U.S. flag

An official website of the Department of Health & Human Services

  • Search All AHRQ Sites
  • Email Updates

Patient Safety Network

1. Use quotes to search for an exact match of a phrase.

2. Put a minus sign just before words you don't want.

3. Enter any important keywords in any order to find entries where all these terms appear.

  • The PSNet Collection
  • All Content
  • Perspectives
  • Current Weekly Issue
  • Past Weekly Issues
  • Curated Libraries
  • Patient Safety 101
  • The Fundamentals
  • Training and Education
  • Continuing Education
  • WebM&M: Case Studies
  • Training Catalog
  • Improvement Resources
  • Innovations
  • About PSNet
  • Editorial Team
  • Technical Expert Panel

Book/Report

Final Report of the Commission on Care.

Washington, DC: Commission on Care; June 2016.

The Veterans Affairs health system has recently faced challenges associated with access and quality. Providing an assessment of the current and future state of the Veterans Health Administration , this report determined that care quality often meets or exceeds expectations but that quality varies from location to location. The authors outline recommendations for system improvements to ensure the safety of care delivery.

Inadequate Outpatient Mental Health Triage and Care of a Patient at the Chico Community-Based Outpatient Clinic in California. March 1, 2023

Long-Term Trends of Psychotropic Drug Use in Nursing Homes. February 1, 2023

Cybersecurity is Patient Safety: Policy Options in the Health Care Sector. December 14, 2022

Evaluation of Quality, Safety and Value in Veterans Health Administration Facilities, Fiscal 2021. November 16, 2022

Veterans Health Administration response to the COVID-19 crisis: surveillance to action. October 26, 2022

Artificial Intelligence in Health Care: Benefits and Challenges of Machine Learning Technologies for Medical Diagnostics. October 26, 2022

COVID-19 in Nursing Homes: CMS Needs to Continue to Strengthen Oversight of Infection Prevention and Control. October 12, 2022

Comprehensive Healthcare Inspection Summary Report: Evaluation of Care Coordination in Veterans Health Administration Facilities, Fiscal Year 2021. October 12, 2022

Solutions from Professional Regulation and Beyond. October 5, 2022

Opportunities to Improve Patient Safety, Advancing U.S. Innovation, and Innovation Hubs. October 5, 2022

CHPSO Annual Reports. September 20, 2022

A System in Need of Repair: Addressing Organizational Failures of the U.S.’s Organ Procurement and Transplantation Network. August 17, 2022

Examining the Status of VA’s Electronic Health Record Modernization Program. August 10, 2022

Adverse Events in Hospitals: A Quarter of Medicare Patients Experienced Harm in October 2018. May 25, 2022

Safety, Equity and Engagement in Maternity Services. January 12, 2022

Complaints to the Parliamentary and Health Service Ombudsman. December 17, 2021

The Safety of Maternity Services in England. August 25, 2021

Pathology Oversight Failures at the Veterans Health Care System of the Ozarks in Fayetteville, Arkansas VA. June 16, 2021

Medical Office Survey: 2020 User Database Report. April 28, 2021

National Healthcare Quality and Disparities Report: Chartbook on Patient Safety. February 17, 2021

Incidence of Adverse Events in Indian Health Service Hospitals. December 23, 2020

Defense Health Agency Processes for Responding to Provider Quality and Safety Concerns. December 23, 2020

Improving Diagnosis in Medicine Act of 2020. December 23, 2020

Making Complaints Count: Supporting Complaints Handling in the NHS and UK Government Departments. October 7, 2020

Covid-19: Assessing the Risk to Public Protection Posed by a Doctor as a Result of Concerns about their Practice during the Pandemic. September 30, 2020

Patient Safety September 17, 2020

Telediagnosis for Acute Care: Implications for the Quality and Safety of Diagnosis. August 19, 2020

First Do No Harm. The Report of the Independent Medicines and Medical Devices Safety Review. July 22, 2020

Culture as a Cure: Assessments of Patient Safety Culture in OECD Countries. July 15, 2020

Infection Control Deficiencies Were Widespread and Persistent in Nursing Homes Prior to COVID-19 Pandemic. May 27, 2020

Patient Safety Network

Connect With Us

LinkedIn

Sign up for Email Updates

To sign up for updates or to access your subscriber preferences, please enter your email address below.

Agency for Healthcare Research and Quality

5600 Fishers Lane Rockville, MD 20857 Telephone: (301) 427-1364

PSNet Log in

Submit Your Case

Please select your preferred way to submit a case.

Continue as a Guest

Track and save your case in My

Edit your case as a draft

Your name will not be publicly

associated with the case

Continue Logged In

Please select your preferred way to submit a case. Note that even if you have an account, you can still choose to submit a case as a guest. And if you do choose to submit as a logged-in user, your name will not be publicly associated with the case. Learn more information here.

Already have a PSNet

Access to quizzes and start earning

CME, CEU, or Trainee Certification.

Get email alerts when new content

matching your topics of interest

National Clinical Care Commission Final Report Published

Published February 16, 2023 in Advocacy , Special Diabetes Program

care commission report

In January 2022, the National Clinical Care Commission issued its final report to Congress. The finding were just published in Diabetes Care Here’s what they said about diabetes and what it means.

What is the National Clinical Care Commission?

National Clinical Care Commission (the Commission or NCCC) is a commission formed in 2018 to evaluate and provide recommendations to improve federal programs related to complex metabolic or autoimmune diseases that represent a significant disease burden in the United States. This includes type 1 diabetes (T1D). There are many federal programs that touch healthcare, and the charter of this commission was to make specific recommendations on how the federal government can improve their programs to meet the needs of its citizens affected by these diseases.

Ellen Leake, past chair of JDRF’s International Board of Directors, served on the NCCC as an appointed representative of JDRF and the T1D community.

The final report outlines evidence-based, actionable recommendations to improve federal diabetes awareness, prevention, and treatment programs; the first guidance like this since 1975. It also calls on the government to improve access to care, address social determinants of health, and improve collaboration between different federal agencies.

What Were Their Recommendations?

The NCCC issued its final report to Congress in January 2022. It included several recommendations around diabetes. These recommendations happen to align with JDRF’s Advocacy Agenda!

Here are some, but not all, of the specifics.

Renew the Special Diabetes Program For Longer at a Higher Level

The Special Diabetes Program (SDP) is a critical program that provides $150 million annually for T1D research at the National Institutes of Health (NIH), the country’s premier medical research agency. The SDP complements JDRF’s research efforts. Together, they are leading to new insights and therapies that are improving the lives of people with diabetes and accelerating progress to cure, treat, and prevent T1D.

The SDP has provided over $3.4 billion to T1D research since its inception in 1997—and the investment has paid enormous dividends—funding research that has directly led to new therapies for the T1D community.

The SDP is set to expire in September, and much of the funding it has received in recent years has been short-term, sometimes in months-long increments. The NCCC realizes the significance of long-term funding and recommends the program be renewed in five-year increments and include annual increases in funding to at least  account for inflation costs. 

JDRF strongly supports this recommendation.

Updates to Centers for Medicare & Medicaid Services

The Centers for Medicare & Medicaid Services (CMS) is the governing body that oversee Medicare and Medicaid, which are federal and state programs that provide health insurance and help with costs to millions of Americans. The NCC had specific recommendations for CMS, including update and regularly (at least every three years) evaluate eligibility requirements for various diabetes devices leading to appropriate coverage determinations. This is important because the landscape of T1D tech is rapidly changing; state of the art today may not be state of the art in three years. This recommendation ensures that the diabetes community will have access to the best tools and therapies. It also recommends that CMS consider patient-reported outcomes into their calculus—which is incredibly important and brings user-feedback into the process.

This recommendation is heartily welcomed by JDRF. JDRF led the fight to have Medicare cover CGM technology—and it took years for this vulnerable population to have access to lifesaving CGMs. This recommendation ensures that the current landscape is regularly evaluated.

Increasing Access to Improve Outcomes

Access to insulin and therapies like insulin pumps and CGMs can be a challenge in America. Insulin affordability is a crisis—even with the recent steps taken to put a cap on the cost of insulin for those on Medicare. For that reason, JDRF is encouraged by two recommendations by the NCCC around cost and access.

One recommendation is that federal policies and programs remove cost barriers to ensure that insulin is affordable for all people with diabetes and that no one with diabetes who needs insulin cannot get it because of cost. JDRF hopes Congress takes this recommendation seriously and works to address the issue.

Another is that the US Department of Health and Human Services (HHS) establish a process to determine and regularly reevaluate high-value diabetes services and treatments to be fully covered (pre-deductible) by health insurance based on their ability to prevent development or progression of diabetes complications. As therapies have improved, so have their abilities to keep individuals with T1D in range more of the time, which leads to fewer complications. JDRF supports this as well.

What Happens Now?           

The NCCC’s work is officially done. Their report was delivered to Congress, and it is up to Congress to take these recommendations and implement them as they see fit. JDRF has and will continue to share our strong support for these recommendations with Congress as part of our ongoing advocacy efforts to improve the lives of those with T1D and accelerate research to cure, treat and prevent T1D.

JDRF is honored to have been involved in the Commission’s work through Ellen and we thank her for her continued commitment to advance research and care for those living with T1D. JDRF also thanks the whole NCCC for their hard work and for making recommendations that will improve the lives of the diabetes community in the US.

Your privacy

We value your privacy. When you visit JDRF.org (and our family of websites), we use cookies to process your personal data in order to customize content and improve your site experience, provide social media features, analyze our traffic, and personalize advertising. By choosing “I Agree”, you understand and agree to JDRF’s Privacy Policy .

I Decline I Agree

Save for Later

Issue Cover

Introduction

Summary and conclusions, article information, the national clinical care commission report to congress: leveraging federal policies and programs to prevent diabetes in people with prediabetes.

ORCID logo

John M. Boltri, Howard Tracer, David Strogatz, Shannon Idzik, Pat Schumacher, Naomi Fukagawa, Ellen Leake, Clydette Powell, Donald Shell, Samuel Wu, William H. Herman; The National Clinical Care Commission Report to Congress: Leveraging Federal Policies and Programs to Prevent Diabetes in People With Prediabetes. Diabetes Care 1 February 2023; 46 (2): e39–e50. https://doi.org/10.2337/dc22-0620

Download citation file:

Individuals with an elevated fasting glucose level, elevated glucose level after glucose challenge, or elevated hemoglobin A 1c level below the diagnostic threshold for diabetes (collectively termed prediabetes) are at increased risk for type 2 diabetes. More than one-third of U.S. adults have prediabetes but fewer than one in five are aware of the diagnosis. Rigorous scientific research has demonstrated the efficacy of both intensive lifestyle interventions and metformin in delaying or preventing progression from prediabetes to type 2 diabetes. The National Clinical Care Commission (NCCC) was a federal advisory committee charged with evaluating and making recommendations to improve federal programs related to the prevention of diabetes and its complications. In this article, we describe the recommendations of an NCCC subcommittee that focused primarily on prevention of type 2 diabetes in people with prediabetes. These recommendations aim to improve current federal diabetes prevention activities by 1 ) increasing awareness of and diagnosis of prediabetes on a population basis; 2 ) increasing the availability of, referral to, and insurance coverage for the National Diabetes Prevention Program and the Medicare Diabetes Prevention Program; 3 ) facilitating Food and Drug Administration review and approval of metformin for diabetes prevention; and 4 ) supporting research to enhance the effectiveness of diabetes prevention. Cognizant of the burden of type 1 diabetes, the recommendations also highlight the importance of research to advance our understanding of the etiology of and opportunities for prevention of type 1 diabetes.

