DOI: 10.2337/ds19-0007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
IN BRIEF This review highlights examples of the translation of the Diabetes Prevention Program (DPP) to underserved populations. Here, underserved populations are defined as groups whose members are at greater risk for health conditions such as diabetes but often face barriers accessing treatment. Strategies to develop and evaluate future DPP translations are discussed.
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Affiliation(s)
- Mona AuYoung
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA
| | - Tannaz Moin
- Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
- VA Health Services Research and Development Center for Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
| | | | - Laura J. Damschroder
- VA Ann Arbor Healthcare System, Center for Clinical Management Research, Ann Arbor, MI
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Moin T. Should Adults with Prediabetes Be Prescribed Metformin to Prevent Diabetes Mellitus? Yes: High-Quality Evidence Supports Metformin Use in Persons at High Risk. Am Fam Physician 2019; 100:134-135. [PMID: 31361108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Tannaz Moin
- University of California, Los Angeles, David Geffen School of Medicine, and VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Lee PG, Damschroder LJ, Holleman R, Moin T, Richardson CR. Older Adults and Diabetes Prevention Programs in the Veterans Health Administration. Diabetes Care 2018; 41:2644-2647. [PMID: 30377187 PMCID: PMC6245214 DOI: 10.2337/dc18-1141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 09/19/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate whether older veterans enrolled in two diabetes prevention programs (DPPs) in the Veterans Health Administration will have similar weight loss as younger veterans. RESEARCH DESIGN AND METHODS Post hoc analysis of data from two prospective, pragmatic, nonrandomized studies of behavioral weight management interventions that were delivered in-person (Department of Veterans Affairs [VA]-DPP) or online (Online-DPP), comparing participation and weight loss between participants aged ≥65 years (N = 120) vs. <65 years (N = 258). RESULTS Over 70% of participants in both age groups completed eight or more sessions within 6 months; a higher proportion completed eight or more sessions in the Online-DPP intervention than in the VA-DPP intervention (P < 0.05). The overall weight changes at 6 and 12 months were similar across the two age groups: ∼5 kg or 5% weight loss compared with baseline (P > 0.05). CONCLUSIONS DPPs delivered in person or online can be similarly effective in older and younger veterans. Online programs may be an important means to improve the reach of DPPs for older adults.
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Affiliation(s)
- Pearl G Lee
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI .,Geriatric Research Education and Clinical Center (GRECC), Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI
| | - Laura J Damschroder
- Personalizing Options through Veteran Engagement (PROVE) Quality Enhancement Research Initiative (QUERI) Program, Ann Arbor Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI
| | - Robert Holleman
- Personalizing Options through Veteran Engagement (PROVE) Quality Enhancement Research Initiative (QUERI) Program, Ann Arbor Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI
| | - Tannaz Moin
- Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA.,Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.,VA Health Services Research and Development (HSR&D) Center for Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA
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Finley EP, Huynh AK, Farmer MM, Bean-Mayberry B, Moin T, Oishi SM, Moreau JL, Dyer KE, Lanham HJ, Leykum L, Hamilton AB. Periodic reflections: a method of guided discussions for documenting implementation phenomena. BMC Med Res Methodol 2018; 18:153. [PMID: 30482159 PMCID: PMC6258449 DOI: 10.1186/s12874-018-0610-y] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 11/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ethnography has been proposed as a valuable method for understanding how implementation occurs within dynamic healthcare contexts, yet this method can be time-intensive and challenging to operationalize in pragmatic implementation. The current study describes an ethnographically-informed method of guided discussions developed for use by a multi-project national implementation program. METHODS The EMPOWER QUERI is conducting three projects to implement innovative care models in VA women's health for high-priority health concerns - prediabetes, cardiovascular risk, and mental health - utilizing the Replicating Effective Programs (REP) implementation strategy enhanced with stakeholder engagement and complexity science. Drawing on tenets of ethnographic research, we developed a lightly-structured method of guided "periodic reflections" to aid in documenting implementation phenomena over time. Reflections are completed as 30-60 min telephone discussions with implementation team members at monthly or bi-monthly intervals, led by a member of the implementation core. Discussion notes are coded to reflect key domains of interest and emergent themes, and can be analyzed singly or in triangulation with other qualitative and quantitative assessments to inform evaluation and implementation activities. RESULTS Thirty structured reflections were completed across the three projects during a 15-month period spanning pre-implementation, implementation, and sustainment activities. Reflections provide detailed, near-real-time information on projects' dynamic implementation context, including characteristics of implementation settings and changes in the local or national environment, adaptations to the intervention and implementation plan, and implementation team sensemaking and learning. Reflections also provide an opportunity for implementation teams to engage in recurring reflection and problem-solving. CONCLUSIONS To implement new, complex interventions into dynamic organizations, we must better understand the implementation process as it unfolds in real time. Ethnography is well suited to this task, but few approaches exist to aid in integrating ethnographic insights into implementation research. Periodic reflections show potential as a straightforward and low-burden method for documenting events across the life cycle of an implementation effort. They offer an effective means for capturing information on context, unfolding process and sensemaking, unexpected events, and diverse viewpoints, illustrating their value for use as part of an ethnographically-minded implementation approach. TRIAL REGISTRATION The two implementation research studies described in this article have been registered as required: Facilitating Cardiovascular Risk Screening and Risk Reduction in Women Veterans (NCT02991534); and Implementation of Tailored Collaborative Care for Women Veterans (NCT02950961).
