Evaluating Diabetes Health Policies Using Natural Experiments

Abstract

The high prevalence and costs of type 2 diabetes makes it a rapidly evolving focus of policy action. Health systems, employers, community organizations, and public agencies have increasingly looked to translate the benefits of promising research interventions into innovative polices intended to prevent or control diabetes. Though guided by research, these health policies provide no guarantee of effectiveness and may have opportunity costs or unintended consequences. Natural experiments use pragmatic and available data sources to compare specific policies to other policy alternatives or predictions of what would likely have happened in the absence of any intervention. The Natural Experiments for Translation in Diabetes (NEXT-D) Study is a network of academic, community, industry, and policy partners, collaborating to advance the methods and practice of natural experimental research, with a shared aim of identifying and prioritizing the best policies to prevent and control diabetes. This manuscript describes the NEXT-D Study group's multi-sector natural experiments in areas of diabetes prevention or control as case examples to illustrate the selection, design, analysis, and challenges inherent to natural experimental study approaches to inform development or evaluation of health policies.

Results from NEXT-D: the association of a pre-diabetes-specific health plan and rates of incident diabetes among a national sample of working-age adults

“…All NEXT-D studies are evaluations of 'naturally' occurring health polices and/or interventions (ie, without randomization), using the strongest observational research designs possible and conducted in close collaboration with organizations implementing those programs. [11][12][13] The academic team members analyzed all data independently and retained sole authority over all publication-related decisions throughout the course of the study.…”

Population Health Management for Diabetes: Health Care System-Level Approaches for Improving Quality and Addressing Disparities

“…However, our review of the literature also found that there are a limited number of published evaluations of specific diabetes population care approaches, and those that are published may not have the level of programmatic detail required for dissemination into other settings. Future research in this area should continue to identify, rigorously evaluate, and publish results from high quality ‘natural experiments’ in diabetes population care management 45 .…”

Practical partnered research to improve weight loss among overweight/obese veterans: lessons from the trenches

“…Research typically follows a slower timeline, whereas program changes may occur more rapidly and/or in real-time. This tension is exacerbated by research funding being more available for traditional clinical trials that focus on testing interventions in relatively controlled circumstances rather than assessing effectiveness and implementation approaches in less controlled real-world settings [6–9]. Frenk (1992) and others have described this tension as navigating trade-offs between scientific excellence (contributing to internal validity) versus being relevant, responsive, and timely (contributing to external validity) [4, 5, 10–13].…”