Graphical Abstract

graphic

Prediabetes is a condition that increases the risk for type 2 diabetes and cardiovascular disease (CVD) ( 1 ). In this article, the National Clinical Care Commission (NCCC) addresses targeted diabetes prevention in people at high risk for diabetes, specifically those with prediabetes, with recommendations focused on increasing awareness of prediabetes, the referral of people with prediabetes to effective lifestyle change programs, and supporting Food and Drug Administration (FDA) approval of metformin for diabetes prevention ( 2 ). The commission’s recommendations also highlight the need for research to enhance and advance strategies to prevent type 2 diabetes and to advance the current state of our knowledge about the pathogenesis and prevention of type 1 diabetes. The recommendations included in this article complement those of the accompanying articles. Implementing recommendations such as making positive changes in food and agricultural policies, enhancing nutritional assistance programs, improving the built environment, reducing environmental exposures, and improving access to health care will benefit all Americans, including those with prediabetes. As type 2 diabetes accounts for 90–95% of diagnosed diabetes in the U.S., preventing or delaying progression to type 2 diabetes among people with prediabetes will have substantial clinical and public health benefits.

Prediabetes and Risk of Diabetes

Prediabetes is a metabolic disorder in which blood glucose levels are elevated but not high enough to be classified as diabetes. The American Diabetes Association (ADA) defines prediabetes as a fasting plasma glucose of 100–125 mg/dL (impaired fasting glucose [IFG]), a plasma glucose level 2 h after a 75-g glucose challenge of 140–199 mg/dL (impaired glucose tolerance [IGT]), or a hemoglobin A1c (HbA 1c ) level of 5.7% to 6.4% ( 1 ).

Prediabetes is prevalent in the U.S. The Centers for Disease Control and Prevention (CDC) estimated that 96 million adults ( 3 ), or about 37% of the U.S. population over 18 years of age, and 18% of teenagers, have prediabetes ( 4 , 5 ). Most people with prediabetes are unaware that they have this condition; only about 19% of people with prediabetes report being told by a health professional that they have prediabetes ( 4 ). Overweight and obesity are strong risk factors for prediabetes. The prevalence of prediabetes also increases with age ( 4 ).

People with prediabetes are at higher risk of developing type 2 diabetes. Risk of progression to type 2 diabetes varies depending on population characteristics and prediabetes definitions ( 6 , 7 ). The rate of progression is higher in those with both IFG and IGT compared with people with only IFG or IGT ( 8 – 11 ). A study of over 77,000 people with prediabetes found that the risk of developing type 2 diabetes increases with higher HbA 1c levels and with higher BMI ( 12 ).

Diabetes Prevention in People with Prediabetes

Applied clinical research has shown that various interventions are effective in delaying or preventing the progression from prediabetes to type 2 diabetes. The Diabetes Prevention Program (DPP) clinical trial demonstrated that an intensive lifestyle intervention that focused on a healthy diet, physical activity, and approximately 7% weight loss reduced the incidence of type 2 diabetes in people with prediabetes by 58%. Metformin reduced the incidence of type 2 diabetes by 31% over 2.8 years ( 13 ). Results of this study indicated that to prevent one case of diabetes during a period of 3 years, 6.9 people would have to participate in the lifestyle intervention and 13.9 would need to be treated with metformin ( 13 ). The DPP enrolled high-risk participants who had both IGT and IFG. Those who have only IGT or IFG have a lower rate of progression to type 2 diabetes. Of note, the number of people who need to participate in a lifestyle intervention to prevent one case of diabetes (i.e., number needed to treat) would be higher for those at lower risk of progression. One meta-analysis of 19 studies conducted in adults with prediabetes, defined by either IGT, IFG, or both, and testing a variety of lifestyle interventions (e.g., differing intensity and duration; focusing on diet, physical activity, or both) found a relative risk reduction of 39% and a number needed to treat of 25 to prevent 1 case of diabetes ( 14 ). A second meta-analysis of 23 studies testing different interventions in similar populations found that lifestyle interventions were associated with a 22% reduction in the incidence of diabetes ( 15 ).

Subsequent analysis of the DPP clinical trial found that the lifestyle intervention was effective in all people with prediabetes, regardless of age, BMI, or baseline risk of progression to type 2 diabetes ( 13 , 16 ). While the absolute benefit of the lifestyle intervention varies based on risk of progression, this analysis demonstrates that those at lower baseline risk of progression also benefit from the lifestyle intervention. In contrast, metformin was more effective in younger individuals, those with higher BMIs, women with histories of gestational diabetes, and people at higher baseline risk of progression to type 2 diabetes. It was not as effective in those over 60 years of age ( 13 , 16 , 17 ). Using this knowledge to inform benefit-based tailored treatment can reduce overtreatment and make prevention of diabetes more efficient, effective, and patient centered ( 16 , 18 ). The effectiveness of lifestyle interventions and metformin has been confirmed by several other studies in people with prediabetes defined by different criteria (people with IFG or IGT) ( 19 – 22 ).

Significantly, the effectiveness of lifestyle interventions to decrease risk of progression to type 2 diabetes is sustained over several to many years, though attenuated. In long-term follow-up of the DPP cohort, diabetes incidence was reduced by 27% in the lifestyle intervention group over 15 years ( 23 ), and a meta-analysis of 19 studies of lifestyle interventions found that participants with prediabetes had a 28% lower risk of diabetes after mean follow-up of 7.2 years ( 14 ).

A recent study assessed the population health impact of the National Health System (NHS) DPP on the incidence of type 2 diabetes in England. Although published in August 2022, after the NCCC submitted its report to the Congress, this report provides a valuable perspective on the impact of a targeted diabetes prevention intervention on population health in a real-world setting. This 9- to 12-month intervention for adults ≥18 years of age with HbA 1c levels of 6.0% to 6.4% or fasting glucose levels of 100–125 mg/dL involved attending at least 13 group-based behavior change sessions incorporating structured education on nutrition, physical activity, and weight loss. The NHS DPP was rolled out in three waves beginning in June 2016. Approximately 50% of English general practices were enrolled in the first wave, and a further 25% were enrolled in the second wave starting in April 2017. The DPP became available to all general practices beginning in April 2018. By April 2020, NHS DPP providers had received 513,312 participant referrals, of whom 271,208 (52.8% of the total) had attended an initial assessment and 101,175 (19.7% of total) had attended at least 60% of program sessions. Using data from the National Diabetes Audit, which records all individuals across England who have been diagnosed with type 2 diabetes, and a difference-in-differences methodology, the authors demonstrated that the incidence of type 2 diabetes in wave 1 and wave 2 practices was significantly lower than would have been expected in the absence of the NHS DPP (difference-in-differences incidence rate ratio of 0.938 [95% CI, 0.905–0.972] and difference-in-differences incidence rate ratio of 0.927 [95% CI, 0.885–0.972] in waves 1 and 2, respectively). Whereas the U.S. DPP clinical trial demonstrated that the incidence of type 2 diabetes was reduced by 58% during the study period and by 34% during observational follow-up among randomized participants, the evaluation of the NHS DPP demonstrated that it reduced the population incidence of type 2 diabetes by 6.2% and 7.3%. This evaluation is a proof of concept that a targeted diabetes prevention intervention with broad reach and high uptake can impact the entire population, not just program participants, in a real-world setting. These findings support efforts to improve and expand the National DPP and the Medicare Diabetes Prevention Program (MDPP) in the United States ( 24 ).

Analysis of DPP clinical trial data, most relevant to people who have both IFG and IGT, has demonstrated that both the DPP lifestyle intervention and metformin are cost-effective in preventing or delaying progression to type 2 diabetes. In the U.S., interventions that cost less than $100,000 per quality-adjusted life-year (QALY) gained are generally considered to be cost-effective ( 25 , 26 ). It has been estimated that over 3 years (the length of the DPP clinical trial) the DPP lifestyle intervention implemented in a small-group format (with 10 participants per group) costs $13,200 per case of type 2 diabetes delayed or prevented and $27,100 per QALY gained, and metformin costs $14,300 per case of type 2 diabetes delayed or prevented and $35,000 per QALY gained ( 27 , 28 ). Research shows that if the effects of the DPP lifestyle intervention are extended beyond the timeframe of the intervention ( 23 ), the cost per QALY gained would further decrease. It has been estimated that over 10 years, the DPP lifestyle intervention implemented in a group format would cost $8,412 per QALY gained; metformin use is associated with a small cost saving ( 28 ). For comparison, intensive blood glucose control for patients with newly diagnosed type 2 diabetes costs approximately $41,000 per QALY gained over a lifetime ( 29 ). Since the cost-effectiveness of an intervention is dependent on participants’ risk of progression to type 2 diabetes and the effectiveness of the intervention, if the lifestyle intervention were implemented in a population at lower risk of progression or the intervention was less effective than observed in the clinical trial, the cost to prevent a case of diabetes or gain a QALY would be higher and the intervention relatively less cost-effective.

There are other compelling reasons for people with prediabetes to participate in lifestyle programs focused on diet, physical activity, and weight loss aside from prevention of type 2 diabetes. People with prediabetes are at increased risk of CVD, chronic kidney disease, and death from any cause ( 30 – 32 ). Preventing CVD and other adverse health outcomes is therefore an important goal of diabetes prevention interventions. In the DPP clinical trial, the lifestyle intervention improved CVD risk factors (lower blood pressure, lower triglycerides, and higher HDL cholesterol) compared with placebo and metformin therapy ( 33 ). Longer-term follow-up of the DPP study cohort has shown a 39% lower CVD end point among participants who did not develop diabetes ( 34 ). Similarly, a meta-analysis of translation and effectiveness studies implementing the DPP in non–research settings found improvements in CVD risk factors (systolic and diastolic blood pressure, HDL, and total cholesterol) in program participants ( 35 ), highlighting that these additional benefits are realized in real-world settings.

Translation of the DPP Into Real-World Settings

Every year, approximately 1.5 million American adults are diagnosed with type 2 diabetes. Many of these cases could be prevented with earlier intervention ( 4 ). The initial DPP clinical trial and subsequent translation studies served as the model for the National DPP, a partnership of public and private organizations working to build the infrastructure necessary to support delivery of this lifestyle intervention throughout the U.S. The CDC provides support to National DPP delivery organizations and ensures program quality, setting specific requirements for data collection and reporting across all CDC-recognized program delivery organizations. Currently, the National DPP has over 2,000 CDC-recognized program delivery organizations across 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, and several U.S. territories.

Of the approximately 14.6 million U.S. adults with diagnosed prediabetes and elevated BMI, ∼300,000 (2%) reported having been referred to a type 2 diabetes prevention program in 2016–2017. Potential barriers to uptake include low rates of screening and diagnosis of prediabetes, inadequate health care professional health care communication with at-risk patients, confusion as to who should be screened and referred, lack of CDC-recognized programs, and insufficient insurance coverage ( 36 ).

