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Implementation Science
Published in: Implementation Science 1/2017

Open Access 01-12-2017 | Research

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

Authors: Laura J. Damschroder, Caitlin M. Reardon, Mona AuYoung, Tannaz Moin, Santanu K. Datta, Jordan B. Sparks, Matthew L. Maciejewski, Nanette I. Steinle, Jane E. Weinreb, Maria Hughes, Lillian F. Pinault, Xinran M. Xiang, Charles Billington, Caroline R. Richardson

Published in: Implementation Science | Issue 1/2017

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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.
Literature
1.
Lindstrom J, Louheranta A, Mannelin M, Rastas M, Salminen V, Eriksson J, Uusitupa M, Tuomilehto J, Finnish Diabetes Prevention Study G. The Finnish Diabetes Prevention Study (DPS): lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care. 2003;26(12):3230–6.CrossRefPubMed
2.
Ramachandran A, Snehalatha C, Mary S, Mukesh B, Bhaskar AD, Vijay V, Indian Diabetes Prevention P. The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia. 2006;49(2):289–97.CrossRefPubMed
3.
Li G, Zhang P, Wang J, Gregg EW, Yang W, Gong Q, Li H, Jiang Y, An Y, Shuai Y, et al. The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Lancet. 2008;371(9626):1783–9.CrossRefPubMed
4.
Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403.CrossRefPubMed
5.
Cefalu WT, Buse JB, Tuomilehto J, Fleming GA, Ferrannini E, Gerstein HC, Bennett PH, Ramachandran A, Raz I, Rosenstock J, et al. Update and next steps for real-world translation of interventions for type 2 diabetes prevention: reflections from a diabetes care editors’ expert forum. Diabetes Care. 2016;39(7):1186–201.CrossRefPubMedPubMedCentral
6.
Balk EM, Earley A, Raman G, Avendano EA, Pittas AG, Remington PL. Combined diet and physical activity promotion programs to prevent type 2 diabetes among persons at increased risk: a systematic review for the Community Preventive Services Task Force. Ann Intern Med. 2015;163(6):437–51.CrossRefPubMedPubMedCentral
7.
Aziz Z, Absetz P, Oldroyd J, Pronk NP, Oldenburg B. A systematic review of real-world diabetes prevention programs: learnings from the last 15 years. Implement Sci. 2015;10(1):172.CrossRefPubMedPubMedCentral
8.
9.
Chambers DA, Glasgow RE, Stange KC. The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. Implement Sci. 2013;8(1):117.CrossRefPubMedPubMedCentral
10.
LeFevre ML, Force USPST. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med. 2014;161(8):587–93.CrossRefPubMed
11.
Paulweber B, Valensi P, Lindstrom J, Lalic NM, Greaves CJ, McKee M, Kissimova-Skarbek K, Liatis S, Cosson E, Szendroedi J, et al. A European evidence-based guideline for the prevention of type 2 diabetes. Horm Metab Res. 2010;42 Suppl 1:S3–36.CrossRefPubMed
12.
13.
Saaristo T, Peltonen M, Keinanen-Kiukaanniemi S, Vanhala M, Saltevo J, Niskanen L, Oksa H, Korpi-Hyovalti E, Tuomilehto J. National type 2 diabetes prevention programme in Finland: FIN-D2D. Int J Circumpolar Health. 2007;66(2):101–12.CrossRefPubMed
14.
Moin T, Damschroder LJ, Youles B, Makki F, Billington C, Yancy W, Maciejewski ML, Kinsinger LS, Weinreb JE, Steinle N, et al. Implementation of a prediabetes identification algorithm for overweight/obese veterans. J Rehabil Res Dev. 2016;53(6):853–62.CrossRefPubMed
15.
Wareham NJ. Mind the gap: efficacy versus effectiveness of lifestyle interventions to prevent diabetes. Lancet Diabetes Endocrinol. 2015;3(3):160–1.CrossRefPubMed
16.
Mainous 3rd AG, Tanner RJ, Scuderi CB, Porter M, Carek PJ. Prediabetes screening and treatment in diabetes prevention: the impact of physician attitudes. J Am Board Fam Med. 2016;29(6):663–71.CrossRefPubMed
17.
