Clinical Trial

. 2017 Jul 26;12(1):94.

doi: 10.1186/s13012-017-0619-3.

Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA)

Laura J Damschroder^{1

2}, Caitlin M Reardon³, Mona AuYoung^{3

4}, Tannaz Moin^{5

6

7}, Santanu K Datta^{8

9}, Jordan B Sparks³, Matthew L Maciejewski^{8

9}, Nanette I Steinle^{10

11}, Jane E Weinreb^{5

6}, Maria Hughes³, Lillian F Pinault^{10

11}, Xinran M Xiang^{12

13}, Charles Billington^{14

15}, Caroline R Richardson^{3

16

12

17}

Affiliations

¹ Ann Arbor VA HSR&D/Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA. laura.damschroder@va.gov.
² VA Diabetes QUERI, Ann Arbor, MI, USA. laura.damschroder@va.gov.
³ Ann Arbor VA HSR&D/Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA.
⁴ Scripps Translational Science Institute/The Scripps Research Institute, 10550 North Torrey Pines Road, Mail Drop: TRY-30, La Jolla, CA, 92037, USA.
⁵ VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd 3, Los Angeles, CA, 90073, USA.
⁶ David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
⁷ Greater Los Angeles VA Health Services Research and Development (HSR&D) Center for Healthcare Innovation, Implementation and Policy, Los Angeles, CA, USA.
⁸ Durham VA Medical Center HSR&D, 411 W Chapel Hill St, Suite 600, Durham, NC, 27701, USA.
⁹ Duke University School of Medicine, Durham, NC, USA.
¹⁰ VA Maryland Healthcare System, 10 North Greene St, Baltimore, MD, 21201, USA.
¹¹ University of Maryland School of Medicine, Baltimore, MD, USA.
¹² Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.
¹³ Louisiana State University Pediatric Neurology Program, 1542 Tulane Ave Rm 763, New Orleans, LA, 70112, USA.
¹⁴ Minneapolis VA Healthcare System, 1 Veterans Drive, Minneapolis, MN, 55417, USA.
¹⁵ University of Minnesota Medical Center, Minneapolis, MN, USA.
¹⁶ VA Diabetes QUERI, Ann Arbor, MI, USA.
¹⁷ University of Michigan Department of Family Medicine, 1018 Fuller St, Ann Arbor, MI, 48104, USA.

PMID: 28747191
PMCID: PMC5530572
DOI: 10.1186/s13012-017-0619-3

Clinical Trial

Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA)

Laura J Damschroder et al. Implement Sci. 2017.

. 2017 Jul 26;12(1):94.

doi: 10.1186/s13012-017-0619-3.

Authors

Affiliations

¹ Ann Arbor VA HSR&D/Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA. laura.damschroder@va.gov.
² VA Diabetes QUERI, Ann Arbor, MI, USA. laura.damschroder@va.gov.
³ Ann Arbor VA HSR&D/Center for Clinical Management Research, P.O. Box 130170, Ann Arbor, MI, 48113-0170, USA.
⁴ Scripps Translational Science Institute/The Scripps Research Institute, 10550 North Torrey Pines Road, Mail Drop: TRY-30, La Jolla, CA, 92037, USA.
⁵ VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd 3, Los Angeles, CA, 90073, USA.
⁶ David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
⁷ Greater Los Angeles VA Health Services Research and Development (HSR&D) Center for Healthcare Innovation, Implementation and Policy, Los Angeles, CA, USA.
⁸ Durham VA Medical Center HSR&D, 411 W Chapel Hill St, Suite 600, Durham, NC, 27701, USA.
⁹ Duke University School of Medicine, Durham, NC, USA.
¹⁰ VA Maryland Healthcare System, 10 North Greene St, Baltimore, MD, 21201, USA.
¹¹ University of Maryland School of Medicine, Baltimore, MD, USA.
¹² Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.
¹³ Louisiana State University Pediatric Neurology Program, 1542 Tulane Ave Rm 763, New Orleans, LA, 70112, USA.
¹⁴ Minneapolis VA Healthcare System, 1 Veterans Drive, Minneapolis, MN, 55417, USA.
¹⁵ University of Minnesota Medical Center, Minneapolis, MN, USA.
¹⁶ VA Diabetes QUERI, Ann Arbor, MI, USA.
¹⁷ University of Michigan Department of Family Medicine, 1018 Fuller St, Ann Arbor, MI, 48104, USA.

