Clinical Identification and Referral of Adults With Prediabetes to a Diabetes Prevention Program

Clinical Identification and Referral of Adults With Prediabetes to a Diabetes Prevention Program

IMPLEMENTATION EVALUATION — Volume 16 — June 27, 2019

Christopher S. Holliday, PhD, MPH1; Janet Williams, MA1; Vanessa Salcedo, MPH2; Namratha R. Kandula, MD, MPH3,4 (View author affiliations)

Suggested citation for this article: Holliday CS, Williams J, Salcedo V, Kandula NR. Clinical Identification and Referral of Adults With Prediabetes to a Diabetes Prevention Program. Prev Chronic Dis 2019;16:180540. DOI: http://dx.doi.org/10.5888/pcd16.180540external icon.

PEER REVIEWED

On This Page

• Abstract
• Introduction
• Purpose and Objectives
• Intervention Approach
• Evaluation Methods
• Evaluation
• Results
• Implications for Public Health
• Acknowledgments
• Author Information
• References
• Tables

Summary

What is already known about this topic?

The prevalence of type 2 diabetes and prediabetes extends to about one-third of the US adult population. Reducing this burden will require prevention programs, but clinical practices do not routinely screen, test, and refer patients to such programs.

What is added by this report?

We describe implementation of diabetes prevention strategies, including robust clinical–community linkages, that helped clinicians and their care teams at 26 health centers to systematically identify patients with prediabetes and refer them to an evidence-based diabetes prevention program.

What are the implications for public health practice?

Strategies developed and tested created robust clinical–community linkages that are generalizable across a wide variety of health centers and health systems across the United States.

Abstract

Purpose and Objectives

Community programs to prevent or delay the onset of type 2 diabetes are effective, but implementing these programs to maximize their reach and impact remains a challenge. The American Medical Association (AMA) partnered with the YMCA of the USA, as part of a Centers for Medicare and Medicaid Innovation demonstration project, to develop, implement, and evaluate innovative quality improvement strategies to increase routine screening, testing, and referral of Medicare patients with prediabetes to diabetes prevention programs (DPPs) at local YMCAs.

Intervention Approach

AMA recruited 26 primary care practices and health systems in 17 US communities to implement point-of-care and retrospective methods (or a combination of both) for screening, testing, and referral of Medicare patients with prediabetes.

Evaluation Methods

We assessed changes in rates of referral and enrollment of patients among participating practices. We used a mixed-methods pretest–posttest evaluation design to determine if use of certain tools and resources, coupled with systems changes, led to increased screening and referrals.

Results

Practices referred a total of 5,640 patients, of whom 1,050 enrolled in a YMCA DPP (19%; range, 2%–98%). Practices (n = 12) that used retrospective (ie, electronic medical record [EMR]) systems to identify eligible Medicare patients via a registry referred more people (n = 4,601) to the YMCA DPP than practices (n = 10) that used a point-of-care method alone (n = 437 patients) or practices (n = 4) that used a combination of these approaches (n = 602 patients). All approaches showed increased enrollment with point-of-care methods being most successful.

Implications for Public Health

Lessons learned from this intervention can be used to increase diabetes prevention in the United States and support the Centers for Medicare and Medicaid Services (CMS) decision to expand Medicare coverage to include the DPP for all Medicare beneficiaries.