Texas Diabetes Education & Care Management Project
description
Transcript of Texas Diabetes Education & Care Management Project
Texas Diabetes Education & Care Management Project
Funded by Bristol-Myers Squibb
Foundation Bureau of Primary Health,
HRSA CDC Diabetes Prevention
(in-kind support)
TDECMP Steering Committee
Bristol-Myers Squibb Foundation HRSA/Bureau of Primary Health CDC/Division of Diabetes Translation UIC Midwest Latino Health Research, Training and
Policy Center Texas Department of Health Diabetes Council Migrant Health Promotion Texas Association of Community Health Centers
Overview
Project Goals & Objectives
Diabetes Education & Empowerment Program (DEEP) Training SessionsInitial TrainingFollow-up Trainings
Preliminary Patient Outcome Evaluation Results
Texas Diabetes Education & Care Management Project (TDECMP)
Goals Conduct one initial train-the-trainer 3 day intensive
training. Train 160 community health workers in self care
management using the DEEP curriculum. Conduct five regional follow-up trainings in Lower
Rio Grande Valley, Laredo, El Paso, San Antonio, and Houston.
Impact 16,000 diabetic patients or people at risk of diabetes by providing diabetes education using DEEP curriculum.
Patient Benefits:
•Improved standards of care for patient.•Off set complications.•Reduced HbA1c.•Overall better health.•Reduced Health Carecosts including ER.
Patient Empowerment:
•Provide Deep classes on weekly basis.
•Provide coordinated services to patients.
Framework for ImplementingDiabetes Self Care Management Program
Program Approach:
•Train team of Promotoras and Clinical staff on DEEP.
•Recruit patients for classes.
Three Step Process
24 health workers attended the initial training representing the five targeted
regions.
Experiential Learning focuses on both Process and Content
Process – teaches participants how to disseminate information using an interactive style of facilitation.
Participants learn how to read food labels
Typical food plates are converted into fats, sugars and sodium.
Texas Department of Health & Bristol-Myers Squibb staff participate in
training
TDECMP has helped community health centers and state health agencies change how they work with people who have diabetes.
Some content such as medication management is covered using
traditional methods
Patients
Recruitment
Promotora
Led Classes
Medical Providers
Involvement
DEEP Curriculum in Action
Diabetes Self Care Management ProgramDelivery Process
Clinical
Support Staff
Community Health CenterTop Five Medical Diagnosis Profile
Source 2002 UDS
2733
1305
1699
386181
0
500
1000
1500
2000
2500
3000
Diabetes Hypertension Otitis Media MentalDisorder
Asthma
Diagnosis
(43.3%)
(20.7%)
(26.9%)
(6.1%)(2.8%)
N=6304
*Gateway Community Health Center
Typical Payment Source Category
1210(9%)210 (1%)
3251(23%)
860 (6%)
8613 (61%)
Uninsured Medicaid Medicare Pvt.Insurance OtherSource 2002 UDS
N=14144
FemaleAge 43HispanicObese4 to 5 ChildrenUninsuredLow Social Economic StatusMultiple Family DwellingSixth Grade EducationHemoglobin A1C Higher than 7%Has a difficult time managing her diabetes
Typical Profile of a Patient with Diabetes
Preliminary Patient Outcomes
Base Line HbA1c before DEEP self-management class 9.1%
After Intervention
HbA1c after self-management course 7.4%
87% Class attendance rate
*Gateway Health Center Data from random chart audit (N=99 patients)
Process Evaluation Results
The goal of 160 was surpassed with a total of 177 health care staff completing the DEEP curriculum training.
A total of 7 trainings were completed exceeding the goal of 6 All five targeted regions participated in the trainings including Lower Rio Grande Valley, Laredo, El Paso, San Antonio, and Houston. Participants from Lubbock, Dallas, and Austin also attended.
Trainee satisfaction has been very positive with an evaluations mean score of 4.8 out of a 5.0 satisfaction scale.
Process Evaluation Results
While several trained health centers have not yet implemented the program completely after being trained, the majority have committed to implement a full DEEP self care management program once project implementation funding is secured.
Trainee limit of 16-20 per session adjusted upwards to 28 per session to meet demand.
Care Management Economic Impact
In collaboration with a third party evaluator, a budget impact model using data from the enrolled diabetic patients will demonstrate the near-term fiscal value attached to the reductions in HbA1c. Example of cost differentials for 1% changes in HbA1c over a 3-year period*^
Patient profile Change in HbA1c level (%)
10 to 9 9 to 8 8 to 7
Diabetes only $1,205 $869 $601
Diabetes with HTN $1,703 $1,260 $897
Diabetes with CVD $2,796 $2,088 $1,503
Diabetes with HTN and CVD $4,116 $3,090 $2,237
Given the number and likely comorbidities of the patient population in the program it is predicted that the savings generated for a State may be significant.* Reference available upon request^ Numbers are summative when one combines a HbA1c
Texas Care Management Chart Audit100 random records: 8 CHC’s
Assumes same risk stratification as Fla High Risk: 30% with HbA1c 10 reduced to 7
Yearly savings = 30 pts x $3,150 = $94,500 Moderate Risk: 20% with HbA1c 9 reduced to 7
Yearly savings = 20 pts x $ 950 = $19,000 Low Risk: 50% with HbA1c 8 reduced to 7
Yearly savings = 50 pts x $ 200 = $10,000
$123,500
Yearly Savings for 2,400 patients = $2,964,000Yearly Savings for 10,000 patients = $12,350,000
Conclusions
It has become evident that teaching self care management education such as DEEP to people with diabetes is perhaps our only chance we have in helping reduce the onset of diabetes type 2 and preventing this chronic disease within affected families.
The DEEP curriculum has been well received by community health centers, Texas Department of Health and CDC. Requests for additional training continues throughout the State of Texas and across the United States.
Preliminary evaluation results clearly indicate a great benefit to patients with diabetes type 2.