Everyone with Diabetes Counts Geneva M. Wilgus Diabetes Self-Management Regional Lead 1
General Desired Outcomes • To improve clinical outcomes of HbA1c, Lipids, Blood Pressure and Weight control for Medicare beneficiaries. • To decrease the number of beneficiaries who require lower extremity amputation due to complications resulting from poorly controlled diabetes. • To improve health literacy and self-efficacy of Medicare and dual-eligible beneficiaries with diabetes. • To create and implement a sustainability plan to increase the numbers of DSME leaders, DSME sites, and improve access via referrals of beneficiaries to DSME classes. 2
Implementation • Free, six week class • Class meets 1x per week • Class is 2.5 hours long • Always led by two peer facilitators • Small group of 8-18 participants • Multiple class settings—community (senior centers, churches, libraries), retirement communities, physician offices, hospitals. 3
Mid Coast Hospital, Maine, June 2016 Class 4
Curriculum
New England Regional Approach • Regional Leadership • State-based teams organize and deliver classes • Taught by state teams • Assist partners with class implementation • Provide licensing and fidelity checks to other organizations • Bi-Weekly “We’re Better Together” conference call for New England diabetes team • Deliverables are completed by individual state program coordinator, except the narrative portion is created by the Regional Lead 6
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Quarterly Deliverable Elements • Task Narrative • Addressing Sustainability, Successes, Barriers & Mitigation, Lower Extremity Amputation Rates, and aggregate number of graduates • Beneficiaries – what’s required to “count”? • Graduates (completed at least 4/6 classes) • With Medicare & Diabetes (any type) • 90% of completers must be from target disparate population: dual eligibility, rural, low-income, and/or minority ethnic groups. • Each state has a set target based on population. Range for New England is 210-450 total beneficiaries by end of contract. 8
Quarterly Deliverable Elements continued • Clinical Data • Pre and Post class clinical data to measure change in A1C, weight, BP, Cholestorol, etc • Each state required to obtain clinical data on 10% of total target by end of contract • Eligible Providers • Recruitment has ended, all six states have met or exceeded this target. • Report on EP’s referrals to DSME, AADE/ADA certification, technical assistance offered, etc. 9
New England’s Numbers (As of April 30, 2017) • 1,351 – program graduates (Aggregate # of all graduates) • 1,064 – Medicare beneficiary graduates who “count” (Contract goal: 1,795) • 81 – peer leaders • 18 – master trainers • 106 – beneficiaries with clinical data collected (Contract goal: 179.5) • 137 – physicians recruited (Contract goal: 113) 10
Why we’re successful: • Advertising, physician office engagement and referrals, lots of phone time with potential students • Good leaders • Fun, engaging, assertive, upholds fidelity of the program • Mix of students in class • Everyone is welcome regardless of age, payor, diagnosis • Solid, evidence-based curriculum • Maintained fidelity of program delivery and content • Simple educational props—flip charts, book, pen & paper activities • Low reading comprehension and low health literacy appropriate 11
New England Demographics (April 30, 2017) 12
New England Patient Activation Survey Results (April 30, 2017) Knowledge Questions - % Correct Answers: NE 100.0 95.3 93.6 92.3 89.8 86.5 80.9 80.0 74.3 71.3 60.0 40.0 20.0 0.0 How does exercise help your blood Which one is the best way to take What is a retinal exam? Carbohydrates (starches and sweets) sugar? care of your feet? break down in your body to what? Pre EDC Post EDC 13
New England Patient Activation Survey Results (April 30, 2017) Coping Questions - % of Positive Responses: NE 95.1 100.0 91.7 89.2 89.1 86.4 Pre EDC Post EDC 80.0 71.5 69.2 60.0 40.5 40.0 20.0 15.1 10.2 0.0 How often in the last week have you felt Do you know of healthy ways to handle the When you need it, do you feel you can ask for Do you feel you can ask your doctor questions Do you feel you can make a plan with goals that overwhelmed by living with diabetes (Always, stress related to your diabetes (Yes)? support on how to live with and take care of about your treatment plan (Yes)? will help control your diabetes (Yes)? Most of the time)? your diabetes (Yes)? 14
New England Patient Activation Survey Results (April 30, 2017) Behavior Questions - % of healthy behaviors: NE 100.0 Pre EDC Post EDC 95.4 93.7 77.6 80.0 75.3 68.0 66.8 60.0 57.2 54.0 47.3 40.0 30.1 20.0 0.0 In the last week, did you eat five or more In the last week, did you exercise for at In the last week, did you test your blood In the last week, did you take your In the last week, did you check your feet servings of fruits or vegetables more than least 30 minutes more than 3 days/week? sugar more than 3 days/week? diabetes medication as ordered by your more than 3 days/week? 3 days/week? doctor more than 3 days/week? 15
Stories • Video • Newspaper • Class reunions • School bus • Spanish • Reunions 16
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