Abstract
IntroductionEvaluation of interventions can help to close the gap between research and practice but seldom takes place during implementation. Using the RE-AIM framework, we conducted a formative evaluation of the first year of the Intermountain Healthcare Diabetes Prevention Program (DPP).MethodsAdult patients who met the criteria for prediabetes (HbA1c of 5.70%–6.49% or fasting plasma glucose of 100–125 mg/dL) were attributed to a primary care provider from August 1, 2013, through July 31, 2014. Physicians invited eligible patients to participate in the program during an office visit. We evaluated 1) reach, with data on patient eligibility, participation, and representativeness; 2) effectiveness, with data on attaining a 5% weight loss; 3) adoption, with data on providers and clinics that referred patients to the program; and 4) implementation, with data on patient encounters. We did not measure maintenance.ResultsOf the 6,862 prediabetes patients who had an in-person office visit with their provider, 8.4% of eligible patients enrolled. Likelihood of participation was higher among patients who were female, aged 70 years or older, or overweight; had depression and higher weight at study enrollment; or were prescribed metformin. DPP participants were more likely than nonparticipants to achieve a 5% weight loss (odds ratio, 1.70; 95% confidence interval, 1.29–2.25; P < .001). Providers from 7 of 8 regions referred patients to the DPP; 174 providers at 53 clinics enrolled patients. The mean number of DPP counseling encounters per patient was 2.3 (range, 1–16).ConclusionThe RE-AIM framework was useful for estimating the formative impact (ie, reach, effectiveness, adoption, and implementation fidelity) of a DPP-based lifestyle intervention deployed in a learning health care system.
Highlights
Evaluation of interventions can help to close the gap between research and practice but seldom takes place during implementation
Likelihood of participation was higher among patients who were female, aged 70 years or older, or overweight; had depression and higher weight at study enrollment; or were prescribed metformin
Diabetes Prevention Program (DPP) participants were more likely than nonparticipants to achieve a 5% weight loss
Summary
Evaluation of interventions can help to close the gap between research and practice but seldom takes place during implementation. Several clinical trials have shown intensive lifestyle interventions to be efficacious in attaining and maintaining weight loss, which is a key to preventing progression to diabetes for those at risk for disease [3,4,5,6,7,8]. The Diabetes Prevention Program Outcomes Study demonstrated that lifestyle or metformin interventions can delay onset of diabetes for 10 years, suggesting that clinical improvements are not just transient effects [9]. Other Diabetes Prevention Program (DPP) translational efforts demonstrated high attendance rates and low attrition rates when participants were invited by a trusted health professional [13], effective weight loss when the program was delivered by trained diabetes educators [14,15], and sustainability when the program was implemented in a community setting [7, 16,17,18]
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