Public Recognition as a Strategy to Improve Quality: The Impact of the National Diabetes Prevention Recognition Program on the YMCA’s Diabetes Prevention Program
Open AccessDiabetes represents a major public health problem, but one that can be prevented or delayed. Creative solutions are needed to improve the prevention of diabetes and reduce the morbidity, mortality, and costs associated with the disease. Interventions to improve the treatment and prevention of disease are not new to the healthcare field, but when the Affordable Care Act authorized the Centers for Disease Control and Prevention (CDC) to establish the National Diabetes Prevention Program, it brought quality improvement (QI) to the community level for diabetes prevention in the form of a national recognition program. The purpose of this research study was to understand the impact a national recognition program had on Diabetes Prevention Program (DPP) providers and outcomes. This research took place within YMCA (Y) organizations delivering the YMCA’s DPP while working toward CDC recognition.A mixed methods study design was used to gain a deeper understanding of if, how and why organizations and outcomes were affected by participation in CDC’s Diabetes Prevention Recognition Program (DPRP), using both case study and secondary data analysis. This design allowed the research to make the important connection between process and outcomes in understanding the impact of the national recognition program. All six case study organizations were eager to earn the credibility CDC’s recognition would afford them with medical providers and for the potential for recognition to help with program sustainability. Yet only two cases had made any changes to improve performance, despite all cases being aware of the gaps between current performance and the benchmarks needed to achieve full recognition. None of the cases achieved full recognition. The secondary data analysis confirmed that the majority of the 131 Y organizations who applied for recognition were not meeting four of the seven recognition standards, limiting them from achieving full recognition. Post DPRP-application gains were made in only two of these standards (percentage of eligible participants based on blood test and post-core session attendance). No difference was found in DPP outcomes (number of core sessions attended and percentage weight loss achieved) for participants between organizations that had applied for recognition compared with those that had not. Program outcomes (number of core sessions attended and percentage weight loss achieved) and program eligibility significantly differed by income status of the population served.This study was the first to assess how an innovative QI strategy, CDC’s DPRP, affected DPP delivery, indicating the recognition program had limited impact on DPP providers and outcomes. This research adds to the growing QI literature by focusing on an intervention targeted at community-based prevention and offers evidence to inform the evolution of the DPRP and the support provided to those organizations that apply.
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