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Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA)

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...

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Autores principales: Damschroder, Laura J., Reardon, Caitlin M., AuYoung, Mona, Moin, Tannaz, Datta, Santanu K., Sparks, Jordan B., Maciejewski, Matthew L., Steinle, Nanette I., Weinreb, Jane E., Hughes, Maria, Pinault, Lillian F., Xiang, Xinran M., Billington, Charles, Richardson, Caroline R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5530572/
https://www.ncbi.nlm.nih.gov/pubmed/28747191
http://dx.doi.org/10.1186/s13012-017-0619-3
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author Damschroder, Laura J.
Reardon, Caitlin M.
AuYoung, Mona
Moin, Tannaz
Datta, Santanu K.
Sparks, Jordan B.
Maciejewski, Matthew L.
Steinle, Nanette I.
Weinreb, Jane E.
Hughes, Maria
Pinault, Lillian F.
Xiang, Xinran M.
Billington, Charles
Richardson, Caroline R.
author_facet Damschroder, Laura J.
Reardon, Caitlin M.
AuYoung, Mona
Moin, Tannaz
Datta, Santanu K.
Sparks, Jordan B.
Maciejewski, Matthew L.
Steinle, Nanette I.
Weinreb, Jane E.
Hughes, Maria
Pinault, Lillian F.
Xiang, Xinran M.
Billington, Charles
Richardson, Caroline R.
author_sort Damschroder, Laura J.
collection PubMed
description 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/m(2) (or BMI ≥ 25 kg/m(2) 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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spelling pubmed-55305722017-08-02 Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA) Damschroder, Laura J. Reardon, Caitlin M. AuYoung, Mona Moin, Tannaz Datta, Santanu K. Sparks, Jordan B. Maciejewski, Matthew L. Steinle, Nanette I. Weinreb, Jane E. Hughes, Maria Pinault, Lillian F. Xiang, Xinran M. Billington, Charles Richardson, Caroline R. Implement Sci Research 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/m(2) (or BMI ≥ 25 kg/m(2) 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. BioMed Central 2017-07-26 /pmc/articles/PMC5530572/ /pubmed/28747191 http://dx.doi.org/10.1186/s13012-017-0619-3 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Damschroder, Laura J.
Reardon, Caitlin M.
AuYoung, Mona
Moin, Tannaz
Datta, Santanu K.
Sparks, Jordan B.
Maciejewski, Matthew L.
Steinle, Nanette I.
Weinreb, Jane E.
Hughes, Maria
Pinault, Lillian F.
Xiang, Xinran M.
Billington, Charles
Richardson, Caroline R.
Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA)
title Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA)
title_full Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA)
title_fullStr Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA)
title_full_unstemmed Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA)
title_short Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA)
title_sort implementation findings from a hybrid iii implementation-effectiveness trial of the diabetes prevention program (dpp) in the veterans health administration (vha)
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5530572/
https://www.ncbi.nlm.nih.gov/pubmed/28747191
http://dx.doi.org/10.1186/s13012-017-0619-3
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