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Advancing Health Policy and Program Research in Diabetes: Findings from the Natural Experiments for Translation in Diabetes (NEXT-D) Network.

Publication ,  Journal Article
Ali, MK; Wharam, F; Kenrik Duru, O; Schmittdiel, J; Ackermann, RT; Albu, J; Ross-Degnan, D; Hunter, CM; Mangione, C; Gregg, EW; NEXT-D Study Group
Published in: Curr Diab Rep
November 20, 2018

PURPOSE OF REVIEW: To advance our understanding of the impacts of policies and programs aimed at improving detection, engagement, prevention, and clinical diabetes management in the USA, we synthesized findings from a network of studies that used natural experiments to evaluate diabetes health policies and programs. FINDINGS: Studies from the Natural EXperiments for Translation in Diabetes (NEXT-D) network used rigorous longitudinal quasi-experimental study designs (e.g., interrupted time series) and analytical methods (e.g., difference-in-differences) to augment causal inference. Investigators partnered with health system stakeholders to evaluate whether glucose testing rates changed from before-to-after clinic interventions (e.g., integrating electronic screening decision prompts in New York City) or employer programs (e.g., targeted messaging and waiving copayments for at-risk employees). Other studies examined participation and behavior change in low- (e.g., wellness coaching) or high-intensity lifestyle modification programs (e.g., diabetes prevention program-like interventions) offered by payers or employers. Lastly, studies assessed how employer health insurance benefits impacted healthcare utilization, adherence, and outcomes among people with diabetes. NEXT-D demonstrated that low-intensity interventions to facilitate glucose testing and enhance engagement in lifestyle modification were associated with small improvements in weight but large improvements in screening and testing when supported by electronic health record-based decision-support. Regarding high-intensity diabetes prevention program-like lifestyle programs offered by payers or employers, enrollment was modest and led to weight loss and marginally lower short-term health expenditures. Health plans that incentivize patient behaviors were associated with increases in medication adherence. Meanwhile, shifting patients to high-deductible health plans was associated with no change in medication use and preventive screenings, but patients with diabetes delayed accessing healthcare for acute complications (e.g., cellulitis). Findings were more pronounced among lower-income patients, who experienced increased rates and acuity of emergency department visits for diabetes complications and other high-severity conditions. Findings from NEXT-D studies provide informative data that can guide programs and policies to facilitate detection, prevention, and treatment of diabetes in practice.

Duke Scholars

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Published In

Curr Diab Rep

DOI

EISSN

1539-0829

Publication Date

November 20, 2018

Volume

18

Issue

12

Start / End Page

146

Location

United States

Related Subject Headings

  • Translational Research, Biomedical
  • Primary Prevention
  • Humans
  • Health Promotion
  • Health Policy
  • Health Expenditures
  • Endocrinology & Metabolism
  • Diabetes Mellitus
  • Animals
  • 3210 Nutrition and dietetics
 

Citation

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Ali, M. K., Wharam, F., Kenrik Duru, O., Schmittdiel, J., Ackermann, R. T., Albu, J., … NEXT-D Study Group. (2018). Advancing Health Policy and Program Research in Diabetes: Findings from the Natural Experiments for Translation in Diabetes (NEXT-D) Network. Curr Diab Rep, 18(12), 146. https://doi.org/10.1007/s11892-018-1112-3
Ali, Mohammed K., Frank Wharam, O. Kenrik Duru, Julie Schmittdiel, Ronald T. Ackermann, Jeanine Albu, Dennis Ross-Degnan, et al. “Advancing Health Policy and Program Research in Diabetes: Findings from the Natural Experiments for Translation in Diabetes (NEXT-D) Network.Curr Diab Rep 18, no. 12 (November 20, 2018): 146. https://doi.org/10.1007/s11892-018-1112-3.
Ali MK, Wharam F, Kenrik Duru O, Schmittdiel J, Ackermann RT, Albu J, et al. Advancing Health Policy and Program Research in Diabetes: Findings from the Natural Experiments for Translation in Diabetes (NEXT-D) Network. Curr Diab Rep. 2018 Nov 20;18(12):146.
Ali, Mohammed K., et al. “Advancing Health Policy and Program Research in Diabetes: Findings from the Natural Experiments for Translation in Diabetes (NEXT-D) Network.Curr Diab Rep, vol. 18, no. 12, Nov. 2018, p. 146. Pubmed, doi:10.1007/s11892-018-1112-3.
Ali MK, Wharam F, Kenrik Duru O, Schmittdiel J, Ackermann RT, Albu J, Ross-Degnan D, Hunter CM, Mangione C, Gregg EW, NEXT-D Study Group. Advancing Health Policy and Program Research in Diabetes: Findings from the Natural Experiments for Translation in Diabetes (NEXT-D) Network. Curr Diab Rep. 2018 Nov 20;18(12):146.
Journal cover image

Published In

Curr Diab Rep

DOI

EISSN

1539-0829

Publication Date

November 20, 2018

Volume

18

Issue

12

Start / End Page

146

Location

United States

Related Subject Headings

  • Translational Research, Biomedical
  • Primary Prevention
  • Humans
  • Health Promotion
  • Health Policy
  • Health Expenditures
  • Endocrinology & Metabolism
  • Diabetes Mellitus
  • Animals
  • 3210 Nutrition and dietetics