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Affiliation(s)
- Erin P. Finley
- South Texas Veterans Health Care System, San Antonio, Texas USA
- UT Health San Antonio, San Antonio, Texas USA
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
| | - Alexis K. Huynh
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
- Veterans Affairs Greater Los Angeles Health System, Los Angeles, California USA
| | - Melissa M. Farmer
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
- Veterans Affairs Greater Los Angeles Health System, Los Angeles, California USA
| | - Bevanne Bean-Mayberry
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
- Veterans Affairs Greater Los Angeles Health System, Los Angeles, California USA
- David Geffen School of Medicine at University of California, Los Angeles, California USA
| | - Tannaz Moin
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
- Veterans Affairs Greater Los Angeles Health System, Los Angeles, California USA
- David Geffen School of Medicine at University of California, Los Angeles, California USA
| | - Sabine M. Oishi
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
- Veterans Affairs Greater Los Angeles Health System, Los Angeles, California USA
| | - Jessica L. Moreau
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
- Veterans Affairs Greater Los Angeles Health System, Los Angeles, California USA
| | - Karen E. Dyer
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
- Veterans Affairs Greater Los Angeles Health System, Los Angeles, California USA
| | - Holly Jordan Lanham
- South Texas Veterans Health Care System, San Antonio, Texas USA
- UT Health San Antonio, San Antonio, Texas USA
| | - Luci Leykum
- South Texas Veterans Health Care System, San Antonio, Texas USA
- UT Health San Antonio, San Antonio, Texas USA
| | - Alison B. Hamilton
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
- Veterans Affairs Greater Los Angeles Health System, Los Angeles, California USA
- David Geffen School of Medicine at University of California, Los Angeles, California USA
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Johnston AW, Cone EB, Bergman J, Moin T, Fink A, Kerfoot BP, Scales CD. Just a Nudge: Applying Behavioral Incentives to Engage Residents in Quality Improvement Education. J Am Coll Surg 2018. [DOI: 10.1016/j.jamcollsurg.2018.07.481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Janney CA, Greenberg JM, Moin T, Kim HM, Holleman RG, Hughes M, Damschroder LJ, Richardson CR, Young AS, Steinle N. Does mental health influence weight loss in adults with prediabetes? Findings from the VA Diabetes Prevention Program. Gen Hosp Psychiatry 2018; 53:32-37. [PMID: 29729586 DOI: 10.1016/j.genhosppsych.2018.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Mental illness may impact outcomes from structured behavioral weight loss interventions. This secondary analysis investigated the influence of mental health on weight loss among Veterans with prediabetes enrolled in either an in-person diabetes prevention program (DPP) or the usual care weight management program (MOVE!) designed to help patients achieve weight loss through changes in physical activity and diet. METHODS Prediabetes was defined by Hemoglobin A1c between 5.7 and 6.4% or Fasting Plasma Glucose 100-125 mg/dL and no use of antiglycemic medications during the past six months. Veterans Health Administrative data were used to assign Veterans into one of three mental health diagnoses: severe mental illness (SMI), affective disorder (AD) without SMI, or No SMI/No AD. The influence of mental health on weight changes at 6 and 12 months was modeled using linear mixed-effects regression. RESULTS On average, Veterans with prediabetes (n = 386) were 59 years old (SD = 10.0 years), with a BMI of 34.8 kg/m2 (SD = 5.3 kg/m2) and A1c of 6.0% (SD = 0.2%). The sample consisted of 12% (n = 47), 39% (n = 150), and 49% (n = 189) diagnosed with SMI, AD and No SMI/No AD, respectively. Across interventions, Veterans with SMI lost less weight than those with AD or No SMI/No AD. From baseline to 6 months, weight loss was significantly less for Veterans with SMI (1.53 kg) compared to Veterans with AD (3.85 kg) or No SMI/No AD (3.73 kg). This weight loss trend by mental health diagnosis continued from baseline to 12 months but was no longer statistically significant at 12 months. CONCLUSION Weight loss was not clinically or statistically different among Veterans with prediabetes diagnosed with AD or No SMI/No AD. However, Veterans diagnosed with SMI exhibited less weight loss over 6 months than Veterans with AD or No SMI/No AD and though not statistically significant, the trend continued to 12 months, suggesting that SMI may influence weight loss outcomes.
