Kaiser Permanente Northern California (KPNC) and its Division of Research (DOR) propose a set of three evaluations of KPNC system-level efforts to prevent development of diabetes in high-risk members. One or more of these studies would be well-suited for pooling with data from other systems in this research network on similar interventions. The applicant research team is highly experienced in working with KPNC clinical and operational leaders to evaluate natural experiments in diabetes care, including recent evaluations as part of the CDC/NIDDK-sponsored TRIAD study. We believe this is an is an opportune moment to examine whether the population approaches that have been effective for patients with diabetes can be adapted to support high-risk pre-diabetic patients to modify lifestyles and prevent progression to diabetes. The primary evaluation is of a KP - employer partnership that has adapted its worksite wellness program to risk stratify all employees using electronic health record (EHR) data and to use intensive outreach, incentives, and coaching (web, telephone, or in-person) to support lifestyle change in high-risk employees. Intervention and control employer sites will be selected in consultation with CalPERS, a large benefits management group representing multiple employers. We expect to identify approximately 750 high-risk employees at each site. Impact will be assessed using both EHR and patient surveys (via mail, phone, or internet at baseline and 12 months) to measure changes in body mass index (BMI), physical activity, blood pressure and lipid levels. The first ancillary study evaluates a telephonic wellness coaching program established in January 2010. It is intended to be part of a portfolio of coaching support that also includes online and in-person services. It is operated by KPNC's Regional Health Education Department (RHE), and will target as many as 10,000 high risk persons per year when fully implemented. We will work with RHE to evaluate program impact among high risk members identified either from EHR or health risk appraisal data, or from a combination. Surveys at baseline and 12 months will again measure changes in BMI, physical activity, blood pressure and lipids. We will also assess readiness to change, preferences for type of coaching, and correlates of these preferences. A second ancillary study examines a regionwide program implemented in 2006 that aims to ensure postpartum screening for diabetes, using a 75-gram oral glucose tolerance test, in all women with gestational diabetes mellitus (GDM). The program conducts outreach to those who prove to have pre-diabetes at testing. The program will be evaluated by examining changes in population incidence (over 5 years postpartum) in cohorts of all women with GDM from 2001-05 vs 2006-2010 (n=12,000 in each cohort). Incidence will be divided into less severe (often screen-detected) and more severe (with A1c >8% or requiring two medications). We hypothesize that the program will lead to decreases in more severe diabetes but to increases in milder disease. We also list a number of natural experiments in diabetes care that we would be able to evaluate.

Public Health Relevance

Understanding how health care systems can organize to prevent diabetes mellitus is a relatively new area of interest among these systems. Researchers at Kaiser Permanente Northern California's Division of Research are proposing to collaborate with the CDC and with researchers from other health systems to study a variety of health system policy approaches to preventing diabetes mellitus among the 3.1 million members of KPNC. We have proposed evaluation studies of a health plan employer partnership that identifies employees at high risk for diabetes on intervenes using outreach and communication, feedback, incentives, and health coaching to change behaviors and reduce risk;a broader evaluation of a new telephone health coaching program that will ultimately be available to all adult members;and the Regional Perinatal Service Center's region-wide program for reducing risk among women who have had gestational diabetes mellitus. We hope that one or more of these studies can be replicated within other health systems and results pooled and shared.

Agency
National Institute of Health (NIH)
Institute
National Center for Chronic Disease Prev and Health Promo (NCCDPHP)
Type
Chronic Disease Control Cooperative Agreement (U58)
Project #
5U58DP002721-03
Application #
8324464
Study Section
Special Emphasis Panel (ZDP1-DYB (08))
Project Start
2010-09-30
Project End
2015-09-29
Budget Start
2012-09-30
Budget End
2013-09-29
Support Year
3
Fiscal Year
2012
Total Cost
$498,797
Indirect Cost
$264,356
Name
Kaiser Foundation Research Institute
Department
Type
DUNS #
150829349
City
Oakland
State
CA
Country
United States
Zip Code
94612
Adams, Alyce S; Soumerai, Stephen B; Zhang, Fang et al. (2015) Effects of eliminating drug caps on racial differences in antidepressant use among dual enrollees with diabetes and depression. Clin Ther 37:597-609
Adams, A S; Bayliss, E; Schmittdiel, J A et al. (2015) The Diabetes Telephone Study: Design and Challenges of a Pragmatic Cluster Randomized Trial to Improve Diabetic Peripheral Neuropathy Treatment. Value Health 18:A723-4
Karter, Andrew J; Parker, Melissa M; Duru, O Kenrik et al. (2015) Impact of a pharmacy benefit change on new use of mail order pharmacy among diabetes patients: the Diabetes Study of Northern California (DISTANCE). Health Serv Res 50:537-59
Adams, Sara R; Wiley, Deanne M; Fargeix, Andromache et al. (2015) Employer-Based Screening for Diabetes and Prediabetes in an Integrated Health Care Delivery System: A Natural Experiment for Translation in Diabetes (NEXT-D) Study. J Occup Environ Med 57:1147-53
Xiao, Hong; Adams, Sara R; Goler, Nancy et al. (2015) Wellness Coaching for People With Prediabetes: A Randomized Encouragement Trial to Evaluate Outreach Methods at Kaiser Permanente, Northern California, 2013. Prev Chronic Dis 12:E207
Ackermann, Ronald T; Kenrik Duru, O; Albu, Jeanine B et al. (2015) Evaluating diabetes health policies using natural experiments: the natural experiments for translation in diabetes study. Am J Prev Med 48:747-54
Palakodeti, S; Uratsu, C S; Schmittdiel, J A et al. (2015) Changes in physical activity among adults with diabetes: a longitudinal cohort study of inactive patients with Type 2 diabetes who become physically active. Diabet Med 32:1051-7
Adams, Alyce S; Madden, Jeanne M; Zhang, Fang et al. (2014) Changes in use of lipid-lowering medications among black and white dual enrollees with diabetes transitioning from Medicaid to Medicare Part D drug coverage. Med Care 52:695-703
Grant, Richard W; Schmittdiel, Julie A; Neugebauer, Romain S et al. (2014) Exercise as a vital sign: a quasi-experimental analysis of a health system intervention to collect patient-reported exercise levels. J Gen Intern Med 29:341-8
Adams, Sara R; Goler, Nancy C; Sanna, Rashel S et al. (2013) Patient satisfaction and perceived success with a telephonic health coaching program: the Natural Experiments for Translation in Diabetes (NEXT-D) Study, Northern California, 2011. Prev Chronic Dis 10:E179

Showing the most recent 10 out of 11 publications