1. Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA)
- Author
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Jane E. Weinreb, Laura J. Damschroder, Jordan B. Sparks, Caitlin M. Reardon, Matthew L. Maciejewski, Mona AuYoung, Xinran M. Xiang, Tannaz Moin, Lillian F. Pinault, Charles J. Billington, Maria Celia B. Hughes, Santanu K. Datta, Caroline R. Richardson, and Nanette I. Steinle
- Subjects
Blood Glucose ,Male ,Comparative Effectiveness Research ,and promotion of well-being ,Glycated Hemoglobin A ,Cost-Benefit Analysis ,Pragmatic clinical trial ,Health informatics ,Medical and Health Sciences ,Health administration ,Body Mass Index ,0302 clinical medicine ,RE-AIM framework ,Weight management ,Medicine ,030212 general & internal medicine ,Veterans ,education.field_of_study ,lcsh:R5-920 ,Health Policy ,Diabetes ,Health services research ,General Medicine ,Health Services ,United States Department of Veterans Affairs ,Patient Satisfaction ,Health Policy & Services ,Female ,lcsh:Medicine (General) ,Type 2 ,medicine.medical_specialty ,Attitude of Health Personnel ,Population ,Clinical Trials and Supportive Activities ,030209 endocrinology & metabolism ,Health Informatics ,Health Promotion ,Consolidated Framework for Implementation Research ,03 medical and health sciences ,Clinical Research ,Information and Computing Sciences ,Behavioral and Social Science ,Diabetes Mellitus ,Humans ,Obesity ,Healthy Lifestyle ,education ,Veterans Affairs ,Health policy ,Metabolic and endocrine ,Nutrition ,Glycated Hemoglobin ,business.industry ,Research ,Prevention ,Public Health, Environmental and Occupational Health ,Overweight ,Prevention of disease and conditions ,Diabetes Prevention Program ,United States ,Clinical trial ,Good Health and Well Being ,Diabetes Mellitus, Type 2 ,Socioeconomic Factors ,Cost Effectiveness Research ,Implementation ,Physical therapy ,3.1 Primary prevention interventions to modify behaviours or promote wellbeing ,business - Abstract
BackgroundThe 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).MethodsA 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) ≥30kg/m2 (or BMI ≥ 25kg/m2 with one obesity-related condition), prediabetes (glycosylated hemoglobin (HbA1c) 5.7-6.5% or fasting plasma glucose (FPG) 100-125mg/dL), lived within 60min 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.ResultsSeveral 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.ConclusionsMulti-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.
- Published
- 2017