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Affiliation(s)
- Carol A Janney
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States; Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine - Midland Regional Campus 4611 Campus Ridge Drive, Midland, MI 48670, United States.
| | - Jared M Greenberg
- VA Greater Los Angeles Health Care System and David Geffen School of Medicine at UCLA, United States
| | - Tannaz Moin
- VA Greater Los Angeles Health Care System and David Geffen School of Medicine at UCLA, United States
| | - Hyungjin Myra Kim
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States; Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, United States
| | - Robert G Holleman
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Maria Hughes
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Laura J Damschroder
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Caroline R Richardson
- Department of Family Medicine, University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - Alexander S Young
- VA Greater Los Angeles Health Care System and David Geffen School of Medicine at UCLA, United States
| | - Nanette Steinle
- University of Maryland Baltimore, School of Medicine and the Maryland VA Health Care System, United States
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Huynh AK, Hamilton AB, Farmer MM, Bean-Mayberry B, Stirman SW, Moin T, Finley EP. A Pragmatic Approach to Guide Implementation Evaluation Research: Strategy Mapping for Complex Interventions. Front Public Health 2018; 6:134. [PMID: 29868542 PMCID: PMC5968102 DOI: 10.3389/fpubh.2018.00134] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/20/2018] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Greater specification of implementation strategies is a challenge for implementation science, but there is little guidance for delineating the use of multiple strategies involved in complex interventions. The Cardiovascular (CV) Toolkit project entails implementation of a toolkit designed to reduce CV risk by increasing women's engagement in appropriate services. The CV Toolkit project follows an enhanced version of Replicating Effective Programs (REP), an evidence-based implementation strategy, to implement the CV Toolkit across four phases: pre-conditions, pre-implementation, implementation, and maintenance and evolution. Our current objective is to describe a method for mapping implementation strategies used in real time as part of the CV Toolkit project. This method supports description of the timing and content of bundled strategies and provides a structured process for developing a plan for implementation evaluation. METHODS We conducted a process of strategy mapping to apply Proctor and colleagues' rubric for specification of implementation strategies, constructing a matrix in which we identified each implementation strategy, its conceptual group, and the corresponding REP phase(s) in which it occurs. For each strategy, we also specified the actors involved, actions undertaken, action targets, dose of the implementation strategy, and anticipated outcome addressed. We iteratively refined the matrix with the implementation team, including use of simulation to provide initial validation. RESULTS Mapping revealed patterns in the timing of implementation strategies within REP phases. Most implementation strategies involving the development of stakeholder interrelationships and training and educating stakeholders were introduced during the pre-conditions or pre-implementation phases. Strategies introduced in the maintenance and evolution phase emphasized communication, re-examination, and audit and feedback. In addition to its value for producing valid and reliable process evaluation data, mapping implementation strategies has informed development of a pragmatic blueprint for implementation and longitudinal analyses and evaluation activities. DISCUSSION We update recent recommendations on specification of implementation strategies by considering the implications for multi-strategy frameworks and propose an approach for mapping the use of implementation strategies within complex, multi-level interventions, in support of rigorous evaluation. Developing pragmatic tools to aid in operationalizing the conduct of implementation and evaluation activities is essential to enacting sound implementation research.
