Translating Research Into Evidence-Based Practice With Potential for Population-Wide Impact

Abstract

Kansagra and Farley argue compellingly that a more flexible and relevant research design is needed to evaluate the population-wide impact of public health interventions—particularly when it relates to research that supports policy and environmental change.1 The use of the National Institutes of Health (NIH)-led Diabetes Prevention Program (DPP) as a proof point in their argument, however, is both unfortunate and inaccurate. Since the publication of the DPP trial results in 2003, at least 26 separate translation studies have been conducted, and a meta-analysis has concluded that clinically significant one-year weight reduction is achievable in DPP-lifestyle intervention adaptations delivered by well-trained community workers.2 One evidence-based translation of the DPP—the YMCA of the USA’s (the Y’s) DPP— is currently being scaled nationally with support from numerous public and private sector organizations including the Centers for Disease Control, the UnitedHealth Group, and the Y. Over the past two years, the Y’s DPP has expanded from just two Ys in Indianapolis, Indiana, and Louisville, Kentucky, to 207 sites spread throughout 47 Ys in 23 states. By the end of 2012, the program is expected to be available at more than 75 Ys in 30 states. In fact, it is the very challenge described in the article—how to go about providing the expertise, quality control, business process infrastructure, and scalability that allow public health initiatives like the DPP to enter into and thrive in the current health care environment—that was the rationale behind the creation of the Diabetes Prevention and Control Alliance (DPCA). Launched in April 2010 by UnitedHealth Group, the Y, and retail pharmacies, the DPCA enables multiple insurers, retail, government, and community-based non-profit partners to work together to bring the DPP-based intervention program to the market and have a population-wide impact. In short, while the authors’ premise is sound, it is premature to discount the population-wide impact and proven scalability of the NIH-led DPP given the emerging evidence of successful translations.