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Am J Prev Med. 2015 Jun;48(6):747-54. doi: 10.1016/j.amepre.2014.12.010.

Evaluating diabetes health policies using natural experiments: the natural experiments for translation in diabetes study.

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Departments of Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address:
Division of General Internal Medicine/Health Services Research, University of California, Los Angeles.
Department of Medicine and the New York Obesity Research Center, St. Luke's-Roosevelt Hospital Center, New York, New York.
Division of Research, Kaiser Permanente Northern California, Oakland, California.
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
Hubert Department of Global Health, Rollins School of Public Health, Emory University, CDC, Atlanta, Georgia; Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.


The high prevalence and costs of type 2 diabetes makes it a rapidly evolving focus of policy action. Health systems, employers, community organizations, and public agencies have increasingly looked to translate the benefits of promising research interventions into innovative policies intended to prevent or control diabetes. Though guided by research, these health policies provide no guarantee of effectiveness and may have opportunity costs or unintended consequences. Natural experiments use pragmatic and available data sources to compare specific policies to other policy alternatives or predictions of what would likely have happened in the absence of any intervention. The Natural Experiments for Translation in Diabetes (NEXT-D) Study is a network of academic, community, industry, and policy partners, collaborating to advance the methods and practice of natural experimental research, with a shared aim of identifying and prioritizing the best policies to prevent and control diabetes. This manuscript describes the NEXT-D Study group's multi-sector natural experiments in areas of diabetes prevention or control as case examples to illustrate the selection, design, analysis, and challenges inherent to natural experimental study approaches to inform development or evaluation of health policies.

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