An Innovative Approach to Managing Diabetes in a Large Public Health System
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Transcript of An Innovative Approach to Managing Diabetes in a Large Public Health System
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An Innovative Approach to Managing Diabetes in a Large Public Health
SystemDonna J. Calvin, PhD, FNP-BC, CNN
Post Doctoral Research AssociateUniversity of Illinois at ChicagoCollege of NursingDepartment of Health Systems ScienceOctober 29, 2012
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Oak Forest Hospital Fantus Clinic
Woodlawn Health CenterEnglewood Health Center
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Background
0% 5% 10% 15% 20%
African Americans
Hispanics
Whites
US
Disparity in the Prevalence of Diabetes in Chicago
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Background
Chicago Diabetes Death Rates
per 100,000
CDPH, 2004
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Background
Chicago Plan for Public Health System Improvement, 2012-2016
Diabetes Hospitalizations by Chicago Zip Codes,
2007
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Access
Cultural incongruence
Lack of knowledge - Provider - Patient
Background
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United States
13 millionMean A1C 7.6%50% < 725% > 9.0
Chicago-County Clinics
40,000 Mean A1C 8.8% 18% < 7.0% 60% > 9.5%
2001 data
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PurposeTo determine the impact of a system-level quality assurance program aimed to improve diabetes outcomes among an urban minority population.
GoalReduce the average blood glucose level (A1C) among a low income, predominately African American and Hispanic population.
Optimal HbA1c (A1C) <7.0 %
A measure of chronic glucose control, and reflects the
prevailing level of glycemia over the past three months.
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Cost of managing diabetes:$174 billion total
$116 billion medical expenditures
$58 billion in reduced national productivity
Significance
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Benefits of Decreasing A1C by 1%
Significance
14%
Decrease in risk of all Diabetes
complications
40%
Decrease in risk of microvascular
diseases
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Decreasing A1C Prevents:
Blindness
Kidney Failure
Amputation
Significance
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What Should We Do?
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Our Evidence-Based Program
Network Diabetes Program
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Ophthalmologists
Physician/NURSE
Dieticians
Social Worker &Psychologist
Pharmacists
Family/FriendsPodiatrists
Patient
.
Providers
Our Evidence-Based Program
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Our Evidence-Based Program
Motivational interviewing
Apply multidisciplinary approach
ABC goals
Signs, symptoms and treatment of hyper/ hypoglycemia self-management of hypo and hyperglycemia
Glucometer (prepare for testing and action if meter breaks or not functioning)
Provider-Level Strategies: Nurses receive three days of intensive education
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Our Evidence-Based Program
Motivational interviewing - self management
The use of insulin in diabetes management- “Clinical inertia”
Treat to target- Implementing the ABCs of Diabetes
Foot exams
Provider-Level Strategies: Physicians receive two days of intensive education
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Our Evidence-Based Program
Patient-Level Strategies
Multicultural staff provide one-on-one encounters:
Knowledge Test
Basic discussion of diabetes
Review of lab results
Assessment of: dietary habits, lifestyle, psychosocial problems
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Our Evidence-Based Program
Patient-Level Strategies
Adjustment of diabetes medication
Referral to: PCP, ophthalmology, podiatry, social worker and/or psychologist as needed
Appointment to attend diabetes class
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Our Evidence-Based Program
Overview of diabetes
Basic self-management skills
Glucose monitoring
A personal consultation after the group class to discuss concerns and misperceptions
HbA1ccarbohydrates
strokeRetinopathy
Heart disease
Foot care
ESRD
Eating out
Diabetes Class (Spanish & English)
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Our Evidence-Based Program
Nurses
Physicians
ABC goals implementations throughout system
Annual Update
“Sugar Beat,” a quarterly diabetes publications with updates in diabetes management
System-Wide Activities
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Results
18.181.9
Mean A1C:7.8%
48.2 51.8
< 7%
Mean A1C: 8.8%
> 7%
A1C
2001
System-Level Data
2008
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Results
31%69%
78% 22%
System-Level DataA1C over 9.5%
2001 2008
< 9.5> 9.5
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12 Wk 26 Wk7.5
8
8.5
9
9.5
109.84 9.81
8.54
8.71
A1c_first A1c_lastN=5,922
NDP Data - More Complex PatientsCrossectional Analysis 2001-2012
ResultsA
1C
N=4,589
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Summary of QA Program
Our Evidence-based Program is Effective:
Meeting national goals
American Diabetes Association (ADA) recognition
Continuity of care
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Future Directions
Lifestyle Center
Last chance clinic
Diabetes Group visits
Collect and analyze data to determine what aspect of our program has the greatest impact
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Elements of the Program
Treating difficult patients
Enhancing provider’s skills
Uniform management in the system (ABC)
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Thank You!
Model for other publicly financed primary health
care systems
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Thank You!
Questions?