Currently, there are differences among the ADA, U.S. Preventive Services Task Force (USPSTF), and American Medical Association (AMA) recommendations for screening for prediabetes. In its 2022 Standards of Medical Care in Diabetes ( 37 ), the ADA recommends that screening for prediabetes and diabetes begin at age 35 years for all people. It also recommends that “testing for prediabetes and/or type 2 diabetes in asymptomatic people should be considered in adults of any age with overweight or obesity who have one or more risk factors” ( 37 ). In August 2021, the USPSTF updated its 2015 recommendation on screening for prediabetes and type 2 diabetes to recommend “screening for prediabetes and type 2 diabetes in adults aged 35–70 years who have overweight or obesity” ( 38 ). The AMA Prediabetes Quality Measures were published in 2018 and recommended that screening for abnormal blood glucose be assessed as “the percentage of patients aged 40 years and older with BMI ≥25 . . . who are screened for abnormal blood glucose at least once in the last three years” ( 39 ). The AMA’s recommendations were taken verbatim from the USPSTF 2015 recommendation that called for screening for abnormal blood glucose in adults 40–70 years of age who are overweight or obese. The AMA recognized the difference between the ADA and USPSTF recommendations and reconciled them by not having an upper age limit cutoff for the measure, essentially aligning with the ADA recommendation. Because participants with prediabetes over the age of 70 were shown to benefit from the lifestyle intervention in the DPP clinical trial, the NCCC adopted this pragmatic approach and recommended screening for prediabetes and type 2 diabetes in people 35 years of age and older who have overweight or obesity.

Better harnessing of the capabilities of electronic medical records to facilitate prediabetes case findings and referrals, increasing payment for the National DPP lifestyle change program to avoid supply distortions, and extending coverage and broadening access to diabetes prevention interventions have also been recommended to address the issues of inadequate professional health care communication with at-risk patients and referrals ( 40 ). Currently, the National DPP is offered in-person, online, via distance learning, and through a combination of these delivery modes to provide populations at high-risk greater access to the intervention. In response to data indicating lower retention rates for some participants in the National DPP (e.g., younger participants and some racial/ethnic groups) ( 41 ), the CDC, along with many of its partners, is also working to improve both participant engagement and retention in the program and has developed many resources to assist delivery organizations with this important effort.

In March 2016, the Secretary of Health and Human Services announced that the National DPP lifestyle change program met statutory eligibility criteria for expansion into Medicare as the MDPP. The decision of the Centers for Medicare and Medicaid Services (CMS) to cover the MDPP was based on an analysis that assessed the impact of the YMCA DPP on Medicare spending and utilization ( 42 ). The YMCA of the USA received a Healthcare Innovation Award from CMS to provide the DPP to Medicare beneficiaries with prediabetes in 17 regional networks of participating YMCA groups nationwide. Using claims data to compute total medical costs for fee-for-service and Medicare Advantage participants and a matched comparison group of nonparticipants, the investigators found that the overall weighted average savings per member per quarter during the first 3 years of the intervention was $278. The MDPP was approved for Medicare Part B or C beneficiaries who have prediabetes and also meet BMI and other program eligibility criteria. Prediabetes is defined as a fasting plasma glucose of 110–125 mg/dL, a plasma glucose level 2 h after a 75-g glucose challenge of 140–199 mg/dL, or an HbA 1c of 5.7–6.4%. Beneficiaries who do not meet these criteria are not eligible to participate. Like the National DPP, the MDPP consists of a minimum of 16 intensive “core” sessions of a CDC-approved curriculum delivered over 6 months in a group-based, classroom-style setting, with monthly follow-up meetings thereafter, for a total of 12 months. Virtual (telehealth) and online programs are not included in the MDPP, although during the coronavirus disease 2019 (COVID-19) pandemic CMS allowed beneficiaries to participate virtually ( 43 ).

An evaluation of the MDPP published in March 2021 demonstrated that of the 2,248 beneficiaries served by the MDPP, beneficiaries attended 16 sessions on average and lost 5.1% of their initial body weight. Forty-nine percent of beneficiaries met the 5% weight loss goal ( 44 ). As of January 2022, only 315 organizations have been approved as MDPP suppliers, a small proportion of the 1,210 MDPP-eligible organizations with preliminary or full recognition by the CDC at that time ( 45 ). Based on feedback from program delivery organizations participating in the CDC’s Diabetes Prevention Recognition Program, the MDPP reimbursement rate is a barrier to MDPP program availability and sustainability, and payments that are dependent on participants achieving at least 5% weight loss may be problematic. Currently, the cost of delivering the National DPP lifestyle change program may outweigh Medicare reimbursement amounts, especially in large urban health systems serving diverse populations. Starting in 2022, CMS reimbursement for participants who meet all performance benchmarks increased 56%, from $450 to $705 per person ( 46 ). It is too early to know whether this change in payment will increase MDPP supply. A pay-for-performance funding model may also have a detrimental impact on health equity. Non-Hispanic White adults are most likely to be retained in the MDPP and to achieve the 5% weight loss goal linked to MDPP pay-for-performance reimbursement. Pay for performance might lead providers to offer the MDPP in affluentWhite neighborhoods, leading to higher participation by White individuals and an increased gap in diabetes prevalence between non-Hispanic White adults and other groups ( 41 ).

As of April 2022, over 600,000 adults at high risk for type 2 diabetes had enrolled in the National DPP lifestyle change program. In 2016–2017, median retention was 28 weeks and the median number of sessions attended was 16. Sixty-three percent of participants were retained in the program through the 18th week, and 32% of participants were retained through the entire program. Retention was associated with older age, non-Hispanic White race, and success in the program as assessed by early weight loss and greater reported physical activity ( 41 ). While people with prediabetes and their clinicians may choose to individualize the decision to participate in a lifestyle change program based on factors such as degree of glycemia, BMI, and presence of other medical conditions and priorities, the vast majority of people with prediabetes have not participated in lifestyle change programs or been prescribed metformin, despite the proven efficacy and cost-effectiveness of these interventions ( 47 ). To date, the FDA has not approved metformin for type 2 diabetes prevention. Prescribing metformin for people with prediabetes is therefore off-label, which may contribute to a lack of patient and clinician awareness of the benefits of metformin. Additionally, clinicians may presume that patients would prefer not to take a medication for type 2 diabetes prevention ( 48 ).

When framing type 2 diabetes prevention efforts through the lens of health equity, which is achieved when every person has the opportunity to attain their full health potential and no one is disadvantaged from achieving this potential because of social position or other socially determined circumstances, the current lack of access to lifestyle programming represents a missed opportunity. The U.S. Department of Health and Human Services defined the “elimination of health disparities and achievement of health equity” as one of their “most critical public health goals” for the 2020–2030 national plan ( 49 ). As has been well documented, type 2 diabetes disproportionately affects American Indian/Alaska Native, Black, Hispanic, and Asian people in the U.S. ( 4 ), and social determinants of health strongly affect type 2 diabetes prevalence in communities. To help address these disparities, we must ensure that preventative interventions are accessible to all people with prediabetes and are equitably implemented in all populations. Achieving these goals requires the sustainment and enhancement of federal programs and activities related to diabetes prevention, including targeted outreach, evidence-based interventions, and research support.

The methods employed by the NCCC have been described previously ( 50 ). Briefly, the 23 members of the NCCC formed three subcommittees that gathered information from federal agencies, stakeholders, key informants, and the public as well as a systematic search and review of the scientific literature. Through an iterative process, the NCCC developed broad recommendations for the Secretary of Health and Human Services and Congress regarding diabetes prevention and treatment. In this report, we describe the recommendations for diabetes prevention among people at high risk for developing diabetes, including those with prediabetes.

Increase Awareness of Prediabetes and the Diagnosis of Prediabetes

Expand support for the cdc’s national public service campaign.

Since 2016, the CDC has collaborated with the Ad Council on a national public service campaign to raise awareness of prediabetes. Since the start of the campaign, approximately 4 million individuals visited the Prediabetes Awareness Campaign website and completed the prediabetes risk test. Although these initial numbers are promising, support is still needed to continue these outreach efforts to reach the intended audience. Most Americans with prediabetes are still unaware of their condition and have not enrolled in the National DPP lifestyle intervention ( 48 , 51 ). In fact, only 19% of adults with prediabetes have been informed by a health care professional that they have prediabetes, with numbers especially low for young and early-middle-aged adults, men, and individuals of Asian or Hispanic ancestry ( 4 ). In addition, only 4.9% of adults diagnosed by a physician with prediabetes were advised to participate in a diabetes prevention program ( 51 ). This underscores the need to improve awareness of prediabetes and the National DPP among both patients and clinicians.

Recommendation

The CDC should utilize various marketing methods, including social media, to increase awareness of prediabetes for populations disproportionately affected by type 2 diabetes.

The CDC should continue tracking visits to the “Do I Have Prediabetes?” campaign webpage and completions of the prediabetes risk test. An expanded focus on the degree to which populations at increased risk are being reached would help to reduce disparities in awareness and could increase engagement in interventions.

Provide CMS Coverage for HbA 1c as a Screening Test for Prediabetes

The USPSTF and the 2022 ADA Standards of Medical Care in Diabetes both recommend FPG, oral glucose tolerance tests (OGTTs), and HbA 1c as appropriate tests for clinicians to use in screening for and diagnosing prediabetes and diabetes ( 37 , 38 ). However, Medicare does not cover HbA 1c testing for prediabetes screening, potentially contributing to low rates of screening among Medicare beneficiaries. The two tests that are covered (FPG and OGTTs) may present logistical barriers (fasting for FPG and extended visits for OGTTs) to identifying patients with prediabetes. These logistical issues do not apply to HbA 1c testing.

The NCCC recommends that CMS provide coverage for HbA 1c testing when used to screen for prediabetes.

Adopt AMA Proposed Clinical Quality Measures for Prediabetes Screening, Intervention, and Follow-up

Screen patients aged ≥35 years with a BMI ≥25 kg/m 2 for abnormal blood glucose at least once in the previous 3 years

∘ Referral to a CDC-recognized diabetes prevention program

∘ Referral to medical nutrition therapy with a registered dietitian

∘ Prescription of metformin

Retest patients’ glycemia in the year after they were identified with prediabetes (the measurement of glycemia is currently under revision as a potential quality outcome measure, i.e., the percentage of patients who do not progress to type 2 diabetes during a defined time period)

The opportunity to identify and intervene for patients at risk for type 2 diabetes may be missed during acute or routine medical visits because of competing priorities or incomplete information available at the time. Registries of patients at high risk or already meeting the criteria for prediabetes (that is, on the basis of BMI, history of hypertension, and glucose or HbA 1c results) could help prompt clinic staff to contact patients to discuss prediabetes, offer definitive diagnostic testing, and offer referrals to the National DPP or MDPP lifestyle change programs. Projects that have systematically retrieved results from medical records to identify and report patients with prediabetes have shown improvement in referrals to the National DPP lifestyle change program ( 55 , 56 ).

To support implementation of the revised 2019 AMA proposed prediabetes quality measures related to screening and interventions for abnormal glycemia, quality improvement programs should be introduced to improve performance and reduce disparities.

Increasing the Availability of, Referral to, and Insurance Coverage for Effective Diabetes Prevention Interventions

Simplify and harmonize national dpp and mdpp rules for program recognition and payment and increase payment rates to ensure program sustainability.

In response to the growing prevalence of type 2 diabetes in the U.S., Congress authorized the CDC to establish the National DPP in 2010 ( 57 ). In 2017, the Physician Fee Schedule final rule enabled National DPP program delivery organizations with full or preliminary CDC recognition to enroll as MDPP suppliers ( 58 ). However, some National DPP providers in rural and underserved areas may experience challenges in achieving full CDC recognition and applying to become MDPP suppliers due to increased administrative burden. Differences also exist between the MDPP and National DPP structures, including blood glucose eligibility criteria and allowable service delivery modalities, which may make it difficult for a provider organization to deliver both the National DPP lifestyle change program and MDPP.

