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2019 HSR&D/QUERI National Conference Abstract

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1116 — Enhancing Participation, Engagement and Satisfaction in Preventive Care Services Among Women Veterans with Prediabetes.

Lead/Presenter: Tannaz Moin,  COIN - Los Angeles
All Authors: Moin T (HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles and and David Geffen School of Medicine at UCLA), Dyer K (HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles), Zuchowski JL (HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles) Bean-Mayberry B (HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles and David Geffen School of Medicine at UCLA) Farmer MM (HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles) Huynh AK (HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles) Finley EP (South Texas Veterans Health Care System and UT Health Science Center, San Antonio) Hamilton AB (HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles and David Geffen School of Medicine at UCLA)

Objectives:
Prediabetes affects one in three US adults and increases risk of incident type 2 diabetes. Diabetes is associated with significant morbidity and mortality and affects 25% of Veterans. Gender disparities in quality of care for diabetes and cardiovascular (CV) risk underscore the importance of innovative approaches to target and promote diabetes prevention among women. Leveraging prior QUERI efforts, we tailored an intensive lifestyle intervention to meet the diverse needs of overweight/obese women Veterans with prediabetes.

Methods:
Overweight/obese women Veterans with prediabetes (HbA1c 5.7-6.4%) were invited to participate in a 12-month tailored, evidence-based intensive lifestyle intervention referred to as the diabetes prevention program (DPP). Eligible participants were offered the choice of either a tailored peer-led, in-person DPP or an online DPP intervention. Patient and implementation outcomes were assessed using patient and provider semi-structured interviews, patient surveys and DPP participation and adherence.

Results:
Among 874 women Veterans screened, 541 (62%) met preliminary eligibility criteria and 302 (56%) were reached to confirm eligibility. Among those reached, 216 (72%) expressed interest in DPP; 51 (24%) chose in-person, peer-led DPP; 160 (74%) chose online DPP and five (2%) were undecided. At baseline, about 30% were aware of their previously documented prediabetes diagnosis and only 16% had previously participated in a lifestyle change program. Participation and adherence were higher with online as compared to in-person DPP (56% online vs. 25% in-person participants completed > 9 sessions/modules). A total of 38 interviews were conducted (N = 18 early implementation and N = 20 post implementation). DPP content was well received regardless of modality; women Veterans and providers valued having a choice between DPP modalities and agreed that offering gender-specific groups may help encourage participation.

Implications:
Tailored interventions which offer women Veterans choices and gender-specific care may help increase their participation and engagement in evidence-based interventions to reduce risk of incident diabetes.

Impacts:
Increasing prediabetes awareness and tailoring DPP intervention delivery to better meet the needs and preferences of high-risk sub-groups of women Veterans may help improve health outcomes, as well as satisfaction with and engagement in VA care among women Veterans.