Whitley HP, Hanson C, Parton JM. Systematic diabetes screening using point-of-care HbA1c testing facilitates identification of prediabetes. Ann Fam Med. 2017;15(2):162–4.CrossRefPubMed
18.
U.S. Department of Health & Human Services. Independent experts confirm that diabetes prevention model supported by the Affordable Care Act saves money and improves health. 2016.
19.
20.
21.
22.
Lindstrom J, Tuomilehto J. The diabetes risk score: a practical tool to predict type 2 diabetes risk. Diabetes Care. 2003;26(3):725–31.CrossRefPubMed
23.
24.
Aekplakorn W, Bunnag P, Woodward M, Sritara P, Cheepudomwit S, Yamwong S, Yipintsoi T, Rajatanavin R. A risk score for predicting incident diabetes in the Thai population. Diabetes Care. 2006;29(8):1872–7.CrossRefPubMed
25.
Ruige JB, de Neeling JN, Kostense PJ, Bouter LM, Heine RJ. Performance of an NIDDM screening questionnaire based on symptoms and risk factors. Diabetes Care. 1997;20(4):491–6.CrossRefPubMed
26.
Rahman M, Simmons RK, Harding AH, Wareham NJ, Griffin SJ. A simple risk score identifies individuals at high risk of developing type 2 diabetes: a prospective cohort study. Fam Pract. 2008;25(3):191–6.CrossRefPubMed
27.
Griffin SJ, Little PS, Hales CN, Kinmonth AL, Wareham NJ. Diabetes risk score: towards earlier detection of type 2 diabetes in general practice. Diabetes Metab Res Rev. 2000;16(3):164–71.CrossRefPubMed
28.
Glumer C, Carstensen B, Sandbaek A, Lauritzen T, Jorgensen T, Borch-Johnsen K, inter s. A Danish diabetes risk score for targeted screening: the Inter99 study. Diabetes Care. 2004;27(3):727–33.CrossRefPubMed
29.
Hippisley-Cox J, Coupland C, Robson J, Sheikh A, Brindle P. Predicting risk of type 2 diabetes in England and Wales: prospective derivation and validation of QDScore. BMJ. 2009;338:b880.CrossRefPubMedPubMedCentral
30.
31.
Damschroder L, Moin T, Datta S, Reardon C, Steinle N, Weinreb J, Billington C, Maciejewski M, Yancy W, Hughes M, et al. Implementation and evaluation of the VA DPP clinical demonstration: protocol for a multi-site non-randomized hybrid effectiveness-implementation type III trial. Implement Sci. 2015;10(1):68.CrossRefPubMedPubMedCentral
32.
33.
34.
Moin T, Damschroder LJ, AuYoung M, Maciejewski ML, Datta SK, Weinreb JE, Steinle NI, Billington C, Hughes M, Makki F et al. Diabetes prevention program translation in the veterans health administration. Am J Prev Med. 2017.
35.
Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89(9):1322–7.CrossRefPubMedPubMedCentral
36.
Kessler RS, Purcell EP, Glasgow RE, Klesges LM, Benkeser RM, Peek CJ. What does it mean to “employ” the RE-AIM model? Eval Health Prof. 2013;36(1):44–66.CrossRefPubMed
37.
Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. 2012;50(3):217–26.CrossRefPubMedPubMedCentral
38.
Simpson DD. A conceptual framework for transferring research to practice. J Subst Abuse Treat. 2002;22(4):171–82.CrossRefPubMed
39.
Kramer MK, Kriska AM, Venditti EM, Miller RG, Brooks MM, Burke LE, Siminerio LM, Solano FX, Orchard TJ. Translating the Diabetes Prevention Program: a comprehensive model for prevention training and program delivery. Am J Prev Med. 2009;37(6):505–11.CrossRefPubMed
40.
41.
Goode AD, Eakin EG. Dissemination of an evidence-based telephone-delivered lifestyle intervention: factors associated with successful implementation and evaluation. Transl Behav Med. 2013;3(4):351–6.CrossRefPubMedPubMedCentral
42.
Damschroder L, Aron D, Keith R, Kirsh S, Alexander J, Lowery J. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):50.CrossRefPubMedPubMedCentral
43.