The NCCC recommends that the CDC continues to streamline the National DPP recognition process while maintaining quality and that CMS coordinates with the CDC to harmonize MDPP processes. Differences in program eligibility and delivery modalities between the National DPP (led by the CDC) and the MDPP (led by CMS) should also be eliminated or, at minimum, reduced.

Ensure Reimbursement for All Proven Effective Modes of Diabetes Prevention Program Delivery (in Person, Telehealth, and Online)

Federal agencies use a variety of methods (e.g., in person, online, and distance learning [telehealth]) to deliver evidence-based interventions to delay or prevent type 2 diabetes ( 57 ). Other diabetes-related interventions, such as the Department of Defense Diabetes Center of Excellence Virtual Diabetes Self-Management Education Program, have also been implemented successfully in a fully virtual platform for military health system beneficiaries. However, payer coverage for these different delivery methods in the general population varies and is often nonexistent. Promoting and improving coverage for evidence-based type 2 diabetes prevention interventions through a variety of delivery methods could improve access.

The NCCC recommends that Congress promote coverage for all proven effective methods of delivery for evidence-based interventions that produce successful participant outcomes that meet or exceed those of the National DPP quality standards.

Mandate Private Insurance Coverage for the National DPP Lifestyle Change Program Under the Provisions of the Affordable Care Act

Section 2713 of the Affordable Care Act requires private health plans to cover certain evidence-based preventive services and to eliminate cost sharing for preventive care, including preventive services recommended by the USPSTF ( 59 ). The current USPSTF recommendation on screening for type 2 diabetes includes the following recommendation: “Clinicians should offer or refer patients with prediabetes to effective preventive interventions,” noting that “lifestyle interventions that focus on diet, physical activity, or both and metformin have demonstrated efficacy in preventing or delaying progression to diabetes in people with prediabetes” ( 38 ). Private insurers are not consistently providing coverage for the National DPP lifestyle change program, a proven effective diabetes prevention intervention. This may contribute to underutilization and fewer cases of type 2 diabetes being prevented.

The NCCC recommends, consistent with provisions of the Patient Protection and Affordable Care Act, that all insurers be required to provide coverage for participation in and completion of a CDC-recognized diabetes prevention program for those who are eligible.

Expand MDPP Access and Sustainability by Eliminating Barriers

The MDPP was approved as a model expansion service in 2016. It is an innovative service delivery model based on the National DPP. The MDPP expanded model is currently being evaluated based on factors such as quality of care delivered, patient outcomes, and costs ( 44 ). MDPP services are covered services under the model expansion, pending results of the evaluation ( 58 ); however, the original lifestyle intervention has already been studied extensively and has substantial evidence supporting its effectiveness across settings and populations.

Additionally, full virtual delivery of the MDPP is not currently included under the expanded model. This likely affected MDPP uptake and completion during the COVID-19 pandemic and is inconsistent with the National DPP, which allows virtual delivery and requires virtual delivery organizations to meet the same CDC national quality standards and achieve the same participant outcomes as in-person delivery organizations. During the COVID-19 pandemic, CMS allowed for virtual delivery of MDPP services; however, it is unclear whether this option will remain in place after the pandemic.

Finally, there is a once-in-a-lifetime limit on the MDPP service ( 60 ). However, people may not be able to fully engage in or complete the program, which may necessitate them repeating the program or re-enrolling at a future date. Currently, it is not possible to do this.

The NCCC recommends that the Medicare DPP be approved as a permanent covered benefit (not only a model expansion service) and that coverage of the MDPP be expanded to include virtual delivery. Furthermore, the once-in-a-lifetime limit on participation in the MDPP should be removed.

Update the MDPP Payment Model

The calendar year 2017 and 2018 Physician Fee Schedule final rules ( 58 , 61 ) established the benefit structure and payment rates for the MDPP based on a diabetes prevention program model test conducted by the YMCA of the USA from 2013 to 2015. The current MDPP payment model offers reimbursement only when participants reach certain attendance and weight loss benchmarks.

Under this model, program delivery organizations assume a level of risk and may be under-resourced to cover the upfront costs associated with program certification, marketing, and participant engagement and enrollment. Current reimbursement rates may not fully incentivize program delivery organizations to apply to become MDPP suppliers, as only a limited number of eligible organizations with CDC preliminary or full recognition have applied to become MDPP suppliers. This limits availability of the MDPP for Medicare beneficiaries with prediabetes and may also have a disproportionate impact on smaller and rural programs that often serve populations at increased risk.

The NCCC recommends that funding be provided to support the testing of new payment models that allow for greater upfront payments and more equitable risk-sharing between CMS and MDPP program delivery organizations. In addition, there should be an increase in payment levels to MDPP program delivery organizations to make MDPP programs financially sustainable. The NCCC notes that the CMS calendar year 2022 Physician Fee Schedule final rule may better align the duration of the MDPP and National DPP and will increase MDPP payment for participants who attend at least 9 sessions.

Provide Incentives for State Medicaid Programs to Cover Proven Effective Diabetes Prevention Programs

Medicaid coverage for the National DPP lifestyle change program is a state-level decision. Since 2012, 20 states have enacted varying levels of Medicaid coverage for the National DPP lifestyle change program ( 62 ). There are variations across states in 1 ) whether the National DPP lifestyle change program is a benefit covered by Medicaid; 2 ) delivery modes covered (i.e., in person, online, distance learning, and telehealth); and 3 ) the level of reimbursement. Additionally, risk for type 2 diabetes is higher in Medicaid beneficiaries, a population that is vulnerable to financial barriers to services. Using information from non–disability-based adult Medicaid beneficiaries 19–64 years of age at high risk for type 2 diabetes and a decision analytic simulation model, Laxy et al. ( 63 ) assessed the incremental cost-effectiveness ratios of covering versus not covering lifestyle interventions for prevention of type 2 diabetes in the Medicaid population. From a health care system perspective, they found that an initial program investment of $800 per person would be offset after 13 years and subsequently translate into cost savings. Minorities and low-income groups would benefit most from the intervention if it were offered by Medicaid ( 63 ).

The NCCC recommends that financial incentives be provided for state Medicaid programs to cover the National DPP lifestyle change program for Medicaid beneficiaries with prediabetes. Coverage should include all proven methods of delivery (i.e., in person, online, and distance learning or telehealth) that produce successful participant outcomes.

Support Additional Federal Programs Focusing on Diabetes Prevention

American Indian and Alaska Native individuals have the highest prevalence of diabetes of any racial and ethnic group ( 4 ). In response, the Special Diabetes Program for Indians (SDPI) was established by Congress in 1997 to support diabetes prevention and treatment among American Indian and Alaska Native communities. The SDPI is coordinated by the Indian Health Service (IHS) Division of Diabetes Treatment and Prevention with guidance from the Tribal Leaders Diabetes Committee. It provides funds for diabetes treatment and prevention to IHS, tribal, and urban Indian health programs ( 64 ). By maintaining a focus on diabetes prevention and leveraging SDPI funds, IHS and tribes implemented programs and services that contributed to lowering prevalence of diabetes in American Indian and Alaska Native adults over 4 years, from 15.4% in 2013 to 14.6% in 2017 ( 65 , 66 ). However, funding for this program has not increased since 2004.

There are also geographic disparities in diabetes prevalence. Alabama has the highest prevalence of diabetes (13.2%) among all U.S. states. The U.S. regions with the highest diabetes prevalence are in the Southeast and Appalachia; rural areas have a higher diabetes prevalence and generally have less medical infrastructure than urban areas ( 67 – 69 ). The Health Resources and Services Administration (HRSA) Delta States Rural Development Network Grant Program provides grants to the eight states in the Mississippi Delta for network and rural health infrastructure development ( 70 ). Grantees are required to focus on diabetes, CVD, and obesity but not specifically on type 2 diabetes prevention. Given the higher burden of type 2 diabetes in the Southern U.S. and the proven effectiveness of diabetes prevention interventions, providing additional resources to the HRSA Delta States Rural Development Network Grant Program would allow the program to include type 2 diabetes prevention as a focus while not detracting from the program’s, or HRSA’s, other important aims.

Recommendations

Funding for the SDPI should be made in 5-year increments so that evidence-based tribal diabetes prevention programs have the resources to 1 ) sustain the effort to combat diabetes and its complications; 2 ) develop additional culturally appropriate, high-impact type 2 diabetes prevention interventions; and 3 ) evaluate outcomes.

Increase funding for SDPI to address inflation costs, which have consumed more than 34% of the program’s resources since 2004, the last year Congress increased funding for the program. In the future, annual increases in funding should, at a minimum, address the costs of inflation.

Increase funding to HRSA’s Delta States Rural Development Network Grant Program to allow the program to include type 2 diabetes prevention as a focus.

Facilitate an Application to the FDA for Approval of Metformin for Diabetes Prevention

Metformin was approved by the FDA in 1995 for treatment of type 2 diabetes, and rigorous scientific evidence supports its safety and effectiveness in delaying the onset of type 2 diabetes in individuals at high risk with prediabetes ( 71 ). However, because metformin is not FDA approved for this purpose, prescribing it for prediabetes is an off-label use, and therefore metformin use in prediabetes treatment may be less frequent.

The DPP Research Group demonstrated that during the 3-year clinical trial, metformin, compared with the placebo intervention, reduced the incidence of diabetes by 34%, and during 15 years of follow-up it reduced diabetes incidence by 18% compared with placebo. After only 2 weeks of treatment withdrawal, the benefit of metformin therapy for diabetes prevention was attenuated ( 72 ). A systematic review and meta-analysis of randomized clinical trials demonstrated attenuation of all medication effects for diabetes prevention at the end of the washout period ( 14 ). The fact that no medication trials to date have shown a persistent benefit on diabetes prevention after medication withdrawal has indeed been a stumbling block for FDA approval of metformin for type 2 diabetes prevention. Requiring that a pharmacologic therapy for diabetes prevention alter the natural history of prediabetes and type 2 diabetes does not seem to be reasonable, since the complications of diabetes arise as a result of the degree and duration of hyperglycemia. Interventions to delay or prevent the onset of hyperglycemia are beneficial, just as those for hypertension and dyslipidemia are beneficial, without necessarily changing untreated blood pressure levels or lipid profiles if treatment is withdrawn.

Although there were no overall differences in the aggregate microvascular outcome in the metformin and placebo groups in the DPP, those who did not progress to diabetes had a 28% lower prevalence of microvascular complications than those who progressed. At the time the NCCC Report was submitted to Congress, there were no published data on the long-term effects of metformin on cardiovascular outcomes. In May 2022, the DPP Research Group published data describing the long-term effects of metformin on cardiovascular events ( 73 ). Over a 21-year median follow-up, the first occurrence of nonfatal myocardial infarction, stroke, or cardiovascular death did not differ between the metformin and placebo groups. Risk factor adjustment did not change these results, and no effect was apparent when a broader cardiovascular outcome was assessed. Thus, despite decreasing diabetes development, metformin did not reduce major adverse cardiovascular events compared with placebo. These results must be viewed in the context of the modest progression of hyperglycemia, extensive out-of-study use of lipid-lowering and antihypertensive medications, provision of a lifestyle intervention to all Diabetes Prevention Program Outcomes Study participants, and increased out-of-study metformin use over time, which may have limited the apparent effects of the intervention.