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Affiliation(s)
- Alexis K. Huynh
- VA Greater Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, United States
| | - Alison B. Hamilton
- VA Greater Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, United States
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Melissa M. Farmer
- VA Greater Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, United States
| | - Bevanne Bean-Mayberry
- VA Greater Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, United States
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Shannon Wiltsey Stirman
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
- VA Palo Alto Healthcare System, Menlo Park, CA, United States
| | - Tannaz Moin
- VA Greater Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, United States
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Erin P. Finley
- South Texas Veterans Healthcare System, San Antonio, TX, United States
- UT Health Science Center, San Antonio, TX, United States
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Moin T, Damschroder LJ, Youles B, Makki F, Billington C, Yancy W, Maciejewski ML, Kinsinger LS, Weinreb JE, Steinle N, Richardson C. Implementation of a prediabetes identification algorithm for overweight and obese Veterans. ACTA ACUST UNITED AC 2018; 53:853-862. [PMID: 28273326 DOI: 10.1682/jrrd.2015.06.0104] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 03/30/2016] [Indexed: 11/05/2022]
Abstract
Type 2 diabetes prevention is an important national goal for the Veteran Health Administration (VHA): one in four Veterans has diabetes. We implemented a prediabetes identification algorithm to estimate prediabetes prevalence among overweight and obese Veterans at Department of Veterans Affairs (VA) medical centers (VAMCs) in preparation for the launch of a pragmatic study of Diabetes Prevention Program (DPP) delivery to Veterans with prediabetes. This project was embedded within the VA DPP Clinical Demonstration Project conducted in 2012 to 2015. Veterans who attended orientation sessions for an established VHA weight-loss program (MOVE!) were recruited from VAMCs with geographically and racially diverse populations using existing referral processes. Each site implemented and adapted the prediabetes identification algorithm to best fit their local clinical context. Sites relied on an existing referral process in which a prediabetes identification algorithm was implemented in parallel with existing clinical flow; this approach limited the number of overweight and obese Veterans who were assessed and screened. We evaluated 1,830 patients through chart reviews, interviews, and/or laboratory tests. In this cohort, our estimated prevalence rates for normal glycemic status, prediabetes, and diabetes were 29% (n = 530), 28% (n = 504), and 43% (n = 796), respectively. Implementation of targeted prediabetes identification programs requires careful consideration of how prediabetes assessment and screening will occur.
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Affiliation(s)
- Tannaz Moin
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA; and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.,Center for the Study of Healthcare Innovation, Implementation and Policy, Health Services Research & Development, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | | | - Bradley Youles
- VA Center for Clinical Management Research, Ann Arbor, MI
| | - Fatima Makki
- VA Center for Clinical Management Research, Ann Arbor, MI
| | - Charles Billington
- Minneapolis VA Health Care System, Minneapolis, MN; and University of Minnesota Medical Center, Minneapolis, MN
| | - William Yancy
- Durham VA Medical Center (VAMC), Durham, NC; and Duke University School of Medicine, Durham, NC
| | - Matthew L Maciejewski
- Durham VA Medical Center (VAMC), Durham, NC; and Duke University School of Medicine, Durham, NC
| | - Linda S Kinsinger
- National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, NC
| | - Jane E Weinreb
- Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, CA; and David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Nanette Steinle
- Baltimore VAMC, Baltimore, MD; and University of Maryland School of Medicine, Baltimore, MD
| | - Caroline Richardson
- VA Center for Clinical Management Research, Ann Arbor, MI.,Department of Family Medicine, University of Michigan, Ann Arbor, MI; and Diabetes Quality Enhancement Research Initiative (QUERI), VA, Ann Arbor, MI
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Hamilton AB, Farmer MM, Moin T, Finley EP, Lang AJ, Oishi SM, Huynh AK, Zuchowski J, Haskell SG, Bean-Mayberry B. Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER): a protocol for a program of research. Implement Sci 2017; 12:127. [PMID: 29116022 PMCID: PMC5678767 DOI: 10.1186/s13012-017-0658-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 10/20/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Enhancing Mental and Physical health of Women through Engagement and Retention or EMPOWER program represents a partnership with the US Department of Veterans Health Administration (VA) Health Service Research and Development investigators and the VA Office of Women's Health, National Center for Disease Prevention and Health Promotion, Primary Care-Mental Health Integration Program Office, Women's Mental Health Services, and the Office of Patient Centered Care and Cultural Transformation. EMPOWER includes three projects designed to improve women Veterans' engagement and retention in evidence-based care for high-priority health conditions, i.e., prediabetes, cardiovascular, and mental health. METHODS/DESIGN The three proposed projects will be conducted in VA primary care clinics that serve women Veterans including general primary care and women's health clinics. The first project is a 1-year quality improvement project targeting diabetes prevention. Two multi-site research implementation studies will focus on cardiovascular risk prevention and collaborative care to address women Veterans' mental health treatment needs respectively. All projects will use the evidence-based Replicating Effective Programs (REP) implementation strategy, enhanced with multi-stakeholder engagement and complexity theory. Mixed methods implementation evaluations will focus on investigating primary implementation outcomes of adoption, acceptability, feasibility, and reach. Program-wide organizational-, provider-, and patient-level measures and tools will be utilized to enhance synergy, productivity, and impact. Both implementation research studies will use a non-randomized stepped wedge design. DISCUSSION EMPOWER represents a coherent program of women's health implementation research and quality improvement that utilizes cross-project implementation strategies and evaluation methodology. The EMPOWER Quality Enhancement Research Initiative (QUERI) will constitute a major milestone for realizing women Veterans' engagement and empowerment in the VA system. EMPOWER QUERI will be conducted in close partnership with key VA operations partners, such as the VA Office of Women's Health, to disseminate and spread the programs nationally. TRIAL REGISTRATION The two implementation research studies described in this protocol have been registered as required: Facilitating Cardiovascular Risk Screening and Risk Reduction in Women Veterans: Trial registration NCT02991534 , registered 9 December 2016. Implementation of Tailored Collaborative Care for Women Veterans: Trial registration NCT02950961 , registered 21 October 2016.
