Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York.
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
Diabetes Educ. 2019 Dec;45(6):616-628. doi: 10.1177/0145721719880503. Epub 2019 Oct 14.
The purpose of this study was to identify patient and program delivery characteristics associated with engagement and weight loss in a Diabetes Prevention Program (DPP) implemented in an urban hospital system.
Patient and program delivery data were collected between July 2015 and December 2017. DPP eligibility was determined based on age, body mass index (BMI), and hemoglobin A1C data via the electronic health record. Engagement was measured at 3 levels: ≤3 sessions, 4 to 8 sessions, and ≥9 sessions. Weight was measured at each DPP session.
Among the eligible patients (N = 31 524), referrals and engagement were lower in men than women, in Spanish speakers than English speakers, in younger (18-34 years) and middle-aged (35-54 years) than older adults, and in patients receiving Medicaid than other patients. Referral and engagement were higher in patients with higher BMIs and those prescribed ≥5 medications. Current smokers were less frequently engaged. Prior health care provider contact was associated with higher engagement. Overall, 28% of DPP participants achieved ≥5% weight loss; younger and middle-aged patients and those who gained weight in the prior 2 years were less likely to lose weight.
This assessment identified characteristics of patients with lower levels of referral and engagement. The DPP staff may need to increase outreach to address barriers to referral and during all points of engagement among men, younger patients, and Spanish speakers. Future research is needed to increase understanding with regard to why referrals and engagement are lower among these groups.
本研究旨在确定与参与度和体重减轻相关的患者和项目交付特征，这些特征与在城市医院系统中实施的糖尿病预防计划（DPP）有关。
患者和项目交付数据于 2015 年 7 月至 2017 年 12 月期间收集。通过电子健康记录，根据年龄、体重指数（BMI）和血红蛋白 A1C 数据确定 DPP 的资格。参与度分为 3 个级别进行衡量：≤3 次、4 到 8 次和≥9 次。每次 DPP 就诊时都会测量体重。
在符合条件的患者（N=31524）中，男性比女性、西班牙语患者比英语患者、年轻（18-34 岁）和中年（35-54 岁）患者比老年患者、以及接受医疗补助的患者比其他患者的转介和参与度较低。BMI 较高和服用≥5 种药物的患者的转介和参与度较高。当前吸烟者的参与度较低。既往与医疗保健提供者的接触与较高的参与度相关。总体而言，28%的 DPP 参与者体重减轻≥5%；年轻和中年患者以及在前两年体重增加的患者不太可能减轻体重。
本评估确定了转介和参与度较低的患者的特征。DPP 工作人员可能需要增加外联活动，以解决男性、年轻患者和西班牙语患者的转介和参与障碍。需要进一步研究，以增加对这些群体的转介和参与度较低的原因的理解。