PMID: 28747191
PMCID: PMC5530572
DOI: 10.1186/s13012-017-0619-3

Abstract

Background: The Diabetes Prevention Program (DPP) is an effective lifestyle intervention to reduce incidence of type 2 diabetes. However, there are gaps in knowledge about how to implement DPP. The aim of this study was to evaluate implementation of DPP via assessment of a clinical demonstration in the Veterans Health Administration (VHA).

Methods: A 12-month pragmatic clinical trial compared weight outcomes between the Veterans Affairs Diabetes Prevention Program (VA-DPP) and the usual care MOVE!® weight management program (MOVE!). Eligible participants had a body mass index (BMI) ≥30 kg/m² (or BMI ≥ 25 kg/m² with one obesity-related condition), prediabetes (glycosylated hemoglobin (HbA1c) 5.7-6.5% or fasting plasma glucose (FPG) 100-125 mg/dL), lived within 60 min of their VA site, and had not participated in a weight management program within the last year. Established evaluation and implementation frameworks were used to guide the implementation evaluation. Implementation barriers and facilitators, delivery fidelity, participant satisfaction, and implementation costs were assessed. Using micro-costing methods, costs for assessment of eligibility and scheduling and maintaining adherence per participant, as well as cost of delivery per session, were also assessed.

Results: Several barriers and facilitators to Reach, Adoption, Implementation, Effectiveness and Maintenance were identified; barriers related to Reach were the largest challenge encountered by site teams. Fidelity was higher for VA-DPP delivery compared to MOVE! for five of seven domains assessed. Participant satisfaction was high in both programs, but higher in VA-DPP for most items. Based on micro-costing methods, cost of assessment for eligibility was $68/individual assessed, cost of scheduling and maintaining adherence was $328/participant, and cost of delivery was $101/session.

Conclusions: Multi-faceted strategies are needed to reach targeted participants and successfully implement DPP. Costs for assessing patients for eligibility need to be carefully considered while still maximizing reach to the targeted population.

Keywords: Consolidated Framework for Implementation Research; Diabetes Prevention Program; Implementation; Pragmatic clinical trial; RE-AIM framework; Veterans; Weight management.

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Conflict of interest statement

Ethics approval and consent to participate

This evaluation was approved by each of five IRBs at the respective research institutions with which the investigators are affiliated.

Consent for publication

Not applicable.

Competing interests

CB reported personal fees from Novo Nordisk and personal fees from Enteromedics outside of the submitted work. MLM reported ownership of Amgen stock due to his spouse’s employment. The other authors have nothing to disclose.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

**Fig. 1**
DPP characteristics reported by Aziz et al.’s systematic review. A red box indicates category for VA-DPP. ^aWorkplace and primary care settings. ^bCommunity, church, YMCA, various venues, leisure, and community settings. ^cHealth care facilities, outpatient settings, hospitals. ^dOther modes include telephone, fax, text, email, online. ^eThirty-nine studies reported because one study reported low and high sites. ^fStandard curriculum = delivery of DPP following a standard curriculum. ^gQA = quality assurance = use of measures to monitor implementation

**Fig. 2**
Conceptual framework: integration of CFIR contextual factors and RE-AIM domains

See this image and copyright information in PMC

References

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Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA)

Affiliations

Implementation findings from a hybrid III implementation-effectiveness trial of the Diabetes Prevention Program (DPP) in the Veterans Health Administration (VHA)

Authors

Affiliations

Abstract

Conflict of interest statement

Ethics approval and consent to participate

Consent for publication

Competing interests

Publisher’s Note

Figures

References

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