A Framework for Implementing the National Diabetes Prevention Program in Los Angeles County

Abstract

IntroductionPreventing type 2 diabetes is a public health priority in the United States. An estimated 86 million Americans aged 20 years or older have prediabetes, 90% of whom are unaware they have it. The National Diabetes Prevention Program (NDPP) has the potential to reduce the incidence of type 2 diabetes; however, little is known about the best way to institutionalize such a program in a jurisdiction with a racially/ethnically diverse population. The objective of this study was to develop a practice-grounded framework for implementing the NDPP in Los Angeles County.MethodsIn 2015, the Los Angeles County Department of Public Health (LACDPH) partnered with Ad Lucem Consulting to conduct a 3-stage formative assessment that consisted of 1) in-depth interviews with key informants representing community-based organizations to learn about their experiences implementing the NDPP and similar lifestyle-change programs and 2) 2 strategic planning sessions to obtain input and feedback from the Los Angeles County Diabetes Prevention Coalition. LACDPH identified core activities to increase identification of people with type 2 diabetes and referral and enrollment of eligible populations in the NDPP.ResultsWe worked with LACDPH and key informants to develop a 3-pronged framework of core activities to implement NDPP: expanding outreach and education, improving health care referral systems and protocols, and increasing access to and insurance coverage for NDPP. The framework will use a diverse partner network to advance these strategies.ConclusionThe framework has the potential to identify people with prediabetes and to expand NDPP among priority populations in Los Angeles County and other large jurisdictions by using a diverse partner network

Inner and outer setting factors that influence the implementation of the National Diabetes Prevention Program (National DPP) using the Consolidated Framework for Implementation Research (CFIR): a qualitative study

“…More research is required to understand how internal and external organization factors influence implementation in order to continue to scale the National DPP. While this study did not identify any outer setting constructs as distinguishing, the outer setting c onstruct, cosmopolitanism , has appeared in National DPP studies focused on referrals from providers, health systems, and other community partners [ 17 , 20 , 40 ]. Organizations with strong external partnerships were able to leverage this into increased referrals to their programs.…”

“…Organization-level evaluations have explored specific implementation strategies (referrals, partner networks, adaptation of materials, etc.) and have shown that use of incentives and healthcare provider-based referrals are promising practices to increase enrollment and participation [ 17 , 20 ]. However, these studies focus on limited organizational characteristics, such as type and location (e.g., state), in their analyses.…”

Exploring Reimbursement Options for the National Diabetes Prevention Program: Lessons Learned From a Pilot Project in Los Angeles, 2014-2018

“…[6][7][8] In 2014, with support from the CDC, the Los Angeles County Department of Public Health launched the Chronic Disease Prevention Strategy (CDPS), a primary goal of which was to expand the National DPP to reach safety-net populations disproportionately impacted by diabetes (eg, low-income and race/ethnic minority groups). 9 At the start of the CDPS initiative, the cost of participating in the National DPP was approximately $500 per person. This cost was prohibitive to both safety-net audiences and the community-based organizations (CBOs) frequently tasked with delivering the program to them (even when offset by grant funding, CBOs often absorbed at least part of program costs).…”

“…Nationally, efforts have been underway to scale the National DPP, including significant investments by the Centers for Disease Control and Prevention (CDC) at the state and local levels to translate this program into community settings, and build infrastructure to support large-scale uptake 6–8. In 2014, with support from the CDC, the Los Angeles County Department of Public Health launched the Chronic Disease Prevention Strategy (CDPS), a primary goal of which was to expand the National DPP to reach safety-net populations disproportionately impacted by diabetes (eg, low-income and race/ethnic minority groups) 9…”

Coordinated Approaches to Strengthen State and Local Public Health Actions to Prevent Obesity, Diabetes, and Heart Disease and Stroke

“…Mosst et al describe a practice-grounded framework used by the Los Angeles County Health Department to scale and sustain the National Diabetes Prevention Program (National DPP) by using a diverse partner network ( 18 ). By developing a 3-pronged framework (expanding outreach and education, improving health care referral systems and protocols, and increasing access to insurance coverage for the National DPP), Los Angeles County took an approach that other large jurisdictions can use to identify people with prediabetes and expand access to and use of CDC-recognized type 2 diabetes prevention programs.…”