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Affiliation(s)
- Alison B. Hamilton
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
| | - Melissa M. Farmer
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
| | - Tannaz Moin
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
| | - Erin P. Finley
- South Texas Veterans Health Care, San Antonio, TX USA
- University of Texas Health Science Center, San Antonio, TX USA
| | - Ariel J. Lang
- VA San Diego Healthcare System, San Diego, CA USA
- University of California San Diego, San Diego, CA USA
| | - Sabine M. Oishi
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
| | - Alexis K. Huynh
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
| | - Jessica Zuchowski
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
| | - Sally G. Haskell
- VA Connecticut Healthcare System, West Haven, CT USA
- Yale School of Medicine, Yale University, New Haven, CT USA
| | - Bevanne Bean-Mayberry
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
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Abstract
PURPOSE OF REVIEW The high prevalence of prediabetes and success of the diabetes prevention program (DPP) has led to increasing efforts to provide readily accessible, cost-effective DPP interventions to the general public. Technology-assisted DPP interventions are of particular interest since they may be easier to widely distribute and sustain as compared to traditional in-person DPP. The purpose of this article is to provide an overview of currently available technology-assisted DPP interventions. RECENT FINDINGS This review focuses on studies that have examined the use of mobile phone text messaging, smartphone/web-based apps, and telehealth programs to help prevent or delay the onset of incident type 2 diabetes. While there is variability in the results of studies focused on technology-assisted DPP and weight loss interventions, there is evidence to suggest that these programs have been associated with clinically meaningful weight loss and can be cost-effective. Patients who are at risk for diabetes can be offered technology-assisted DPP and weight loss interventions to lower their risk of incident diabetes. Further research should determine what specific combination of intervention features would be most successful.
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Affiliation(s)
- Shira Grock
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, David Geffen School of Medicine at UCLA, 900 Veteran Avenue, 24-130 Warren Hall, Los Angeles, CA, 90095, USA.
| | - Jeong-Hee Ku
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, David Geffen School of Medicine at UCLA, 900 Veteran Avenue, 24-130 Warren Hall, Los Angeles, CA, 90095, USA
| | - Julie Kim
- Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, David Geffen School of Medicine at UCLA, 900 Veteran Avenue, 24-130 Warren Hall, Los Angeles, CA, 90095, USA
| | - Tannaz Moin
- Veterans Affairs Greater Los Angeles Healthcare Systems, 10940 Wilshire Boulevard, Suite 700, Los Angeles, CA, 90024, USA
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Damschroder LJ, Reardon CM, AuYoung M, Moin T, Datta SK, Sparks JB, Maciejewski ML, Steinle NI, Weinreb JE, Hughes M, Pinault LF, Xiang XM, Billington C, Richardson CR. Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA). Implement Sci 2017; 12:94. [PMID: 28747191 PMCID: PMC5530572 DOI: 10.1186/s13012-017-0619-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/04/2017] [Indexed: 11/10/2022] Open
Abstract
Background The Diabetes Prevention Program (DPP) is an effective lifestyle intervention to reduce incidence of type 2 diabetes. However, there are gaps in knowledge about how to implement DPP. The aim of this study was to evaluate implementation of DPP via assessment of a clinical demonstration in the Veterans Health Administration (VHA). Methods A 12-month pragmatic clinical trial compared weight outcomes between the Veterans Affairs Diabetes Prevention Program (VA-DPP) and the usual care MOVE!® weight management program (MOVE!). Eligible participants had a body mass index (BMI) ≥30 kg/m2 (or BMI ≥ 25 kg/m2 with one obesity-related condition), prediabetes (glycosylated hemoglobin (HbA1c) 5.7–6.5% or fasting plasma glucose (FPG) 100–125 mg/dL), lived within 60 min of their VA site, and had not participated in a weight management program within the last year. Established evaluation and implementation frameworks were used to guide the implementation evaluation. Implementation barriers and facilitators, delivery fidelity, participant satisfaction, and implementation costs were assessed. Using micro-costing methods, costs for assessment of eligibility and scheduling and maintaining adherence per participant, as well as cost of delivery per session, were also assessed. Results Several barriers and facilitators to Reach, Adoption, Implementation, Effectiveness and Maintenance were identified; barriers related to Reach were the largest challenge encountered by site teams. Fidelity was higher for VA-DPP delivery compared to MOVE! for five of seven domains assessed. Participant satisfaction was high in both programs, but higher in VA-DPP for most items. Based on micro-costing methods, cost of assessment for eligibility was $68/individual assessed, cost of scheduling and maintaining adherence was $328/participant, and cost of delivery was $101/session. Conclusions Multi-faceted strategies are needed to reach targeted participants and successfully implement DPP. Costs for assessing patients for eligibility need to be carefully considered while still maximizing reach to the targeted population.
