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.
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.
The UHG created the business case and technical and operational infrastructure necessary for nationwide dissemination of the YMCA's Diabetes Prevention Program (YMCA's DPP), as part of the National Diabetes Prevention Program. The YMCA's DPP is a group-based model of 16 core sessions with monthly follow-up delivered by trained lifestyle coaches.
A variety of mechanisms were used to identify, screen, and encourage enrollment for people with prediabetes into the YMCA's DPP.
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.
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.
In less than 2 years, the YMCA's 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 $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.
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.
Nourishing Beginnings is an integrated referral and service delivery model supporting Medicaid-eligible pregnant individuals by providing increased nutritional food access throughout pregnancy up to ...three months postpartum, through community health workers (CHW), who simultaneously address and provide support for social service needs of the client.
To study the impact of possible interventions on food security, the program includes two distinct interventions each paired with traditional CHW services, nutrition educational materials, and provision of basic essential cooking tools. Interventions consist of either bi-weekly home food delivery from the local food bank or bi-weekly financial assistance with healthy food access navigation. The study population consists of 160 pregnant individuals (18 or older,<22 weeks pregnant; 80 per intervention arm) who were referred to a countywide Pathways Community HUB (HUB), a community-based care coordination network that uses an evidence-based model to connect at-risk individuals to resources that address medical, social, economic, and behavioral health needs. Key data collection occurs at baseline, eight weeks after intervention begins, near delivery (36–38 weeks gestation), and three months postpartum. Intervention groups are compared to each other as well as against HUB historical controls and a concurrent matched sample from local Medicaid data.
The goal of Nourishing Beginnings is to improve long-term health outcomes (i.e., maternal and infant) both directly and mediated through a set of proximal outcomes, including prenatal care, food security, diet and nutrition, reported race discrimination and psychosocial factors including depression, stress, healthy eating self-efficacy, and social support.
Clinical Trials #: NCT05341960.
To have a significant impact on public health, partnerships are essential — especially among researchers and organizations that can translate such research into action. Based on the experience of ...YMCA of the USA, this commentary describes how to develop a partnership strategy. It also highlights the opportunities and challenges associated with developing partnerships and translating theory into action.
A Coordinated National Model for Diabetes Prevention Vojta, Deneen, MD; Koehler, Timothy B., BS; Longjohn, Matt, MD, MPH ...
American journal of preventive medicine,
April 2013, Letnik:
44, Številka:
4
Journal Article
Recenzirano
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 YMCA's Diabetes Prevention Program (YMCA's DPP), as part of the National Diabetes Prevention Program. The YMCA's 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 YMCA's 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 YMCA's 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 $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.
Background
Accelerated translation of real-world interventions for hypertension management is critical to improving cardiovascular outcomes and reducing disparities.
Objective
To determine whether a ...positive deviance approach would improve blood pressure (BP) control across diverse health systems.
Design
Quality improvement study using 1-year cross sections of electronic health record data over 5 years (2013–2017).
Participants
Adults ≥ 18 with hypertension with two visits in 2 years with at least one primary care visit in the last year (
N
= 114,950 at baseline) to a primary care practice in Better Health Partnership, a regional health improvement collaborative.
Interventions
Identification of a “positive deviant” and dissemination of this system’s best practices for control of hypertension (i.e., accurate/repeat BP measurement; timely follow-up; outreach; standard treatment algorithm; and communication curriculum) using 3 different intensities (
low
: Learning Collaborative events describing the best practices;
moderate
: Learning Collaborative events plus consultation when requested; and
high
: Learning Collaborative events plus practice coaching).
Main Measures
We used a weighted linear model to estimate the pre- to post-intervention average change in BP control (< 140/90 mmHg) for 35 continuously participating clinics.
Key Results
BP control post-intervention improved by 7.6% 95% confidence interval (CI) 6.0–9.1, from 67% in 2013 to 74% in 2017. Subgroups with the greatest absolute improvement in BP control included Medicaid (12.0%, CI 10.5–13.5), Hispanic (10.5%, 95% CI 8.4–12.5), and African American (9.0%, 95% CI 7.7–10.4). Implementation intensity was associated with improvement in BP control (high: 14.9%, 95% CI 0.2–19.5; moderate: 5.2%, 95% CI 0.8–9.5; low: 0.2%, 95% CI−3.9 to 4.3).
Conclusions
Employing a positive deviance approach can accelerate translation of real-world best practices into care across diverse health systems in the context of a regional health improvement collaborative (RHIC). Using this approach within RHICs nationwide could translate to meaningful improvements in cardiovascular morbidity and mortality.