Although other pharmacologic treatments have been shown to be effective for type 2 diabetes prevention, including weight loss medications (orlistat and phentermine-topiramate), thiazolidinediones, α-glucosidase inhibitors, and even insulin glargine, the NCCC did not recommend them for diabetes prevention. A more recent study has also highlighted the potential role of glucagon-like peptide 1-receptor agonists for type 2 diabetes prevention ( 74 ). Because every kilogram of weight lost is associated with an additional 7% decrease in risk of progression to diabetes ( 14 ), newer treatments, including once-weekly glucagon-like peptide 1-receptor agonists and new dual receptor agonists such as tirzepatide, have great potential to reduce weight and prevent type 2 diabetes if rigorously demonstrated to be safe and effective for this indication.

Because there is no comprehensive synthesis of available data, pursuing FDA approval of metformin would require the applicant to collect, analyze, and organize data to show the safety and effectiveness of metformin in patients with prediabetes. As multiple generic versions of metformin exist, pharmaceutical companies have little incentive to do this. While data could be submitted to the FDA for review through other means, i.e., a Citizen’s Petition, the costs and amount of work involved with filing a Citizen’s Petition are high ( 75 ).

The NCCC recommends that funding be provided to the National Institutes of Health to fund a third party to collect, analyze, and summarize the available data from the Diabetes Prevention Program clinical trial describing the effectiveness and safety of metformin for type 2 diabetes delay or prevention in patients with prediabetes, including subpopulations most likely to benefit. Such a summary (with safety and efficacy data) should then be used to inform an appropriate submitter’s request for the FDA to review and consider an indication for the use of metformin in high-risk patients with prediabetes.

Support Research to Enhance the Effectiveness of Interventions for Type 2 Diabetes Prevention and Improve Our Understanding of the Etiology and Opportunities for Prevention of Type 1 Diabetes

Support research to understand who is most likely to benefit from participation in diabetes prevention lifestyle interventions and from metformin to better target these interventions to those at risk for type 2 diabetes.

Despite the remarkable outcomes of the DPP, most people with prediabetes have not participated in a diabetes prevention program such as the National DPP lifestyle change program and are not taking metformin ( 47 ). The reasons for not using metformin for prediabetes vary greatly and, as referenced previously, may include 1 ) physicians not wanting to use medication to treat people with prediabetes; 2 ) physicians’ and patients’ lack of awareness of the benefit of using metformin; 3 ) concerns about possible side effects of metformin; 4 ) concerns about lack of FDA approval for use of metformin in treating prediabetes; or 5 ) a combination of these reasons. These factors emphasize the importance of further studies on metformin uptake and alternative medication choices to treat prediabetes.

People with prediabetes are a heterogeneous group. In addition to social, geographic, financial, or cultural barriers, individuals have different physiologic characteristics that contribute to dysglycemia. As a result, some people with prediabetes may develop type 2 diabetes and other complications (e.g. CVD and kidney failure) more quickly than others ( 76 ). More research could improve our understanding of how these parameters affect specific risk factors and lead to the development of individually tailored screening and both lifestyle and pharmacologic interventions to maximize effectiveness. Solutions, strategies, and policies need to be developed that can be implemented and sustained at scale. Research to assess the performance of screening tests and efficacy of interventions across racial and ethnicity populations is also needed ( 77 ).

∘ What impediments prevent participation in effective diabetes prevention programs for communities with the greatest needs?

∘ Are programs that combine both lifestyle intervention and metformin to prevent diabetes more effective than programs with either lifestyle change or metformin alone?

∘ What is the best number, frequency, duration, and content of lifestyle intervention sessions to successfully prevent diabetes in the long term?

∘ What are the barriers and solutions to long-term maintenance of weight loss for those people who successfully complete a diabetes prevention program?

∘ What are the barriers and solutions at the health system, provider, and patient levels to implementation, and how can in-person and virtual diabetes prevention programs be more effectively implemented?

Support Research to Elucidate the Causes and Prevention of Type 1 Diabetes

Scientifically, it is still not well understood why people develop type 1 diabetes or how it can be best prevented ( 78 ). Approximately 30% of patients with new-onset type 1 diabetes present with diabetic ketoacidosis (DKA) ( 79 , 80 ), a serious yet avoidable acute metabolic complication. Some interventions (such as immune modulators and monoclonal antibodies) may be able to delay or prevent type 1 diabetes ( 81 ). A better understanding of the causes of type 1 diabetes can help identify those at high risk before they develop type 1 diabetes complications such as diabetic ketoacidosis.

In 1998 Congress passed the Special Statutory Funding Program for Type 1 Diabetes Research, also known as the Special Diabetes Program (SDP). This program has resulted in substantial progress in type 1 diabetes research and development of innovative collaborative research consortia and clinical trials networks. The SDP has funded research studies such as The Environmental Determinants of Diabetes in the Young (TEDDY) and the Type 1 Diabetes TrialNet, both of which have improved our understanding of the basic biological mechanisms of type 1 diabetes and are making strides to discover new treatment and prevention modalities ( 81 , 82 ). Additional research is needed to leverage emerging data from TEDDY and TrialNet to 1 ) develop screening programs to identify people at high risk for type 1 diabetes who might benefit from interventions; 2 ) develop efficient and cost-effective screening methods for type 1 diabetes in the general population; and 3 ) advance research to prevent type 1 diabetes.

The SDP was originally funded for 5-year intervals, but the program most recently has been funded for shorter intervals, sometimes on an annual basis. This change to short-term funding inhibits opportunities for research progress because it limits planning and initiation of long-term research projects. Sustained multiyear funding could help use federal dollars more effectively, maximize research opportunities for long-term studies such as TEDDY and TrialNet, and pursue new promising treatment and prevention studies and trials. Additionally, the SDP funding for type 1 diabetes research has been level at $150 million since 2004, without increases to account for inflation.

The NCCC recommends funding the SDP in 5-year increments so that new, innovative research can be developed effectively.

An increase in SDP program funding is needed to address inflation costs. Inflation costs have consumed more than 34% of the program’s resources since 2004, the last year Congress increased funding for the SDP. In the future, annual increases in funding should, at minimum, address the costs of inflation.

Increased awareness and advocacy for the National DPP

Expanded coverage for prediabetes/type 2 diabetes screening and diagnostic testing

Adoption and promotion of clinical quality standards

Support for the use of metformin in prediabetes

Requirements for insurance coverage and permanent benefit status for prevention programs and various delivery modalities

Sustainable funding and support for new payment models

Streamlining and harmonizing the National DPP and the MDPP

Enhancement of state Medicaid coverage for the National DPP lifestyle change program

Support for special federal programs dedicated to American Indians and Alaskan Native communities and networks of rural Mississippi Delta communities

Lastly, the NCCC subcommittee made recommendations on applied research of essential diabetes prevention programs, including ways to optimize intervention program effectiveness, and research on prevention of type 1 diabetes.

See accompanying articles, pp. 252 , 255 , e14 , e24 , e51 , and e60 .

C.P. was the Designated Federal Officer for the National Clinical Care Commission. All other authors were members of the National Clinical Care Commission.

J.M.B. and H.T. made equal contributions as first authors.

This article is part of a special article collection available at https://diabetesjournals.org/collection/1586/The-Clinical-Care-Commission-Report-to-Congress .

Acknowledgments. The NCCC acknowledges Alicia A. Livinski and Nancy L. Terry, biomedical librarians from the National Institutes of Health Library, Division of Library Services, Office of Research Services, who performed the literature searches. The NCCC also thanks Yanni Wang (International Biomedical Communications) and Heather Stites (University of Michigan) for their editorial assistance.

Funding. The NCCC was supported through a Joint Funding Agreement among eight federal agencies: the Agency for Healthcare Research and Quality (AHRQ), the Centers for Disease Control and Prevention (CDC), the Centers for Medicare and Medicaid Services (CMS), the Food and Drug Administration (FDA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the National Institutes of Health (NIH), and the Office of Minority Health (OMH). The Office of the Assistant Secretary for Health (OASH), the Office of Disease Prevention and Health Promotion (ODPHP), and the Office on Women’s Health (OWH) provided management staff and contractor support.

The funders had no role in the preparation, review, or approval of the manuscript or the decision to submit the manuscript for publication. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Health and Human Services or other departments and agencies of the federal government.

Duality of Interest. No potential conflicts of interest relevant to this article were reported.

Prior Presentation. Parts of this study were presented at the 82nd Scientific Sessions of the American Diabetes Association, New Orleans, LA, 3–7 June 2022.

Email alerts

Clinical Compendia

This Feature Is Available To Subscribers Only

Sign In or Create an Account

Privacy & Cookies: This site uses cookies. By continuing to use this website, you agree to their use. To find out more, including how to control cookies, see here: Cookie Policy

Care Inspectorate

Welcome to the care inspectorate.

Corporate Plan 2022-25

Annual returns 2022-23, find a care service, latest news and updates.

We look at the quality of care in Scotland to ensure it meets high standards. Where we find that improvement is needed, we support services to make positive changes.

For professionals

professional

Passionate about good care?

Work with us

An  online tool  where people who use service and their carers can  share their experiences of adult social care service.

View Care Opinion online tool

care commission report

For the public

Latest publications

Inverclyde Council. protecting children in the electronic age

Inverclyde Council. rights respecting school awards

Inverclyde Council Scrutiny Report

Involving People Plan Easy Read

Covid-19 adult care home statistics

Technology good practice guide

Joint review of diversion from prosecution

MOU - NHS Education for Scotland

Featured publication View all

Corporate plan 2022-2025.

Our vision is for world-class social care and social work in Scotland, where everyone, in every community, experiences high-quality care, support and learning, tailored to their rights, needs and wishes. We aim to achieve that by working towards four strategic outcomes: high-quality care for all; improving outcomes for all; everyone’s rights are realised and respected; and our people are skilled, confident and well supported.

Latest inspection reports

Care service inspection reports, published in the last four weeks and grouped by our evaluation of their care and support.

3 Excellent

44 very good, 32 adequate, 0 unsatisfactory, 116 ungraded, latest news and blogs view all.

Technology good practice guide

Joint inspection of adult support and protection in the city of Edinburgh partnership

Say hello @CareInspect

Information

You appear to be using an unsupported browser, and it may not be able to display this site properly. You may wish to upgrade your browser .

We use cookies to collect anonymous data to help us improve your site browsing experience.

Click 'Accept all cookies' to agree to all cookies that collect anonymous data. To only allow the cookies that make the site work, click 'Use essential cookies only.' Visit 'Set cookie preferences' to control specific cookies.

Your cookie preferences have been saved. You can change your cookie settings at any time.

Read care service inspection reports

The Care Inspectorate regularly carries out inspections on care services to make sure they're meeting the right standards.

If you want to see how a certain care service is performing, you can read their latest inspection report online.

The Care Inspectorate website has a list of all inspection reports published in the last 4 weeks.

You can also search its full directory of care services , where the latest report for each care service is available.

This includes reports on:

There is a problem

Thanks for your feedback

Note: Your feedback will help us make improvements on this site. Please do not provide any personal information

Some functionality has been disabled

To experience the best that the Church of England website has to offer, you need to enable JavaScript in your browser's settings. Turnon.js provides guidance on how to activate JavaScript for your particular browser.

A Christian presence in every community

Popular search items

Final report of the Reimagining Care Commission

The Archbishops’ Commission on Reimagining Care was tasked with developing a radical and inspiring vision of care and support, drawing on Christian theology, tradition, and values.