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Affiliation(s)
- Laura J Damschroder
- Ann Arbor VA HSR&D/Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA. .,VA Diabetes QUERI, Ann Arbor, MI, USA.
| | - Caitlin M Reardon
- Ann Arbor VA HSR&D/Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA
| | - Mona AuYoung
- Ann Arbor VA HSR&D/Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA.,Scripps Translational Science Institute/The Scripps Research Institute, 10550 North Torrey Pines Road, Mail Drop: TRY-30, La Jolla, CA, 92037, USA
| | - Tannaz Moin
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd 3, Los Angeles, CA, 90073, USA.,David Geffen School of Medicine, University of California, Los Angeles, CA, USA.,Greater Los Angeles VA Health Services Research and Development (HSR&D) Center for Healthcare Innovation, Implementation and Policy, Los Angeles, CA, USA
| | - Santanu K Datta
- Durham VA Medical Center HSR&D, 411 W Chapel Hill St, Suite 600, Durham, NC, 27701, USA.,Duke University School of Medicine, Durham, NC, USA
| | - Jordan B Sparks
- Ann Arbor VA HSR&D/Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA
| | - Matthew L Maciejewski
- Durham VA Medical Center HSR&D, 411 W Chapel Hill St, Suite 600, Durham, NC, 27701, USA.,Duke University School of Medicine, Durham, NC, USA
| | - Nanette I Steinle
- VA Maryland Healthcare System, 10 North Greene St, Baltimore, MD, 21201, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jane E Weinreb
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd 3, Los Angeles, CA, 90073, USA.,David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Maria Hughes
- Ann Arbor VA HSR&D/Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA
| | - Lillian F Pinault
- VA Maryland Healthcare System, 10 North Greene St, Baltimore, MD, 21201, USA.,University of Maryland School of Medicine, Baltimore, MD, USA
| | - Xinran M Xiang
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.,Louisiana State University Pediatric Neurology Program, 1542 Tulane Ave Rm 763, New Orleans, LA, 70112, USA
| | - Charles Billington
- Minneapolis VA Healthcare System, 1 Veterans Drive, Minneapolis, MN, 55417, USA.,University of Minnesota Medical Center, Minneapolis, MN, USA
| | - Caroline R Richardson
- Ann Arbor VA HSR&D/Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA.,VA Diabetes QUERI, Ann Arbor, MI, USA.,Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.,University of Michigan Department of Family Medicine, 1018 Fuller St, Ann Arbor, MI, 48104, USA
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Moin T, Damschroder LJ, AuYoung M, Maciejewski ML, Datta SK, Weinreb JE, Steinle NI, Billington C, Hughes M, Makki F, Holleman RG, Kim HM, Jeffreys AS, Kinsinger LS, Burns JA, Richardson CR. Diabetes Prevention Program Translation in the Veterans Health Administration. Am J Prev Med 2017; 53:70-77. [PMID: 28094135 PMCID: PMC6699500 DOI: 10.1016/j.amepre.2016.11.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 10/19/2016] [Accepted: 11/08/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION This clinical demonstration trial compared the effectiveness of the Veterans Affairs Diabetes Prevention Program (VA-DPP) with an evidence-based usual care weight management program (MOVE!®) in the Veterans Health Administration health system. DESIGN Prospective, pragmatic, non-randomized comparative effectiveness study of two behavioral weight management interventions. SETTING/PARTICIPANTS Obese/overweight Veterans with prediabetes were recruited from three geographically diverse VA sites between 2012 and 2014. INTERVENTION VA-DPP included 22 group-based intensive lifestyle change sessions. MAIN OUTCOME MEASURES Weight change at 6 and 12 months, hemoglobin A1c (HbA1c) at 12 months, and VA health expenditure changes at 15 months were assessed using VA electronic health record and claims data. Between- and within-group comparisons for weight and HbA1c were done using linear mixed-effects models controlling for age, gender, race/ethnicity, baseline outcome values, and site. Analyses were conducted in 2015-2016. RESULTS A total of 387 participants enrolled (273 VA-DPP, 114 MOVE!). More VA-DPP participants completed at least one (73.3% VA-DPP vs 57.5% MOVE! p=0.002); four (57.5% VA-DPP vs 42.5% MOVE!, p=0.007); and eight or more sessions (42.5% VA-DPP vs 31% MOVE!, p=0.035). Weight loss from baseline was significant at both 6 (p<0.001) and 12 months (p<0.001) for VA-DPP participants, but only significant at 6 months for MOVE! participants (p=0.004). Between groups, there were significant differences in 6-month weight loss (-4.1 kg VA-DPP vs -1.9 kg MOVE!, p<0.001), but not 12-month weight loss (-3.4 kg VA-DPP vs -2.0 kg MOVE!, p=0.16). There were no significant differences in HbA1c change or outpatient, inpatient, and total VA expenditures. CONCLUSIONS VA-DPP participants had higher participation rates and weight loss at 6 months, but similar weight, HbA1c, and health expenditures at 12 months compared to MOVE! PARTICIPANTS Features of VA-DPP may help enhance the capability of MOVE! to reach a larger proportion of the served population and promote individual-level weight maintenance.
