Suchergebnisse

Purpose: Measure attendance to the Young Men's Christian Association (YMCA) of the USA (Y-USA) diabetes prevention program (DPP) and show how attendance impacts weight loss and medical spending in a population of Medicare beneficiaries. Design: Observational study using a pre- and post-specification. Setting: A total of 17 participating YMCAs nationwide. Participants: 3317 Medicare beneficiaries with prediabetes. Intervention: Community-based trainings of lifestyle intervention (National DPP). Measures: We used weight measurements from the Y-USA DPP participants, and Medicare fee-for-service part A and B claims data (January 2011–December 2016) from Chronic Conditions Data Warehouse. Analysis: We used multivariate regression models to test the impact of class attendance on weight loss and Medicare expenditures. Results: From a maximum of 24 classes, participants on average attended 14 (standard deviation: 6). The relationship between attendance and both weight loss and savings were approximately linear. During each weekly class, participants lost an average of 0.72 (confidence interval [CI]: 0.67-0.77) pounds and saved on average $58 (CI: $38-78) in medical expenses per class attended. Conclusions: Attendance to diabetes prevention programs is often challenging. To obtain both clinically relevant changes (weight loss greater than 5% of one's initial body weight) and economically relevant savings, completing at least 14 core sessions is essential. Steps to increase attendance and motivation across vulnerable groups may be an essential consideration for policymakers.

Purpose: To test the role of financial incentives to motivate engagement in diabetes prevention programs (DPPs). Design: Minnesota, Montana, and New York randomized 3 different approaches to providing incentives: incentivizing class attendance and weight loss (all states), class attendance only (NY), and weight loss only (NY). We used New York to test how different approaches to providing incentives influence DPP completion and attendance. Setting: Health-care facilities and local young men's Christian association. Participants: Eight hundred thirty one Medicaid enrollees in Minnesota, 204 in Montana, and 560 in New York. Intervention Measure: Impact of the financial incentives on DPP program completion rates. We measured completion of DPP classes in 2 ways: completing 9 or more or 16 or more DPP classes. Analysis: Multivariate logistic model to compare completion of DPP classes between participants randomized into receiving financial incentives and controls. Results: Receipt of incentives was associated with higher odds at attending 9 or more classes (odds ratio [OR]: 2.2; P < .01) in Minnesota, Montana (OR: 2.2; P < .05), and New York (OR: 1.9; P < .01) as well as attending 16 or more classes in Minnesota (OR: 3.1; P < .01), Montana (OR: 2.1; P < .01), and New York (OR: 2.9; P < .01). In New York, individuals paid to attend classes attended more classes than individuals paid based on results only. Conclusion: Among Medicaid beneficiaries, financial incentives improve DPP class attendance.

Residents of cities face housing instability due to high housing costs. We conduct a randomized experiment evaluating the impacts of a flexible "shallow subsidy" among 668 qualified renters with recent housing instability. This local subsidy provides $7,200 a year directly to families earning less than 30 percent of the median family income, who choose how much assistance to use each month. Using administrative data, we track outcomes for the first year of program administration. After one year, the program has no statistically significant effect on homelessness, cash benefit receipt, or emergency rental assistance utilization, demonstrating no harm when compared to alternatives. However, the program leads to a 29 percentage point decrease in participants' use of other types of local government housing services, which they must weigh against the shallow subsidy. We show that the program can be administratively cost-saving, but is not always beneficial for a very low-income subset of applicants.