In this new report – ‘Care and Support Reimagined: a National Care Covenant for England’ – the Commission has laid out steps towards reaching this new vision. The report argues that we must:

You can read the report here:

Live launch

Join the live launch of the report from 11:00 on 24 January 2023 on our YouTube channel .

Commission on Long-Term Care

The Commission on Long-Term Care met on September 12, 2013 and voted in favor of putting the Final Report forward as the broad agreement of the Commission. The Commission released the Final Report at a public meeting on September 18, 2013. A video of the meeting and a copy of the slide presentation on the Final Report from the meeting are available here . The Final Report is available here . The Commission completed its work and submitted its Final Report to Congress on September 30, 2013.  This site is maintained to provide ongoing public access to the content of the public hearings and the Commission’s Report.

The Commission on Long-Term Care was established under Section 643 of American Taxpayer Relief Act of 2012 (P.L. 112-240), signed into law January 2, 2013.

The statute directs the Commission to: “…develop a plan for the establishment, implementation, and financing of a comprehensive, coordinated, and high-quality system that ensures the availability of long-term services and supports for individuals in need of such services and supports, including elderly individuals, individuals with substantial cognitive or functional limitations, other individuals who require assistance to perform activities of daily living, and individuals desiring to plan for future long-term care needs.”

The statute further directs the Commission within 6 months of the appointment of Commissioners (by September 12, 2013) to: “…vote on a comprehensive and detailed report based on the long-term care plan… [described above]… that contains any recommendations or proposals for legislative or administrative action as the Commission deems appropriate, including proposed legislative language to carry out the recommendations or proposals.”

The Commission was composed of 15 members. Three members each were appointed by the President of the United States, the majority leader of the Senate, the minority leader of the Senate, the Speaker of the House of Representatives, and the minority leader of the House of Representatives.  The Commission  elected Dr. Bruce Chernof as its Chair and Dr. Mark Warshawsky as its Vice-Chair. A list of the Commissioners is provided here .

The Commission completed its work and submitted its Final Report to Congress on September 30, 2013.

logo

Inspection Reports

Under the Regulation of Care (Jersey) Law 2014, the Commission will publish reports following inspections of care homes, home care services and day care services (adult). This page will also include any other reports published by the Care Commission.

Care Service Inspection Reports

Other inspection reports.

Provide Us With Your Feedback

The form below enables members of the public to provide feedback to us on any care service or care professional in which they have come into contact with.

CA.gov

View Medical Survey Reports

Please select a Health Plan from the drop-down menu below to see a list of documents available regarding the particular plan.

Licensing & Reporting

Need Help with Your Health Plan?

Call the DMHC Help Center

1-888-466-2219

or submit an Independent Medical Review/Complaint Form

...or answer a few quick questions

What kind of health plan do you have?

Featured Links

Go to the DMHC Facebook

Documents & Links

Need Help? Call the DMHC Help Center at 1-888-466-2219

Gavin Newsom

burger-menu

care commission report

The Joint Commission's Report To The Carnegie Foundation

Joint commission assignment.

Last week I found the information that I gathered from the assignment on conducting a visit to a local healthcare facility to hold the most interesting concepts from me. Having worked for different healthcare facilities, I have had my share of Joint Commission visits. It is not at all a visit that hospital employees look forward to. Learning about the details behind what the surveyors intend to achieve by examining hospital practices, questioning employees and asking patients about their stay makes more sense now. The assignment allowed me to get more in depth information on all the processes involved in hospital accreditations. Being able to get firsthand knowledge about the methods the facility uses to deliver safe, high-quality patient

Summary: The Accountable Care Organization

The Accountable Care Organization members reward the physician and health care facility when their performance meets

Importance Of NCQA ACO Accreditation

The NCQA ACO program is meant to create an alignment of the healthcare plan with the state, employer, and even the federal purchasers need to form a leverage that will be used in the promoting of organizations to make a transformation for healthcare providers (Carver & Jesie, 2011). The best thing about the ACO accreditation is that it helps making a determination of whether the various organizations have the right infrastructure for accountability. The purchasers are more concerned with whether the organization is in a better position to serve. They are also in need of assurance that they will get quality care from the organizations. Through the process of NCQA accreditation, the purchaser gets the right information (Blazej,

Advantages And Disadvantages Of Clinical Integration In The Strategic Planning Process

Physicians and Hospitals go hand in hand when it comes to the medical care of patients, and it is this relationship that allows the patients to receive the care they need and deserve. It is also this relationship that we as health care administrators need to understand. In order to fully understand this relationship we need to define the concept of the integrated physician model. We also need to explain the importance of clinical integration in the strategic planning process, and the dynamics of and controversies surrounding accountable care organizations and alternative approaches to the current health system. I will also explain the advantages and disadvantages for hospitals and physician’s models. All of these things are important for health care administrators to understand about the relationship between a physician and the facility they work at.

The NASW Code Of Ethics In Social Work Education

The NASW code of ethics a promotes integrity, competence, dignity, worth of the person, and the importance of human relationships, etc. Accreditation is a system for recognizing educational institutions and professional programs affiliated with those institutions as having a level of performance, integrity, and quality that entitles them to the confidence of the educational community and the public they serve. The Commission on Accreditation (COA) of the Council on Social Work Education (CSWE) is recognized by the Council for Higher Education Authority to accredit baccalaureate and master’s degree programs in social work education in the United States and its territories. The COA is responsible for formulating, promulgating, and implementing

Pros And Cons Of The Care Quality Commission

Their role is to register care providers, monitor, inspect and rate healthcare services. The CQC has a role in publishing views of the major quality issues and performance ratings to enable consumers to choose care in health and social care. The Commission ensures the quality and safety of care in hospitals, dentists, ambulances etc. The CQC is sponsored by the Department of Health.

Essay On African American Medicine

Although history proves that the medical system can be corrupt, the knowledge I acquired on medical history positively impacted my perspective on my career choice. It deepened my desire to become an African American health care professional. Also, it motivated me to contribute to the positive development of medical practices in the United

Abraham Flexner Contribution To The Progressive University

He was very interested in seeing if the institutions that teach medicine are actually qualified to provide an outstanding education in the medical field. As a result, Flexner came out with the Flexner Report in 1910. The Flexner Report is also known as the Carnegie Foundation Bulletin Number Four. This report transformed and revolutionized education in medicine ("Flexner Report Transformed Med Schools"). While completing his report, Flexner visited many medical institutions and evaluated them from an educator point of view rather than a medical practitioner. As he did his evaluation, he questioned many perspectives. He looked specifically at five criteria: the entrance requirements, the size and specific training of faculty, the extent of both endowment and the amount of tuition charged per student, the quality and the amount of labs available, and the amount of hospitals that would function as teaching and whose staff would act as a clinical faculty. With the results, he categorized the schools into three categories. First, he compared each institution to John Hopkins, which is considered one of the best medical institutions in the United States. Second, he identified the substandard institutions, which could be improved by providing financial assistance. Lastly, he classified the group that was rated as such poor quality that the institutions must be closed or merged with

Differentiating Roles And Main Activities Of CMS And Joint Commission

CMS`s Medicare and Medicaid program might one those heading to failure because of the financial constraints the government has been imposing on this program. Also, public reporting on how the hospitals, providers and nursing homes are faring. They are also more current and projected like “Quality Improvement Organizations, Post- Acute Care Reform Plan and Development of Quality Indicators for Inpatient Rehabilitation Facilities (IRFs) which is, an overall goal of this project was to assist CMS in developing appropriate measures to monitor and evaluate the quality of rehabilitation services provided to Medicare beneficiaries in IRFs”, (CMS, 2017, p. 10). As for The Joint Commission, the current and projected initiatives are “Performance Measures for Acute Stroke Ready Hospital Certification which all currently certified acute stroke ready hospitals, as well as those hospitals seeking initial certification, will be required to implement data collection for five standardized measures effective with discharges on and after January 1, 2018”, (TJC,2017, p.1). In 2016, an advanced certification was launched for Total Hip and Total Replacement Knee and in 2017, advanced certification for Palliative Care program was launched. All these initiatives which has been launched or not yet will bring change to our

Joint Commission Essay

If there are no RIF, our organization will be accredited. If, we are given RIF, accreditation will not be awarded until corrected. If given a RIF, we must complete Evidence of Standards Compliance (ESC) to show that the organization is now meeting those standards and elements of performance. The ESC report on corrective actions taken must indicate, by title, one individual ultimately responsible for the corrective action and overall and ongoing compliance. Concisely describe the actions completed to correct each finding (for example, staff training, and policies/procedures developed, revised, approved, and so forth). We must indicate the dates each action was completed to correct each finding. A description how compliance will be sustained with this element of performance (for example, processes policies, procedures, and so forth). Once Joint Commission receives and approves an ESC it will be required to monitor compliance for four months. An explanation of the plan for assessing effectiveness of the corrective action taken and include sample size for audit based on average daily census, monthly visits, and so forth and random sampling method used if our organization is not performing an audit on 100% of the population and

Ambulatory Data System

Filed authorized documents ensuring proper sequencing of forms. Maintained inpatient and outpatient medical records utilizing the Terminal Digit File System. Performed filing and clerical duties associated the retention, maintenance, retrieval, disposition, control of records. Reviewed medical records for accuracy and completeness. Ensured staff filed proper forms within the medical records. Quality assurance of medical records following sure all rules and regulations were followed for Joint Commission Accreditation of Healthcare Organization (JCAHO) review. Processed, logged, copied, and properly mailed records and correspondence to patients and outside agencies. Organized administrative activities for 297-person organization. Independently performed assigned duties in accordance with regulatory guidance and accreditation guidelines, using discretion and judgment to make appropriate methodology. Provided advice and regulatory guidance, verbally and written to staff. Supervised and distributed workload

Attitudes In Health Care

Clinical Performance: The way in which health care providers function in clinical care settings. ((ABMS), 1999)

Hospital Compare In Healthcare

The patients experience within the hospital is collected from a survey done randomly among patients. Each hospital must have at least 300 survey responses per year. After collecting the data, the data is submitted to the survey data warehouse, where it is analyzed and adjusted to truly reflect the hospital’s conditions. The Centers for Medicare and Medicaid Services along with the Agency for healthcare research standardize the survey results with the hospital consumer assessment of healthcare providers and systems survey. This survey has only thirty-two questions which are analyzed each year. It is given to patients randomly throughout the year, collected by those who receive training in giving the survey. Some questions that are asked are in the category of composite topics which include; nurse communication, doctor communication, responsiveness of hospital staff, pain management, questions about medications, discharge information, and cleanliness of the hospital. This is all done to show the patient the true quality of the hospital, and the general effect on the

Accreditation Definition

The process of declaring by designated authority that an organization, service or individual has demonstrated competency, authority and/or credibility to meet a predetermined set of standards is called Accreditation. It is also a mechanism that seeks to reassure external stock holders that quality and safety standards are demonstrated. A secondary and more recent goal in some applications, notably health care, is to provide a basis for quality improvement initiatives. Accreditation is an element in a network of activities that seeks to regulate conduct in the health sector. Health organizations, and individual professionals, are networked together, and their behavior is assessed by independent bodies through accreditation programs, standards,

The Importance Of Public Accountability

Public accountability has re-emerged as a top priority for health systems all over the world. Public accountability refers to

More about The Joint Commission's Report To The Carnegie Foundation

Related topics.