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Affiliation(s)
- Tannaz Moin
- Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California; VA Health Services Research and Development (HSR&D) Center for Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles, California.
| | | | - Mona AuYoung
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan
| | - Matthew L Maciejewski
- Department of Medicine, Durham VA Medical Center, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Santanu K Datta
- Department of Medicine, Durham VA Medical Center, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Jane E Weinreb
- Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Nanette I Steinle
- Department of Medicine, Baltimore VA Medical Center, Baltimore, Maryland; Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland
| | - Charles Billington
- Department of Medicine, Minneapolis VA Healthcare System, Minneapolis, Minnesota; Department of Medicine, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Maria Hughes
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan
| | - Fatima Makki
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan
| | - Robert G Holleman
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan
| | - H Myra Kim
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan; Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan
| | - Amy S Jeffreys
- Department of Medicine, Durham VA Medical Center, Durham, North Carolina
| | - Linda S Kinsinger
- VHA National Center for Health Promotion and Disease Prevention, Durham, North Carolina
| | - Jennifer A Burns
- Ann Arbor VA Center for Clinical Management Research, Ann Arbor, Michigan
| | - Caroline R Richardson
- Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Family Medicine, University of Michigan, Ann Arbor, Michigan; VA Diabetes QUERI, Ann Arbor, Michigan
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Cone E, Bergman J, Moin T, Wietsma A, Fink A, Kerfoot BP, Scales C. MP92-16 QUALITY IMPROVEMENT FOR UROLOGISTS: CURRICULAR KEYS FOR EDUCATING RESIDENTS (QUICKER). J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Masheb RM, Chan SH, Raffa SD, Ackermann R, Damschroder LJ, Estabrooks PA, Evans-Hudnall G, Evans NC, Histon T, Littman AJ, Moin T, Nelson KM, Pagoto S, Pronk NP, Tate DF, Goldstein MG. State of the art conference on weight management in VA: Policy and research recommendations for advancing behavioral interventions. J Gen Intern Med 2017; 32:74-78. [PMID: 28271431 PMCID: PMC5359158 DOI: 10.1007/s11606-016-3965-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article summarizes outcomes of the behavioral interventions work group for the Veterans Health Administration (VHA) State of the Art Conference (SOTA) for Weight Management. Sixteen VHA and non-VHA subject matter experts, representing clinical care delivery, research, and policy arenas, participated. The work group reviewed current evidence of efficacy, effectiveness, and implementation of behavioral interventions for weight management, participated in phone- and online-based consensus processes, generated key questions to address gaps, and attended an in-person conference in March 2016. The work group agreed that there is strong evidence for efficacy and effectiveness of core behavioral intervention components and processes, but insufficient evidence to determine the comparative effectiveness of multiple clinician-delivered weight management modalities, as well as technologies that may or may not supplement clinician-delivered treatments. Effective strategies for implementation of weight management services in VHA were identified. The SOTA work group's foremost policy recommendations are to establish a system-wide culture for weight management and to identify a population-level health metric to measure the impact of weight management interventions that can be tracked and clearly communicated throughout VHA. The work group's top research recommendation is to determine how to deploy and scale the most effective behavioral weight management interventions for Veterans.
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Affiliation(s)
- Robin M Masheb
- Yale School of Medicine, New Haven, CT, USA.
