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

  • Economics and Policy in Diabetes (ES Huang and AA Baig, Section Editors)
  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

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.

Summary

Findings from NEXT-D studies provide informative data that can guide programs and policies to facilitate detection, prevention, and treatment of diabetes in practice.

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Acknowledgments

The NEXT-D Study Writing Group members are the guarantors for the work, including the study designs, access to data, and decision to submit and publish the manuscript.

Disclaimer

The opinions expressed herein and the interpretation and reporting of these data are the responsibility of the authors and are not official recommendations, interpretations, or policies of the Centers for Disease Control and Prevention, National Institutes of Health, or the US Government.

Funding

The NEXT-D network was supported by a cooperative agreement jointly funded by the Centers for Disease Control and Prevention [66] and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) under CDC Funding Opportunity Announcement (FOA) Number: RFA-DP10-002, entitled Natural Experiments and Effectiveness Studies to Identify the Best Policy and System Level Practices to Prevent Diabetes and Its Complications.

Dr. Ali also receives support from the NIDDK-funded Georgia Center for Diabetes Translation Research (P30 DK111024).

Drs. Schmittdiel, Ross-Degnan, and Wharam also receive support from the NIDDK-funded Health Delivery Systems Center for Diabetes Translational Research (P30 DK092924).

The NEXT-D Study Group comprises additional investigators, namely:

• Harvard Medical School and Harvard Pilgrim Healthcare Institute: Steve Soumerai, Emma Eggleston, Christine Lu, Fang Zhang

• University of California at Los Angeles: Tannaz Moin, Susan L. Ettner, Norman Turk, Lindsay Kimbro

• Kaiser Permanente: Sara Adams, Mindy Boccio, Nancy Goler, Rashel Sanna, Andromache Fargeix, Victoria George, Romain Neugebauer, Assiamira Ferrara, Susan Brown

• Mount Sinai: Nancy Sohler, Brenda Matti, Edwin Young, Carolyn Chu, Francisco Perez Mata, Julian Botta, Pindan Hao, Carolina Hurtado

• Northwestern University: Margaret Moran, Ray Kang, Andrew Cooper, Matthew O’Brien, David Liss, Joyce Tang, Ann Holmes, Chandan Saha

• Centers for Disease Control and Prevention: Bernice Moore, Heather Devlin, Patricia Shea

• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK): Sandy Garfield

The NEXT-D investigators would like to acknowledge collaborative and administrative support from the following stakeholders: United Health Group: Bob Luchs, Charlie Chan, Abigail Keckhafer, Anya Kirvan, Sam Ho, Deneen Vojta, and Ted Prospect.

Author information

Author notes

  1. Carol Mangione and Edward W. Gregg were co-senior authors.

Authors and Affiliations

  1. Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Mailstop K10, 4770 Buford Highway, Atlanta, GA, 30341, USA

    Mohammed K. Ali & Edward W. Gregg

  2. Hubert Department of Global Health, Emory University, 1518 Clifton Road NE, Ste 7041 CNR Building, Atlanta, GA, 30322, USA

    Mohammed K. Ali

  3. Harvard Pilgrim Health Care Institute, Department of Population Medicine, Harvard Medical School, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA

    Frank Wharam & Dennis Ross-Degnan

  4. Division of General Internal Medicine, University of California Los Angeles, 911 Broxton Ave., Los Angeles, CA, 90024, USA

    O. Kenrik Duru

  5. Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA

    Julie Schmittdiel

  6. Department of Medicine, General Medicine Division, Northwestern University, Rubloff Building 10th Floor 750 N Lake Shore, Chicago, IL, 60611, USA

    Ronald T. Ackermann

  7. Division of Endocrinology, Diabetes and Bone Diseases, Icahn School of Medicine at Mount Sinai, 1111 Amsterdam Avenue Babcock Building - 10th Floor, New York, NY, 10025, USA

    Jeanine Albu

  8. Office of Behavioral and Social Sciences Research, National Institutes of Health, 31 Center Drive, Bethesda, MD, 20892, USA

    Christine M. Hunter

  9. Division of General Internal Medicine, University of California Los Angeles, UCLA Med-GIM & HSR BOX 957394, 10940 Wilshire Blvd, Los Angeles, CA, 90095, USA

    Carol Mangione

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Correspondence to Mohammed K. Ali.

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Conflict of Interest

Mohammed K. Ali, Frank Wharam, O. Kenrik Duru, Julie Schmittdiel, Ronald T. Ackermann, Jeanine Albu, Dennis Ross-Degnan, Christine M. Hunter, Carol Mangione, and Edward W. Gregg declare that they have no conflict of interest.

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This article is part of the Topical Collection on Economics and Policy in Diabetes

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Ali, M.K., Wharam, F., Kenrik Duru, O. 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, 146 (2018). https://doi.org/10.1007/s11892-018-1112-3

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