Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
Welch Center for Prevention, Epidemiology, & Clinical Research, Johns Hopkins University, Baltimore, MD, USA.
BMJ Open Qual. 2024 Jun 5;13(2):e002752. doi: 10.1136/bmjoq-2024-002752.
Pre-diabetes affects one-third of US adults and increases the risk of type 2 diabetes. Effective evidence-based interventions, such as the Diabetes Prevention Program, are available, but a gap remains in effectively translating and increasing uptake of these interventions into routine care.
We applied the Translating Research into Practice (TRiP) framework to guide three phases of intervention design and development for diabetes prevention: (1) summarise the evidence, (2) identify local barriers to implementation and (3) measure performance. In phase 1, we conducted a retrospective cohort analysis of linked electronic health record claims data to evaluate current practices in the management of pre-diabetes. In phase 2, we conducted in-depth interviews of 16 primary care physicians, 7 payor leaders and 31 patients to elicit common barriers and facilitators for diabetes prevention. In phase 3, using findings from phases 1 and 2, we developed the core elements of the intervention and performance measures to evaluate intervention uptake.
In phase 1 (retrospective cohort analysis), we found few patients with pre-diabetes received diabetes prevention interventions. In phase 2 (stakeholder engagement), we identified common barriers to include a lack of knowledge about pre-diabetes among patients and about the Diabetes Prevention Program among clinicians. In phase 3 (intervention development), we developed the START Diabetes Prevention Clinical Pathway as a systematic change package to address barriers and facilitators identified in phases 1 and 2, performance measures and a toolkit of resources to support the intervention components.
The TRiP framework supported the identification of evidence-based care practices for pre-diabetes and the development of a well-fitted, actionable intervention and implementation plan designed to increase treatment uptake for pre-diabetes in primary care settings. Our change package can be adapted and used by other health systems or clinics to target prevention of diabetes or other related chronic conditions.
三分之一的美国成年人患有糖尿病前期，这增加了他们患 2 型糖尿病的风险。目前已有有效的循证干预措施，如糖尿病预防计划，但在有效翻译和将这些干预措施纳入常规护理方面仍存在差距。
我们应用转化研究实践（TRiP）框架来指导糖尿病预防干预设计和开发的三个阶段：（1）总结证据，（2）确定实施的本地障碍，（3）衡量绩效。在第 1 阶段，我们对链接的电子健康记录索赔数据进行了回顾性队列分析，以评估管理糖尿病前期的当前实践。在第 2 阶段，我们对 16 名初级保健医生、7 名支付方领导和 31 名患者进行了深入访谈，以了解糖尿病预防的常见障碍和促进因素。在第 3 阶段，我们利用第 1 阶段和第 2 阶段的研究结果，开发了干预措施的核心要素和绩效衡量标准，以评估干预措施的采用情况。
在第 1 阶段（回顾性队列分析）中，我们发现很少有糖尿病前期患者接受了糖尿病预防干预措施。在第 2 阶段（利益相关者参与）中，我们发现了常见的障碍，包括患者对糖尿病前期和临床医生对糖尿病预防计划缺乏了解。在第 3 阶段（干预措施的开发）中，我们开发了 START 糖尿病预防临床路径作为一个系统的变革方案，以解决第 1 阶段和第 2 阶段确定的障碍和促进因素、绩效衡量标准和一套支持干预措施的资源工具包。
TRiP 框架支持确定糖尿病前期的循证护理实践，并开发了一个贴合度高、可操作的干预措施和实施计划，旨在增加初级保健环境中糖尿病前期的治疗采用率。我们的变革方案可以被其他医疗系统或诊所采用，以针对预防糖尿病或其他相关慢性病。