Damschroder LJ, Lowery JC. Evaluation of a large-scale weight management program using the Consolidated Framework for Implementation Research (CFIR). Implement Sci. 2013;8:51.CrossRefPubMedPubMedCentral
44.
Miles MB, Huberman AM, Saldaña J. Qualitative data analysis: a methods sourcebook. Thousand Oaks: SAGE Publications, Inc.; 2014.
45.
46.
Damschroder L, Goodrich D, Kim H, Holleman R, Gillon L, Kirsh S, Richardson C, Lutes L. Development and validation of the ASPIRE-VA coaching fidelity checklist (ACFC): a tool to help ensure delivery of high-quality weight management interventions. Transl Behav Med. 2016;6(3):369-85.
47.
Damschroder LJ, Lutes LD, Kirsh S, Kim HM, Gillon L, Holleman RG, Goodrich DE, Lowery JC, Richardson CR. Small-changes obesity treatment among veterans: 12-month outcomes. Am J Prev Med. 2014;47(5):541–53.CrossRefPubMed
48.
STATA. Data analysis and statistical control. 2016.
49.
Steinberg D, Bennett GG, Svetkey L. The dash diet, 20 years later. JAMA. 2017.
50.
Masheb RM, Chan SH, Raffa SD, Ackermann R, Damschroder LJ, Estabrooks PA, Evans-Hudnall G, Evans NC, Histon T, Littman AJ et al. State of the art conference on weight management in VA: policy and research recommendations for advancing behavioral interventions. J Gen Intern Med. 2017;32(1):74-8.
51.
Schwarz PE, Lindstrom J, Kissimova-Scarbeck K, Szybinski Z, Barengo NC, Peltonen M, Tuomilehto J, project D-P. The European perspective of type 2 diabetes prevention: diabetes in Europe—prevention using lifestyle, physical activity and nutritional intervention (DE-PLAN) project. Exp Clin Endocrinol Diabetes. 2008;116(3):167–72.CrossRefPubMed
52.
Laatikainen T, Dunbar JA, Chapman A, Kilkkinen A, Vartiainen E, Heistaro S, Philpot B, Absetz P, Bunker S, O’Neil A, et al. Prevention of type 2 diabetes by lifestyle intervention in an Australian primary health care setting: Greater Green Triangle (GGT) Diabetes Prevention Project. BMC Public Health. 2007;7:249.CrossRefPubMedPubMedCentral
53.
Lindstrom J, Neumann A, Sheppard KE, Gilis-Januszewska A, Greaves CJ, Handke U, Pajunen P, Puhl S, Polonen A, Rissanen A, et al. Take action to prevent diabetes—the IMAGE toolkit for the prevention of type 2 diabetes in Europe. Horm Metab Res. 2010;42 Suppl 1:S37–55.CrossRefPubMed
54.
55.
Jackson SL, Long Q, Rhee MK, Olson DE, Tomolo AM, Cunningham SA, Ramakrishnan U, Narayan KM, Phillips LS. Weight loss and incidence of diabetes with the Veterans Health Administration MOVE! lifestyle change programme: an observational study. Lancet Diabetes Endocrinol. 2015;3(3): 173-80.
56.
Matthews L, Kirk A, Macmillan F, Mutrie N. Can physical activity interventions for adults with type 2 diabetes be translated into practice settings? A systematic review using the RE-AIM framework. Transl Behav Med. 2014;4(1):60–78.CrossRefPubMed
57.
Harden SM, Gaglio B, Shoup JA, Kinney KA, Johnson SB, Brito F, Blackman KC, Zoellner JM, Hill JL, Almeida FA, et al. Fidelity to and comparative results across behavioral interventions evaluated through the RE-AIM framework: a systematic review. Syst Rev. 2015;4:155.CrossRefPubMedPubMedCentral
58.
Wong ES, Wang V, Liu CF, Hebert PL, Maciejewski ML. Do Veterans Health Administration enrollees generalize to other populations? Med Care Res Rev. 2016;73(4):493-507.
59.
Frayne S, Phibbs CS, Friedman SA, Saechao F, Berg E, Balasubramanian V, Bi X, Iqbal S, Mattocks K, Haskell S et al. Sourcebook: women veterans in the Veterans Health Administration. Volume 2. Sociodemographics and use of VHA and non-VA care (Fee). In., vol. 2. Washington, DC.: Women’s Health Evaluation Initiative, Women’s Health Services, Veterans Health Administration, Department of Veterans Affairs; 2012.