- VA Connecticut Healthcare System, 950 Campbell Ave Psychology Service, 116B, West Haven, CT, 06516, USA.
| | - Stephanie H Chan
- VHA National Center for Health Promotion and Disease Prevention, Durham, NC, USA
| | - Susan D Raffa
- VHA National Center for Health Promotion and Disease Prevention, Durham, NC, USA
| | - Ronald Ackermann
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | - Neil C Evans
- VA Office of Connected Care, Washington, DC, USA
| | - Trina Histon
- Kaiser Permanente Care Management Institute, Washington, DC, USA
| | | | - Tannaz Moin
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Karin M Nelson
- VA Puget Sound Healthcare System, Tacoma, WA, USA
- University of Washington, Seattle, WA, USA
| | - Sherry Pagoto
- University of Massachusetts Medical School, Worcester, MA, USA
| | | | - Deborah F Tate
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Michael G Goldstein
- VHA National Center for Health Promotion and Disease Prevention, Durham, NC, USA
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AuYoung M, Damschroder LJ, Kinsinger L, Moin T, Richardson CR. Practical partnered research to improve weight loss among overweight/obese veterans: lessons from the trenches. BMC Med Res Methodol 2017; 17:50. [PMID: 28356073 PMCID: PMC5371178 DOI: 10.1186/s12874-017-0321-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 03/08/2017] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Obesity and obesity-related conditions, such as type 2 diabetes, are a major issue for Veteran health. Veterans Health Administration (VA) researchers and health systems leaders have worked separately and together to provide more effective weight management programs for Veterans. Although randomized clinical trials are often considered the gold standard for establishing efficacy of interventions in controlled circumstances, pragmatic clinical trials (PCTs) provide agility for translation. MAIN TEXT VA researchers and health system leaders collaboratively designed a PCT to compare the Diabetes Prevention Program (VA-DPP) to usual care (MOVE!®) in promoting weight loss and glycemic control among overweight/obese Veterans with prediabetes. Together, they navigated the tensions that exist between quality improvement and research activities, facing challenges but reaping significant rewards. Early findings led to updated national guidance for delivering obesity treatment in VA. SHORT CONCLUSION Partnered research and the use of PCTs can be powerful strategies for accelerating evidence-based findings into practice. Collaborative partnerships between researchers and health systems leaders can help enhance and sustain translation in real-world settings.
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Affiliation(s)
- Mona AuYoung
- Ann Arbor VA Center for Clinical Management Research, VA HSR&D/CCMR (Mail Stop 152), P.O. Box 130170, Ann Arbor, MI 48113-0170 USA
| | - Laura J. Damschroder
- Ann Arbor VA Center for Clinical Management Research, VA HSR&D/CCMR (Mail Stop 152), P.O. Box 130170, Ann Arbor, MI 48113-0170 USA
- VA Diabetes QUERI, VA HSR&D/CCMR (Mail Stop 152), P.O. Box 130170, Ann Arbor, MI 48113-0170 USA
| | - Linda Kinsinger
- National Center for Health Promotion and Disease Prevention, 3022 Croasdaile Dr #200, Durham, NC 27705 USA
| | - Tannaz Moin
- VA Greater Los Angeles Healthcare System, Los Angeles, CA USA
- David Geffen School of Medicine, University of California, Los Angeles, CA USA
- Greater Los Angeles CA Health Services Research and Development (HSR&D) Center for Healthcare Innovation, Implementation and Policy, 11301 Wilshire Blvd, Mail Code 111D, Los Angeles, CA 90073 USA
| | - Caroline R. Richardson
- Ann Arbor VA Center for Clinical Management Research, VA HSR&D/CCMR (Mail Stop 152), P.O. Box 130170, Ann Arbor, MI 48113-0170 USA
- VA Diabetes QUERI, VA HSR&D/CCMR (Mail Stop 152), P.O. Box 130170, Ann Arbor, MI 48113-0170 USA
- Department of Family Medicine, University of Michigan, 1018 Fuller St, Ann Arbor, MI 48104-1213 USA
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Hochman M, Briggs-Malonson M, Wilkes E, Bergman J, Daskivich LP, Moin T, Brook I, Ryan GW, Brook RH, Mangione CM. Fostering a Commitment to Quality: Best Practices in Safety-net Hospitals. J Health Care Poor Underserved 2016; 27:293-307. [PMID: 27763471 DOI: 10.1353/hpu.2016.0008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In 2007, the Martin Luther King, Jr.-Harbor Hospital (MLK-Harbor), which served a large safety-net population in South Los Angeles, closed due to quality challenges. Shortly thereafter, an agreement was made to establish a new hospital, Martin Luther King, Jr. Community Hospital (MLKCH), to serve the unmet needs of the community. To assist the newly appointed MLKCH Board of Directors in building a culture of quality, we conducted a series of interviews with five high-performing hospital systems. In this report, we describe our findings. The hospitals we interviewed achieved a culture of quality by: 1) developing guiding principles that foster quality; 2) hiring and retaining personnel who are stewards of quality; 3) promoting efficient resource utilization; 4) developing a well-organized quality improvement infrastructure; and 5) cultivating integrated, patient-centric care. The institutions highlighted in this report provide important lessons for MLKCH and other safety-net institutions.
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