Advancing Health Policy and Program Research in Diabetes: Findings from the Natural Experiments for Translation in Diabetes (NEXT-D) Network
| Autor: | Frank Wharam, Ronald T. Ackermann, Jeanine Albu, Julie A. Schmittdiel, Dennis Ross-Degnan, Mohammed K. Ali, Christine M. Hunter, O. Kenrik Duru, Carol M. Mangione, Edward W. Gregg |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Natural experiment
Biomedical Endocrinology Diabetes and Metabolism Psychological intervention Coaching Translational Research Biomedical 0302 clinical medicine Health care 030212 general & internal medicine Translational Medical Research Nutrition and Dietetics Health Policy Behavior change Diabetes Health Services Primary Prevention Policy Public Health and Health Services Patient Safety medicine.medical_specialty Clinical Sciences 030209 endocrinology & metabolism Health Promotion Article 03 medical and health sciences Endocrinology & Metabolism Clinical Research Diabetes mellitus Translational Research Behavioral and Social Science Internal Medicine medicine Diabetes Mellitus Animals Humans Obesity Health policy Metabolic and endocrine Nutrition business.industry Clinical management Clinical study design Prevention medicine.disease Good Health and Well Being Family medicine NEXT-D Study Group Health Expenditures business |
| Zdroj: | Current diabetes reports, vol 18, iss 12 |
| Popis: | PURPOSE OF REVIEW: To advance our understanding of the impacts of policies and programs aimed at improving detection, engagement, prevention, and clinical diabetes management in the United States, we synthesized findings from a network of studies that used natural experiments to evaluate diabetes health policies and programs FINDINGS: Studies from the Natural EXperiments for Translation in Diabetes (NEXT-D) network used rigorous longitudinal quasi-experimental study designs (e.g., interrupted time series) and analytical methods (e.g., difference-in-differences) to augment causal inference. Investigators partnered with health system stakeholders to evaluate whether glucose testing rates changed from before-to-after clinic interventions (e.g., integrating electronic screening decision prompts in New York City) or employer programs (e.g., targeted messaging and waiving copayments for at-risk employees). Other studies examined participation and behavior change in low-(e.g., wellness coaching) or high-intensity lifestyle modification programs (e.g., Diabetes Prevention Program-like interventions) offered by payers or employers. Lastly, studies assessed how employer health insurance benefits impacted healthcare utilization, adherence, and outcomes among people with diabetes. NEXT -D demonstrated that low-intensity interventions to facilitate glucose testing and enhance engagement in lifestyle modification were associated with small improvements in weight but large improvements in screening and testing when supported by electronic health record based decision-support. Regarding high-intensity Diabetes Prevention Program-like lifestyle programs offered by payers or employers, enrollment was modest and led to weight loss and marginally lower short-term health expenditures. Health plans that incentivize patient behaviors were associated with increases in medication adherence. Meanwhile, shifting patients to high-deductible health plans was associated with no change in medication use and preventive screenings, but patients with diabetes delayed accessing healthcare for acute complications (e.g., cellulitis). Findings were more pronounced among lower-income patients, who experienced increased rates and acuity of emergency department visits for diabetes complications and other high-severity conditions. SUMMARY: Findings from NEXT-D studies provide informative data that can guide programs and policies to facilitate detection, prevention, and treatment of diabetes in practice. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|