ABSTRACT
As European and American cities suffer the effects of declining manufacturing bases place promotion strategies have become increasingly important to attract new investment. These involve the ...creation of a new image of cities. However, very little is known about how effective the marketed image is. The role of the image of Manchester (UK) promoted by the Central Manchester Development Corporation (CMDC) in office relocation is evaluated. An analysis of the experience of office managers as consumers of this image reveals considerable diversity of perception. The results suggest the need for further research into the nature and effectiveness of place images.
Effective management of hypertension (HTN) is a priority in primary care, necessary to decrease the costs, morbidity, and mortality associated with cardiovascular disease. Strategies to support ...quality improvement (QI) efforts in primary care are needed to make significant improvements in population health, especially for patients who experience socioeconomic inequalities.
To address the high rate (>50%) of uncontrolled HTN in the state of Ohio, a statewide QI project was implemented in high-volume Medicaid practices, aimed at improving blood pressure control and addressing racial disparities. The initiative expanded to include coaching QI to support efforts in primary care practices.
The Model for Improvement guided development of Plan-Do-Study-Act (PDSA) cycles facilitated by QI coaching and APRN collaboration to implement key components of HTN guidelines: accurate blood pressure measurement, effective treatment, and timely follow-up.
Interventions were implemented after PDSA cycles over 18 months in two practice sites to address HTN control. Linking multiple PDSA test cycles and review of data bimonthly allowed for reflection on the impact of interventions for non-Hispanic Black patients and the overall patient population.
The percentage of patients with controlled HTN, repeat blood pressure measurement, and timely follow-up improved in an urban primary care practice associated with an academic medical center and in a rural federally qualified health center.
Primary care practices can benefit from the external support of coaching when implementing QI processes to make meaningful change. APRNs are key collaborators for expanding QI efforts in primary care.
Rotaviruses are a major cause of acute gastroenteritis, which is often fatal in infants. The viral genome consists of 11 double-stranded RNA segments, but little is known about their cis-acting ...sequences and structural elements. Covariation studies and phylogenetic analysis exploring the potential structure of RNA11 of rotaviruses suggested that, besides the previously predicted “modified panhandle” structure, the 5’ and 3’ termini of one of the isoforms of the bovine rotavirus UKtc strain may interact to form a tRNA-like structure (TRLS). Such TRLSs have been identified in RNAs of plant viruses, where they are important for enhancing replication and packaging. However, using tRNA mimicry assays (in vitro aminoacylation and 3’- adenylation), we found no biochemical evidence for tRNA-like functions of RNA11. Capping, synthetic 3’ adenylation and manipulation of divalent cation concentrations did not change this finding. NMR studies on a 5’- and 3’-deletion construct of RNA11 containing the putative intra-strand complementary sequences supported a predominant panhandle structure and did not conform to a cloverleaf fold despite the strong evidence for a predicted structure in this conserved region of the viral RNA. Additional viral or cellular factors may be needed to stabilise it into a form with tRNA-like properties.
To compare a sevoflurane-nitrous oxide (N2O) general anesthetic technique with a standard technique of propofol for induction, and isoflurane-N2O for maintenance.
Prospective, randomized study.
...University-affiliated tertiary-care hospital.
62 adults undergoing elective surgery using the laryngeal mask airway (LMA).
Patients received either the standard technique of propofol for induction and isoflurane-N2O for maintenance (controls) or sevoflurane-N2O for both induction and maintenance of general anesthesia.
Induction and emergence times, heart rate, blood pressure, oxygen saturation, and end-tidal carbon dioxide were recorded.
Time to loss of consciousness was faster after propofol (mean +/- SEM: 51 +/- 3 sec) than after sevoflurane-N2O (85 +/- 10 sec; p < 0.05). Ready for surgery times, were however, similar between groups (10 +/- 1 vs. 11 +/- 1 min, respectively). All patients in the control group had apnea after LMA insertion compared with 4 patients in the sevoflurane-N2O group (p < 0.05). Heart rate was lower 5 and 10 minutes after LMA insertion in the sevoflurane-N2O group (69 +/- 3 and 66 +/- 3 bpm) versus the control group (81 +/- 3 bpm and 74 +/- 3 bpm, p < 0.05). After cessation of anesthetic gases, there were no differences in time to LMA removal, eye opening, or exiting the operating room (OR) between the control group (7, 8, and 10 min) and sevoflurane-N2O groups (7, 8, and 12 min, respectively). The majority of patients in both groups (92% to 97%) rated their anesthetic experience as excellent or good.
Sevoflurane-N2O and propofol provided comparable conditions for LMA insertion. Sevoflurane-N2O was not associated with a faster return of consciousness or faster time to exit the OR compared with isoflurane-N2O.
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