U.S. flag

An official website of the United States government

Here's how you know

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Office on Women's Health Logo womenshealth.gov

Call the OWH HELPLINE: 1-800-994-9662 9 a.m. — 6 p.m. ET, Monday — Friday OWH and the OWH helpline do not see patients and are unable to: diagnose your medical condition; provide treatment; prescribe medication; or refer you to specialists. The OWH helpline is a resource line. The OWH helpline does not provide medical advice.

Please call 911 or go to the nearest emergency room if you are experiencing a medical emergency.

National Clinical Care Commission Issues Final Report to Improve Diabetes Prevention and Treatment

The National Clinical Care Commission , a federal advisory committee established by the National Clinical Care Commission Act of 2017 – PDF , recently released its final report outlining recommendations to improve diabetes awareness, prevention, and treatment. The report called for additional federal efforts to improve access to health care, address social determinants of health, and improve trans-agency collaboration.

The Commission’s report – the first of its kind since 1975 – highlights evidence-based recommendations to address: (1) diabetes prevention and control in the general population; (2) diabetes prevention in populations who are at high risk of developing type 2 diabetes; and (3) treatment of diabetes and its complications. It also underscores the need to address the diabetes epidemic as it cuts across many sectors, including food, housing, commerce, transportation, and the environment.

According to the CDC, 34.2 million people or 10.5% of the population have diabetes in the United States. When left untreated, diabetes can lead to serious conditions such as cardiovascular disease, kidney failure, limb amputation, and blindness. Diabetes during pregnancy can lead to complications for women such as high blood pressure or stroke and increases risks of birth defects, stillbirth, and preterm birth. In addition, individuals with poorly controlled diabetes have at least a two-fold greater risk of death from COVID-19.

According to the report, nearly 90 million American adults have prediabetes , or higher-than-normal blood glucose levels and about 85% do not know they have it. If current trends continue, one in three Americans will develop diabetes in their lifetime. Advancing health equity is critical to improving the health and long-term wellbeing of Americans impacted by diabetes and controlling rising costs associated with treatment and management of the disease.

“The National Clinical Care Commission’s report is a roadmap to leverage a variety of federal programs to prevent diabetes and improve diabetes management and control,” said Dorothy Fink, M.D., Deputy Assistant Secretary for Women’s Health and Director, Office on Women’s Health. “OWH is pleased to disseminate the hard work of the Commission, which we co-sponsored with the Office of Disease Prevention and Health Promotion, to address diabetes prevention and treatment.”

The 23-member Commission, representing federal and non-federal entities with diverse disciplines, was overseen by the U.S. Department of Health and Human Services. The Commission members have significant public- and private-sector experience including primary care, endocrinology, pharmacology, patient advocacy, public health, veteran health, and minority health. Federal members also included representatives from the Department of Veterans affairs, the Department of Defense, and the Department of Agriculture.

To read the Commission’s full report, visit: https://health.gov/about-odphp/committees-workgroups/national-clinical-care-commission/report-congress .

A federal government website managed by the Office on Women's Health in the Office of the Assistant Secretary for Health at the U.S. Department of Health and Human Services.

1101 Wootton Pkwy, Rockville, MD 20852 1-800-994-9662 • Monday through Friday, 9 a.m. to 6 p.m. ET (closed on federal holidays).

HHS & OWH logos

Massachusetts State Seal

Official websites use .mass.gov

Secure websites use HTTPS certificate

A lock icon ( ) or https:// means you’ve safely connected to the official website. Share sensitive information only on official, secure websites.

care commission report

Home Care Licensing Commission

The purpose of the Home Care Licensing Commission is to study and make recommendations to establish a statewide licensing process for home care agencies in the Commonwealth.

Established in Outside Section 97 of the FY21 Budget, the Home Care Licensing Commission will study current licensure, reporting, and oversight requirements across the long-term care services industry and support systems and other relevant state agencies, including the provider monitoring conducted by the aging services access points; home care agency licensure requirements in other states; processes for implementing a statewide home care agency licensure process; and current licensure processes in the health care industry in Massachusetts and make recommendations on strategies to implement a statewide home care agency licensure process; licensure, reporting and oversight requirements for the home care agencies; the standards for the issuance of a provisional license; ensuring recommendations for home care agency licensure process will align with state oversight process already in place through the aging services access points, the home care worker registry and the nurse aide registry; and any other matters pertaining to licensing home care agencies.

Final Report

Commission members

Margret cooke, jd, elizabeth chen, phd, mba, mph , lauren peters, whitney moyer, patricia d. jehlen, thomas m. stanley, julie watt faqir, patricia kelleher, lisa gurgone, lesley nolan, danielle lord, stephen digiacomo, upcoming events, related organizations.

Help Us Improve Mass.gov with your feedback

The feedback will only be used for improving the website.

Thank you for your website feedback! We will use this information to improve this page.

If you would like to continue helping us improve Mass.gov, join our user panel to test new features for the site.

Home

System for challenging social care decisions ‘failing those who need it’

Published: 28 Feb 2023

Adults receiving social care in England and Wales are being failed if they try to challenge decisions made by local authorities, according to an inquiry conducted by the Equality and Human Rights Commission (EHRC).  

Evidence published today by the equality and human rights regulator reveals local authority processes are confusing and slow, with risks that people do not get the care they need. Social care users, and their loved ones, find making complaints difficult and stressful, often at a time when they are in crisis.  

The EHRC launched its inquiry in July 2021 to understand the experiences of social care users and carers who have challenged decisions made by local authorities. It examined the procedures in place among local authorities across England and Wales and gathered insight from social care professionals too.  

The inquiry found that some people are deterred from seeking help by a complicated system that should instead be upholding their rights to challenge decisions about their care.  

Marcial Boo, Chief Executive of the Equality and Human Rights Commission, said:  

“When social care works well it makes an enormous difference, helping people live their lives as they choose. But the social care system in England and Wales is struggling, with people’s needs being balanced against tight budgets.  

“While local authorities are facing huge pressures, they must protect people’s rights when making decisions about their care. Effective ways for people to challenge those decisions are crucial to ensuring that good decisions are made and people’s needs are met.” 

The inquiry heard that some people are not given crucial information about how to challenge decisions, and under half of the local authorities surveyed always signpost users to independent advice or support. This creates unnecessary barriers for users and fears of negative consequences if complaints are made, including loss of access to the social care needed.  

There is also poor collection and analysis of equality data. This missing information could help councils to understand how well they meet the social care needs of different groups, so services can be improved. 

Marcial Boo added:  

“People who receive social care should not be left in the dark about how to challenge decisions that affect their wellbeing, dignity and independence so fundamentally.  

“Our findings demonstrate that improvements must be made to the accessibility of information, the clarity of the complaints process and the availability of support. 

“The need for reform and additional funding for local authorities to deliver social care is widely acknowledged. Our inquiry sets out a number of steps that should be taken now to uphold equality and human rights standards when people challenge decisions about their care.”

The EHRC makes recommendations for local authorities in England and Wales, the UK and Welsh governments and other bodies with a role in the care system.  

The recommendations include a call for the UK Government to make the Local Government and Social Care Ombudsman (LGSCO) the statutory complaints standards authority for adult social care in England, and for the LGSCO to receive new powers to initiate investigations into areas of concern without the need for individual complaints.

Michael King, Local Government and Social Care Ombudsman, said:  

“We welcome the Equality and Human Rights Commission’s inquiry report which echoes the issues we regularly find in our investigations about adult care services, of which we uphold more than two thirds. 

“People have a right to good quality care that respects their basic rights to dignity, autonomy and fair treatment. If things go wrong, there should be transparent, effective and accessible procedures in place for people to challenge decisions made by their local councils.  

“But we know this is not always the case, which is why we have been calling for statutory signposting to our service. As the newly-empowered statutory complaints standards authority, we would ensure complaints were dealt with clearly and consistently across the country, and that lessons from complaints were properly scrutinised and embedded. 

“We have previously highlighted our concerns about the erosion of effective local complaints processes and the particular challenges faced by people with disabilities in accessing the complaints process. The EHRC’s report confirms the problems we are finding with access for people with communication needs as we increasingly look at complaints through the lens of human rights. 

“The EHRC has made a number of pragmatic recommendations which support the powers we have been calling on the government to give us, including the ability for us to carry out investigations where we think there is unremedied injustice regardless of whether we have received a complaint.”

The recommendations also include a call for the Welsh Government to work with local authorities and others to improve the collection and analysis of equality data from social care users, including those who challenge decisions. This data should be used to identify and address poor outcomes where they are experienced by people who share particular protected characteristics. 

Eryl Besse, Wales Commissioner for the EHRC, said:  

“The views and wishes of people who receive social care should be taken into account.  

“To ensure good decisions are made and people’s needs are met, there must be effective ways to challenge care decisions. Our findings show that this will require improvements to be made to the accessibility of information, the clarity of the complaints process, and the availability of support. 

“Our inquiry sets out several steps that should be taken now to uphold equality and human rights standards. The launch of the new Citizens Voice Body for Health and Social Care in April 2023, and wider social care reforms in Wales, present opportunities to support these improvements”. 

Gillian Baranski, Chief Inspector at Care Inspectorate Wales, said: 

“Ensuring people are at the heart of decision-making and their voices are heard is one of the core principles guiding the CIW’s work. 

“I welcome this inquiry and look forward to continuing to work closely with the EHRC to ensure its recommendations are taken forward.” 

Read the report:

Challenging adult social care decisions inquiry report

Notes to Editors:

153 local authorities out of an eligible 174 with responsibility for adult social care responded to our survey (133 in England and 20 in Wales). In-depth interviews were conducted with 12 councils spread across different regions, to understand the processes and practices of local authorities (2 in Wales).  

332 individuals accessing adult social care, their representatives and carers responded to a survey of people’s experiences of challenging decisions (59 from Wales). In-depth interviews were carried out with 41 people seeking or accessing care and carers (10 from Wales).  

54 in-depth interviews (23 with Wales stakeholders) and 12 focus group discussions (3 in Wales) were held with a wide range of individuals and organisations, including professionals working within social care, advocacy providers, older and disabled people’s organisations, statutory bodies, professional associations and legal experts. 15 written submissions were received from organisations and experts.   

Read the inquiry Terms of Reference . 

Press contact details

For more press information contact the Commission's media office on:

0161 829 8102

'They are a cancer:' Deputy gangs still operating within LA County sheriff's department, report says

The report also determined that new deputy cliques form as members of existing groups retire or otherwise leave LASD.

Carlos Granda Image

A scathing report issued by the Civilian Oversight Commission shows members of such deputy gangs "run'' many of the county's patrol stations.

LOS ANGELES (KABC) -- A scathing report issued Friday by the Civilian Oversight Commission revealed there are deputy gangs and cliques still operating within the Los Angeles County Sheriff's Department, including at several stations such as East Los Angeles and Compton.

According to the special counsel's 70-page report, members of such deputy gangs as the Executioners, the Banditos, the Regulators, the Spartans, the Gladiators, the Cowboys and the Reapers "run'' many of the county's patrol stations, as opposed to the sergeants, lieutenants and captains ostensibly in charge.

The report also determined that new deputy cliques form as members of existing groups retire or otherwise leave the sheriff's department. There is evidence to suggest that gangs are now re-emerging in Men's Central Jail after efforts over the years to eradicate the problem of excessive force behind bars, the special counsel found.

