Do you know somebody affected by diabetes? With more than 29 million Americans suffering from Type 1 or Type 2 diabetes and another 86 million affected by prediabetes, chances are, you do. In fact, diabetes has become so prevalent that the prevention and management of these serious diseases have become a national priority. In March 2016, the Patient-Centered Outcomes Research Institute (PCORI) responded by teaming up with the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) to advance the second phase of the Natural Experiments for Translation in Diabetes (NEXT-D) initiative dedicated to reducing the burden of diabetes across the U.S.
NEXT-D2, the second phase of the NEXT-D initiative, uses the collective input of eight academic institutions to provide rigorous evaluations of recently introduced policies or programs from both public agencies and private organizations that may impact diabetes in the U.S.
The NEXT-D2 team considers such programs “natural experiments”—that is, experiments that are rolled out in real-world settings without the control of research investigators. For example, how has Medicaid expansion affected the health outcomes of patients with diabetes? What are the health impacts of high deductible health plans? Over the course of five years, NEXT-D2 aims to examine these natural experiments to generate compelling evidence that will ultimately guide the decisions of U.S. healthcare policies and programs related to diabetes prevention and management.
“By leveraging resources from our network of funders and participating institutions, NEXT-D2 has the means to explore the health impact of recent policies and programs on diverse populations at a national scale,” said Abel Kho, co-principal investigator of the Northwestern NEXT-D2-team. “So often, well intentioned efforts are introduced, but we do not have the concrete evidence to validate their utility. Through NEXT-D2, we will gain insights from well designed natural experiments to better understand how health care legislation can effectively reduce diabetes risk, its complications, and health inequalities across broad segments of the U.S. population.”
Six of the PCORI-funded National Patient-Centered Clinical Research Network’s (PCORnet) Clinical Data Research Networks (CDRN) are contributors to NEXT-D2’s efforts, including PaTH: Towards a Learning Health System in the Mid-Atlantic Region, Research Action for Health Network (REACHnet), Accelerating Data Value Across a National Community Health Center Network (ADVANCE), Chicago Area Patient Centered Outcomes Research Network (CAPriCORN), the New York City Clinical Data Research Network (NYC-CDRN) and the Greater Plains Collaborative (GPC).
Among the many projects NEXT-D2 is exploring are three that are funded specifically by PCORI. Those explore the impact of targeted health policies to prevent diabetes; the impact of Medicaid health homes on diabetics; and the impact of state health policies on diabetes outcomes. Two additional studies funded by the CDC are using the PCORnet Partner Networks CAPriCORN and ADVANCE for NEXT-D2 research.
NEXT-D2 is also leveraging PCORnet’s existing infrastructure, with particular reliance on its Common Data Model (CDM). The NEXT-D2 team has been utilizing the CDM to standardize its data and collaborating with PCORnet to continuously improve the CDM for future research such as through the addition of standardized data on social determinants of health. By shedding new light on important diabetes factors and adding refinements to our CDM, NEXT-D2 is an excellent example of a study that is working to bring healthcare back to our most valuable stakeholders: patients.
The Patient-Centered Outcomes Research Institute (PCORI) is an independent, nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers, and clinicians with the evidence-based information needed to make better-informed healthcare decisions. PCORI is committed to continually seeking input from a broad range of stakeholders to guide its work. More information is available at www.pcori.org.
PCORnet, the National Patient-Centered Clinical Research Network, is an innovative initiative of the Patient-Centered Outcomes Research Institute (PCORI). The goal of PCORnet is to improve the nation’s capacity to conduct clinical research by creating a large, highly representative network that directly involves patients in the development and execution of research. More information is available at www.pcornet.org.