Factors in Placement and Enrollment of Primary Care Patients in YMCA's Diabetes Prevention Program, Bronx, New York, 2010-2015

Earle C Chambers, Colin D Rehm, Jordan Correra, Lydia Elena Garcia, Melinda E Marquez, Judith Wylie-Rosett, Amanda Parsons, Earle C Chambers, Colin D Rehm, Jordan Correra, Lydia Elena Garcia, Melinda E Marquez, Judith Wylie-Rosett, Amanda Parsons

Abstract

Introduction: The reach of the New York State YMCA's Diabetes Prevention Program (DPP) to at-risk populations may be increased through integration with primary care settings. Although considerable effort has been made in the referral and retention of patients, little is known about the factors associated with the placement of potential participants into YMCA's DPP.

Methods: Among Montefiore Health System (MHS) patients referred to YMCA's DPP (n = 1,249) from July 10, 2010, through November 11, 2015, we identified demographic factors (eg, age, preferred language) and primary care practice-level factors (eg, time between referral and start of session, session season) associated with placement into a session and subsequent drop-out. We also evaluated factors associated with weight loss.

Results: Patients were predominantly female (71%) and aged 45 years or older (71%). Patients preferring sessions in Spanish were less often placed in sessions. Patients aged 18 to 44 years were less often placed (P = .01) and enrolled (P = .001) than patients aged 60 years or older. Sessions conducted in the summer and spring had higher enrollment than fall and winter months. Patients who started the YMCA's DPP within 2 months of their referral date were more often enrolled (54.4%) than patients who waited 4 or more months (21.6%) to start their sessions. Patients aged 45 to 59 years lost marginally less weight than those aged 60 years or older (-3.1% vs -3.8%; P = .07).

Conclusion: Although this evaluation gives some insight into the barriers to placement and enrollment in YMCA's DPP, challenges remain. Efforts are under way to increase referral of patients to community-based DPPs.

Figures

Figure
Figure
Distribution of weight change among 287 Montefiore Health System patients enrolled in the New York State YMCA’s Diabetes Prevention Program, 2011–2015. [Table: see text]

References

    1. Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta (GA): US Department of Health and Human Services, Centers for Disease Control and Prevention; 2011.
    1. Tabák AG, Jokela M, Akbaraly TN, Brunner EJ, Kivimäki M, Witte DR. Trajectories of glycaemia, insulin sensitivity, and insulin secretion before diagnosis of type 2 diabetes: an analysis from the Whitehall II study. Lancet 2009;373(9682):2215–21. 10.1016/S0140-6736(09)60619-X
    1. National Diabetes Prevention Program. . Accessed February 2, 2017.
    1. Diabetes Prevention Program (DPP) Research Group. The Diabetes Prevention Program (DPP): description of lifestyle intervention. Diabetes Care 2002;25(12):2165–71. 10.2337/diacare.25.12.2165
    1. Diabetes Prevention Program Research Group; Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, et al. 10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet 2009;374(9702):1677–86. Erratum in Lancet 2009;374(9707):2054. 10.1016/S0140-6736(09)61457-4
    1. Bozack A, Millstein S, Garcel JM, Kelly K, Ruberto R, Weiss L. Implementation and outcomes of the New York State YMCA Diabetes Prevention Program: a multisite community-based translation, 2010–2012. Prev Chronic Dis 2014;11:E115. 10.5888/pcd11.140006
    1. New York State YMCA Diabetes Prevention Program: outcomes and implications. New York (NY): The New York Academy of Medicine, Center for Evaluation and Applied Research; New York State Health Foundation; October 2012.
    1. Ackermann RT, Finch EA, Brizendine E, Zhou H, Marrero DG. Translating the Diabetes Prevention Program into the community. The DEPLOY Pilot Study. Am J Prev Med 2008;35(4):357–63. 10.1016/j.amepre.2008.06.035
    1. American Medical Association, Centers for Disease Control and Prevention. Preventing type 2 diabetes: a guide to refer your patients with prediabetes to an evidence-based diabetes prevention program. . Accessed February 2, 2017.
    1. Centers for Disease Control and Prevention Diabetes Prevention Recognition Program. Standards and operating procedures. 2015. . Accessed February 2, 2017.
    1. Ruggiero L, Oros S, Choi YK. Community-based translation of the diabetes prevention program’s lifestyle intervention in an underserved Latino population. Diabetes Educ 2011;37(4):564–72. 10.1177/0145721711411107
    1. Merriam PA, Tellez TL, Rosal MC, Olendzki BC, Ma Y, Pagoto SL, et al. Methodology of a diabetes prevention translational research project utilizing a community-academic partnership for implementation in an underserved Latino community. BMC Med Res Methodol 2009;9(1):20. 10.1186/1471-2288-9-20
    1. Whittemore R. A systematic review of the translational research on the Diabetes Prevention Program. Transl Behav Med 2011;1(3):480–91. 10.1007/s13142-011-0062-y
    1. Spring B, Sohn MW, Locatelli SM, Hadi S, Kahwati L, Weaver FM. Individual, facility, and program factors affecting retention in a national weight management program. BMC Public Health 2014;14(1):363. 10.1186/1471-2458-14-363
    1. Jiang L, Manson SM, Dill EJ, Beals J, Johnson A, Huang H, et al. Participant and site characteristics related to participant retention in a diabetes prevention translational project. Prev Sci 2015;16(1):41–52. 10.1007/s11121-013-0451-1
    1. Jiandani D, Wharton S, Rotondi MA, Ardern CI, Kuk JL. Predictors of early attrition and successful weight loss in patients attending an obesity management program. BMC Obes 2016;3(1):14. 10.1186/s40608-016-0098-0
    1. Honas JJ, Early JL, Frederickson DD, O’Brien MS. Predictors of attrition in a large clinic-based weight-loss program. Obes Res 2003;11(7):888–94. 10.1038/oby.2003.122
    1. Cowie CC, Rust KF, Ford ES, Eberhardt MS, Byrd-Holt DD, Li C, et al. Full accounting of diabetes and pre-diabetes in the U.S. population in 1988–1994 and 2005–2006. Diabetes Care 2009;32(2):287–94. Erratum in Diabetes Care 2011;34(10):2338. 10.2337/dc08-1296
    1. Lloyd L, Miller B. The impact of seasonality on changes in body weight and physical activity in Mexican-American women. Women Health 2013;53(3):262–81. 10.1080/03630242.2013.781095
    1. Matthews CE, Freedson PS, Hebert JR, Stanek EJ 3d, Merriam PA, Rosal MC, et al. Seasonal variation in household, occupational, and leisure time physical activity: longitudinal analyses from the seasonal variation of blood cholesterol study. Am J Epidemiol 2001;153(2):172–83. 10.1093/aje/153.2.172
    1. US Census Bureau. American Community Survey, 2014 American Community Survey 1-year estimates generated by Colin D. Rehm using American FactFinder. . Accessed April 28, 2016.
    1. Chambers EC, Wylie-Rosett J, Blank AE, Ouziel J, Hollingsworth N, Riley RW, et al. Increasing referrals to a YMCA-based Diabetes Prevention Program: effects of electronic referral system modification and provider education in federally qualified health centers. Prev Chronic Dis 2015;12:E189. 10.5888/pcd12.150294

Source: PubMed

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