"Contrary to the statements of the prior sheriff, deputy gangs exist and operate in the department, as they have for the last 50 years. They are a cancer," said Bert Deixler, the special counsel who led the investigation.

"Many of the people with whom we spoke expressed fears of personal or professional harm, not just for themselves, but often for spouses and children who serve in a department," he added.

Most troubling, the report said, the gangs "create rituals that valorize violence, such as recording all deputy involved shootings in an official book, celebrating with 'shooting parties,' and authorizing deputies who have shot a community member to add embellishments to their common gang tattoos.''

Hans Johnson, who is on the Civilian Oversight Commission, called the report "50 years of denial, obfuscation, foot dragging and stonewalling about the reality that is documented in this report."

The commission came up with a number of recommendations, including rotating deputies to different stations and outlawing gang-related tattoos.

Deputies sued in civil lawsuits arising from the alleged use of excessive force cost taxpayers tens of millions of dollars in judgments and settlements, the report said, estimating that the additional cost to the county in such cases is upwards of $55 million.

Meanwhile, past administrations such as that of disgraced former Sheriff Lee Baca have promoted tattooed deputy gang members to the highest levels of leadership in the LASD, the report contends.

"Promoting deputy gang members into leadership positions reinforces the power of deputy gangs and deputy cliques and undermines the ability of officials to implement reforms aimed at eliminating them within the department,'' the special counsel team wrote this week.

While not addressing the report directly, Sheriff Robert Luna said Friday that he was elected to "bring new leadership and accountability'' to the department, and has created an office for "constitutional policing,'' led by former U.S. Attorney Eileen Decker.

That office, Luna said in a statement, "will be staffed with attorneys, investigators, and auditors, and it will be tasked with helping to eradicate deputy gangs from this department. The vast majority of the department personnel are hardworking and dedicated professionals who are committed to humbly serving the community.''

"We look forward to working with the Civilian Oversight Commission and Inspector General on this in the future.''

Inspector General Max Huntsman said, "We're going to start moving the culture right now. It's already begun since the election. The new sheriff has a totally different approach and I've seen change within the sheriffs department in response to that."

In the hearing Friday at which Diexler presented the report, the Civilian Oversight Commission approved the document and adopted its guidance. The report's recommendations will be sent to Luna, with the commission's urging that he adopt, implement and start enforcing them immediately. The document will also be sent to the Board of Supervisors to fulfill their September 2021 directive to develop a plan to address the problem.

"We have faith that Sheriff Luna's administration understands the damage that deputy gangs cause,'' Danielle Butler Vappie, interim executive director for the commission, said in a statement. The gangs "put a stain on all the positive work that is being done by honorable deputies each day,'' she added.

Meanwhile, some people told ABC7 they're skeptical that there will be any actual changes.

"What there isn't is the testimony from family members that are faced with retaliation by these deputy gang members on a daily basis," said one speaker.

The investigation involved eight hearings that included witness testimony and public comments. The special counsel's team also interviewed nearly 80 anonymous witnesses.

Supervisors voted to implement the commission in January 2016 with the mission to oversee and improve public transparency and accountability with respect to the Sheriff's Department. The long history of documentation on deputy gangs includes the 2012 Citizens' Commission on Jail Violence Report, the Inspector General's analysis of the Banditos, Loyola Law School's study of the deputy gang issue, Knock LA's investigative series, and most recently a 2021 Rand study.

City News Service, Inc. contributed to this report.

Los Angeles County Sheriff's Department

care commission report

LA County sheriff's recruits graduate months after Whittier crash

care commission report

SoCal woman details encounter with alleged jewelry thief

care commission report

Man accused of sexually assaulting young girl in Bellflower

care commission report

1 killed in car-to-car shooting near school campus in Cerritos

Top stories.

care commission report

Crestline woman with cancer misses treatments over unplowed roads

care commission report

Sinkhole swallows Range Rover in Laguna Beach, triggers gas leak

care commission report

Woman, 2 children killed in West Covina apartment fire

care commission report

ATM thieves use glue and 'tap' function to drain accounts at Chase

care commission report

Ronald Reagan Presidential library vandalized ahead of DeSantis visit

2 killed in wrong-way crash on 118 Fwy in Porter Ranch

LA councilmembers to announce new sanctuary city legislation this week

Ron DeSantis visits SoCal 1 year away from Super Tuesday

IMAGES

  1. 'It was tragic': Premier welcomes long-term care commission report ahead of its release

    care commission report

  2. voiceforchildren: Jersey Care Commission/Ofsted Report

    care commission report

  3. Aged Care Quality and Safety Royal Commission report

    care commission report

  4. care-quality-commission-report-hero

    care commission report

  5. Care Quality Commission inspection and report

    care commission report

  6. Commission on Care Final Report

    care commission report

VIDEO

  1. Maryland Health Care Commission September 2022 Commission Meeting

  2. 20220921 Individual Care Plan

  3. Maryland Health Care Commission December 2022 Meeting

  4. Decision of Punjab Health Care Commission

  5. Health Care Reform Raises Concerns For Undocumented

  6. Pension and salary increase report || big breaking news for government employees ||

COMMENTS

  1. Reports

    Reports | Jersey Care Commission Reports The Regulation of Care (Jersey) Law 2014, Article 43 requires that the Commission prepares and publishes an annual report and statement of accounts. The 2019 report is the first such report. Annual Reports 2019 Annual Report - Jersey Care Commission 2020 Annual Report - Jersey Care Commission

  2. Final Report of the Commission on Care.

    Final Report of the Commission on Care. August 3, 2016 Washington, DC: Commission on Care; June 2016. The Veterans Affairs health system has recently faced challenges associated with access and quality.

  3. The National Clinical Care Commission Report to Congress

    The final report, transmitted to Congress in January 2022, contained 39 specific recommendations, including 3 foundational recommendations that addressed the necessity of an all-of-government approach to diabetes, health equity, and access to health care.

  4. National Clinical Care Commission Final Report Published

    National Clinical Care Commission Final Report Published Published February 16, 2023 in Advocacy, Special Diabetes Program In January 2022, the National Clinical Care Commission issued its final report to Congress. The finding were just published in Diabetes Care Here's what they said about diabetes and what it means.

  5. National Clinical Care Commission Report to Congress: Leveraging

    In this report, we describe the recommendations for diabetes prevention among people at high risk for developing diabetes, including those with prediabetes. Results Increase Awareness of Prediabetes and the Diagnosis of Prediabetes Expand Support for the CDC's National Public Service Campaign

  6. Report to Congress

    The National Clinical Care Commission submitted their report to Congress and the Secretary of Health and Human Services (HHS) in January 2022. The report outlines the Commission's evidence-based findings and recommendations for improving federal diabetes prevention and treatment programs. Download the Report to Congress [PDF - 2.5 MB] About ODPHP

  7. Welcome to the Care Inspectorate

    We aim to achieve that by working towards four strategic outcomes: high-quality care for all; improving outcomes for all; everyone's rights are realised and respected; and our people are skilled, confident and well supported. View the publication Latest inspection reports

  8. Read care service inspection reports

    The Care Inspectorate website has a list of all inspection reports published in the last 4 weeks. You can also search its full directory of care services, where the latest report for each care service is available. This includes reports on: childminders child day care care homes for adults and children childcare agencies care at home

  9. Final report of the Reimagining Care Commission

    The Archbishops' Commission on Reimagining Care was tasked with developing a radical and inspiring vision of care and support, drawing on Christian theology, tradition, and values. In this new report - 'Care and Support Reimagined: a National Care Covenant for England' - the Commission has laid out steps towards reaching this new vision.

  10. Commission on Long-Term Care

    This site is maintained to provide ongoing public access to the content of the public hearings and the Commission's Report. The Commission on Long-Term Care was established under Section 643 of American Taxpayer Relief Act of 2012 (P.L. 112-240), signed into law January 2, 2013. The statute directs the Commission to: "…develop a plan for ...

  11. National Clinical Care Commission

    The National Clinical Care Commission is no longer active. Between 2018 and 2021, the National Clinical Care Commission (the Commission or NCCC) evaluated and provided recommendations to improve federal programs related to complex metabolic or autoimmune diseases that represent a significant disease burden in the United States.

  12. Inspection Reports

    Under the Regulation of Care (Jersey) Law 2014, the Commission will publish reports following inspections of care homes, home care services and day care services (adult). This page will also include any other reports published by the Care Commission. ... Children's Care Home Services Overview Report 2020 with response;

  13. PDF State Employees Health Care Commission Annual Report Plan Year 2022

    commission. (2) The state health care benefits program shall provide the benefits and services required by K.S.A. 75-6524, and amendments the reto. (c) The Kansas state employees health care commission shall designate by rules and regulations those persons who are qualified to participate in the state health care

  14. View Medical Survey Reports

    The Knox-Keene Health Care Service Plan Act, regulations, administrative decisions, Director's Letters, and other information. Opportunities to Participate Comment on draft regulations or participate in the rulemaking process

  15. The Joint Commission's Report To The Carnegie Foundation

    The Joint Commission's Report To The Carnegie Foundation. Within the early 19th century, the practice of medicine was disorganized and contained poor quality care. There were several organizations and individuals that joined together in an effort to correct this underlying problem. Founded in 1847, the American Medical Association encouraged ...

  16. National Clinical Care Commission Issues Final Report to Improve

    The National Clinical Care Commission, a federal advisory committee established by the National Clinical Care Commission Act of 2017 - PDF, recently released its final report outlining recommendations to improve diabetes awareness, prevention, and treatment.The report called for additional federal efforts to improve access to health care, address social determinants of health, and improve ...

  17. Department of Aging and Adult Services

    The Department of Aging and Adult Services (DAAS) promotes an Age-friendly community for all residents of Santa Clara County. DAAS strives to ensure a safe and independent lifestyle for older adults, dependent adults, and the disabled.

  18. HIV Commission

    Members of the Commission are appointed by the Santa Clara County Board of Supervisors and include persons who are living with or affected by HIV and persons who have expertise in the field of HIV. The mission of the Santa Clara County HIV Commission is to ensure a stigma-free, compassionate, and comprehensive system of HIV prevention and care ...

  19. Home Care Licensing Commission

    About Us. Established in Outside Section 97 of the FY21 Budget, the Home Care Licensing Commission will study current licensure, reporting, and oversight requirements across the long-term care services industry and support systems and other relevant state agencies, including the provider monitoring conducted by the aging services access points ...

  20. HIV/AIDS Reporting Requirements

    If you like to report an HIV case or have any difficulty retrieving these files, please call Santa Clara County's HIV Surveillance teams confidential lines at (408) 792-3727 or (408) 792-3733. You can also send a completed form to confidential fax at (408) 792-3722. Health care providers can mail case reports by using double envelopes and mail ...

  21. System for challenging social care decisions 'failing those who need it

    Marcial Boo, Chief Executive of the Equality and Human Rights Commission, said: "When social care works well it makes an enormous difference, helping people live their lives as they choose. But the social care system in England and Wales is struggling, with people's needs being balanced against tight budgets. "While local authorities are ...

  22. Joint Commission hiring Physician Surveyor

    The Ambulatory Care Surveyor- MD surveys ambulatory organizations throughout the United States within the full scope of the Joint Commission's Ambulatory Programs.

  23. LA County deputy gangs continue to operate, new reports shows

    The long history of documentation on deputy gangs includes the 2012 Citizens' Commission on Jail Violence Report, the Inspector General's analysis of the Banditos, Loyola Law School's study of the ...