60.
Vojta D, Koehler TB, Longjohn M, Lever JA, Caputo NF. A coordinated national model for diabetes prevention: linking health systems to an evidence-based community program. Am J Prev Med. 2013;44(4, Supplement 4):S301–6.CrossRefPubMed
61.
Ackermann RT, Marrero DG. Adapting the Diabetes Prevention Program lifestyle intervention for delivery in the community: the YMCA model. Diabetes Educ. 2007;33(1):69. 74-65, 77-68.CrossRefPubMed
62.
Moin T, Ertl K, Schneider J, Vasti E, Makki F, Richardson C, Havens K, Damschroder L. Women veterans’ experience with a web-based diabetes prevention program: a qualitative study to inform future practice. J Med Internet Res. 2015;17(5):e127.CrossRefPubMedPubMedCentral
63.
Saaristo T, Moilanen L, Korpi-Hyovalti E, Vanhala M, Saltevo J, Niskanen L, Jokelainen J, Peltonen M, Oksa H, Tuomilehto J, et al. Lifestyle intervention for prevention of type 2 diabetes in primary health care: one-year follow-up of the Finnish National Diabetes Prevention Program (FIN-D2D). Diabetes Care. 2010;33(10):2146–51.CrossRefPubMedPubMedCentral
64.
Malo JA, Versace VL, Janus ED, Laatikainen T, Peltonen M, Vartiainen E, Coates MJ, Dunbar JA. Evaluation of AUSDRISK as a screening tool for lifestyle modification programs: international implications for policy and cost-effectiveness. BMJ Open Diabetes Res Care. 2015;3(1):e000125.CrossRefPubMedPubMedCentral
65.
Tuomilehto J, Schwarz PE. Preventing diabetes: early versus late preventive interventions. Diabetes Care. 2016;39 Suppl 2:S115–20.CrossRefPubMed
66.
Neamah HH, Kuhlmann AK, Tabak RG. Effectiveness of program modification strategies of the diabetes prevention program: a systematic review. Diabetes Educ. 2016;42(2): 153-65.
67.
Dunkley AJ, Bodicoat DH, Greaves CJ, Russell C, Yates T, Davies MJ, Khunti K. Diabetes prevention in the real world: effectiveness of pragmatic lifestyle interventions for the prevention of type 2 diabetes and of the impact of adherence to guideline recommendations: a systematic review and meta-analysis. Diabetes Care. 2014;37(4):922–33.CrossRefPubMed
68.
Shepperd S, Lewin S, Straus S, Clarke M, Eccles MP, Fitzpatrick R, Wong G, Sheikh A. Can we systematically review studies that evaluate complex interventions? PLoS Med. 2009;6(8):e1000086.CrossRefPubMedPubMedCentral
69.
Harvey G, Kitson A. Translating evidence into healthcare policy and practice: single versus multi-faceted implementation strategies—is there a simple answer to a complex question? Int J Health Policy Manag. 2015;4(3):123–6.CrossRefPubMedPubMedCentral
70.
Alva ML, Hoerger TJ, Jeyaraman R, Amico P, Rojas-Smith L. Impact of the YMCA of the USA Diabetes Prevention Program On Medicare Spending And Utilization. Health Aff (Millwood). 2017;36(3):417–24.CrossRef
71.
Herman WH, Hoerger TJ, Brandle M, Hicks K, Sorensen S, Zhang P, Hamman RF, Ackermann RT, Engelgau MM, Ratner RE. The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance. Ann Intern Med. 2005;142(5):323–32.CrossRefPubMedPubMedCentral
Metadata
Title
Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA)
Authors
Laura J. Damschroder
Caitlin M. Reardon
Mona AuYoung
Tannaz Moin
Santanu K. Datta
Jordan B. Sparks
Matthew L. Maciejewski
Nanette I. Steinle
Jane E. Weinreb
Maria Hughes
Lillian F. Pinault
Xinran M. Xiang
Charles Billington
Caroline R. Richardson
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2017
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-017-0619-3

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