Deneen Vojta

A Coordinated National Model for Diabetes Prevention Linking Health Systems to an Evidence-Based Community Program

BACKGROUND Twenty-six million U.S. adults have diabetes, and 79 million have prediabetes. A 2002 Diabetes Prevention Program research study proved the effectiveness of a lifestyle intervention that yielded a 58% reduction in conversion to type 2 diabetes. However, cost per participant was high, complicating efforts to scale up the program. PURPOSE UnitedHealth Group (UHG) and the YMCA of the USA, in collaboration with the CDC, sought to develop the infrastructure and business case to scale the congressionally authorized National Diabetes Prevention Program nationwide. Emphasis was placed on developing a model that maintained fidelity to the original 2002 Diabetes Prevention Program research study and could be deployed for a lower cost per participant while yielding similar outcomes. DESIGN The UHG created the business case and technical and operational infrastructure necessary for nationwide dissemination of the YMCAs Diabetes Prevention Program (YMCAs DPP), as part of the National Diabetes Prevention Program. The YMCAs DPP is a group-based model of 16 core sessions with monthly follow-up delivered by trained lifestyle coaches. SETTING/PARTICIPANTS A variety of mechanisms were used to identify, screen, and encourage enrollment for people with prediabetes into the YMCAs DPP. INTERVENTION Substantial investments were made in relationship building, business planning, technology, development, and operational design to deliver an effective and affordable 12-month program. The program intervention was conducted July 2010-December 2011. Data were collected on the participants over a 15-month period between September 2010 and December 2011. Data were analyzed in February 2012. MAIN OUTCOME MEASURES The main outcome measures were infrastructure (communities involved and personnel trained); engagement (screening and enrollment of people with prediabetes); program outcomes (attendance and weight loss); and service delivery cost of the intervention. RESULTS In less than 2 years, the YMCAs DPP was effectively scaled to 46 communities in 23 states. More than 500 YMCA Lifestyle Coaches were trained. The program enrolled 2369 participants, and 1723 participants completed the core program at an average service-delivery cost of about

Feasibility and Preliminary Outcomes of a Scalable, Community-based Treatment of Childhood Obesity

400 each. For those individuals completing the program, average weight loss was about 5%. UHG anticipates that within 3 years, savings from reduced medical spending will outweigh initial costs. CONCLUSIONS Large-scale prevention efforts can be scalable and sustainable with collaboration, health information technology, community-based delivery of evidence-based interventions, and novel payment structures that incentivize efficiency and outcomes linked to better health and lower future costs.

Effective Interventions For Stemming The Growing Crisis Of Diabetes And Prediabetes: A National Payer’s Perspective

OBJECTIVE: Clinic-based treatments of childhood obesity are effective but typically have limited reach and are costly. In this study, we evaluated the effects of a scalable weight management program for children and teenagers. METHODS: Participants were 155 children and their parent/guardian. Children had a mean ± SD age of 11.3 ± 2.8 years, BMI z score of 2.23 ± 0.41, and a percentage overweight of 72.5 ± 34.0. Most (92%) were obese, and nearly half (46.5%) were ≥99th percentile for BMI. The primary outcome was change in percentage overweight from baseline to 6 months. RESULTS: At 6 months, children experienced a 3.4 percentage point reduction in percentage overweight (P = .001). Children <13 years had a 4.3 percentage point reduction in percentage overweight, whereas those ≥13 years had a 1.0 percentage point reduction. Those who attended a greater number of face-to-face group sessions experienced greater changes in percentage overweight. There were significant improvements in child health-related quality of life as reported by both children and their parents. CONCLUSIONS: These data suggest that a scalable, community-based pediatric obesity intervention can result in clinically significant reductions in percentage overweight, as well as improvements in health-related quality of life.

A randomized comparative effectiveness trial of using cable television to deliver diabetes prevention programming

Between a fifth and a third of US adults will have diabetes by midcentury, up from one in ten now, according to a government estimate. We project that over the next decade, around 40 million adults could have diabetes and 100 million could be diagnosed with its clinical precursor, prediabetes. Related health care spending could reach

18‐month outcomes of a community‐based treatment for childhood obesity

512 billion annually in 2021. Evidence-based interventions can curb diabetes and its clinical complications, but little has been done to implement them on a wide scale. Whats needed, among other measures, are new risk-assessment methods to identify subpopulations that will benefit most; the enrollment of consumers in new care models that support and encourage lifestyle change; partnerships with pharmacists, nurses, and health coaches; and new programs in Medicare and Medicaid that encourage patient engagement and lifestyle change.

Growth of molecular diagnostics and genetic testing in the USA, 2008–2011: analysis and implications

To evaluate the use and effectiveness of two “in‐home” strategies for delivering diabetes prevention programming using cable television.

Intensive remote monitoring versus conventional care in type 1 diabetes: A randomized controlled trial

Few studies have evaluated community‐based interventions for childhood obesity and even fewer provide efficacy data 1 year later.

Effects of a Pediatric Weight Management Program With and Without Active Video Games: A Randomized Trial

AIMS Advances in genomics and molecular diagnostic testing are expanding, but national data on which to base clinical, regulatory and reimbursement policies in the USA are lacking. The study objective is to provide current estimates of utilization/spending trends for private and public payers. PATIENTS & METHODS Healthcare utilization/expenditure claims data for 32 million individuals across the USA in 2008-2011 were analyzed. Genetic testing and molecular diagnostic usage was categorized by major testing groups: infectious disease, cancer and inherited/other acquired conditions. RESULTS Per-person testing cost grew by 14% per year between 2008 and 2011, primarily resulting from increased utilization. Spending per person for Medicare and Medicaid was higher than for commercially insured patients. Expenditure across the USA was estimated at US

Effects of a pediatric weight management program with and without active video games

5.5 billion in 2011, up 13% from 2010. DISCUSSION Greater understanding of usage and technology diffusion requires increased data transparency and granularity. Conclusion & future perspective: The use of genetic testing and molecular diagnostics will grow over the next 5 years, with uncertainty about the precise diffusion trajectory. By strengthening the capacity to capture and analyze trends in this changing area of medicine, we increase our chances of promoting positive change to the benefit of patients.

Comparative effectiveness and costs of insulin pump therapy for diabetes.

While frequent contact with diabetes care providers may improve glycemic control among patients with type 1 diabetes (T1D), in‐person visits are labor‐intensive and costly. This study was conducted to assess the impact of an intensive remote therapy (IRT) intervention for pediatric patients with T1D.