Moving Pickens County Primary Care towards Patient-Centered Medical Home Qualifications through a Diabetes Self-Management Education Program Elizabeth Junkin, MS3
Outline Results/ Background Objectives Methods Impact
Outline Results/ Background Objectives Methods Impact
Pickens County, AL • Population: 19,349 • 7 primary care physicians
Pickens County, AL Pickens County Primary Care Dr. Julia Boothe
Pickens County, AL • 15.1% of the population >20 years old has been told by a physician they have diabetes • 12.12% in the state of Alabama • 9.11% in the United States
Why a Diabetes Self-Management Education (DSME) Program? Patients are more likely to engage in • preventative care services and are less likely to participate in risky health behavior. • Goal for Healthy People 2020: Increase the amount of diabetic patients that • receive diabetes education training to 62.5% In 2008, only 56.8% of diabetic patients reported • they participated in a diabetes education program
Which Patient-Centered Medical Home (PCMH) qualification will this fulfill? • The Quality and Safety standard set by the Joint Principles of the Patient-Centered Medical Home • Involves assuring the patient participates in the decision-making process
Why must the DSME be recognized by the American Diabetes Association (ADA)? • Recognition is mandatory in order to receive reimbursement from Medicaid and Medicare. • Standards based on National Standards for Diabetes Self-Management Education and Support
National Standards for Diabetes Self-Management Education and Support 1 2 3 4 5 Internal External Program Instructional Access Structure Input coordination staff 6 7 8 9 10 Individual- Ongoing Patient Quality Curriculum ization support progress improvement
DSME Curriculum 1. Diabetes disease process 2. Nutritional management 3. Physical activity 4. Medications 5. Monitoring blood sugar 6. Acute complications 7. Chronic complications 8. Psychosocial issues 9. Health and behavior change
Outline Results/ Background Objectives Methods Impact
Outline Results/ Background Objectives Methods Impact
Objectives What are the characteristics, health status, and educational 1. needs of the diabetic patients at Pickens County Primary Care, and are they interested and/or willing to participate in a DSME Program? Is the staff of Pickens County Primary Care interested and/or 2. willing to be involved in the creation and implementation of a DSME Program? Does Pickens County Primary Care have the resources and staff 3. to meet the requirements for their DSME Program to receive recognition from the American Diabetes Association Education Recognition Program? What curriculum and structure should the DSME Program for 4. Pickens County Primary Care follow to best meet their patients’ educational and support needs?
Outline Results/ Background Objectives Methods Impact
Outline Results/ Background Objectives Methods Impact
Methods Patient Clinic Survey EHR Staff Review Survey DSME Implementation Plan
EHR Review • Assess the total number of diabetic patients • Assess complications, controlled vs. uncontrolled, and number of diabetes-related visits through ICD-9 codes
Controlled/ ICD-9 Code Complication Uncontrolled C 250.00 None UC 250.02 C 250.10 Ketoacidosis UC 250.12 C 250.20 Hyperosmolarity UC 250.22 C 250.30 All codes for Other Coma UC 250.32 Type II Diabetes C 250.40 Renal UC 250.42 C 250.50 Ophthalmic UC 250.52 C 250.60 Neuro UC 250.62 C 250.70 Peripheral Circulatory Disorder UC 250.72 C 250.80 Other UC 250.82 C 250.90 Unspecified UC 250.92
Patient Survey • Based on Diabetic Care Profile by the Michigan Diabetes Research and Training Center Topics Include: Demographics Logistics of classes Health status Transportation availability Education/advice received Technology access Understanding of diabetes care General interest Social support
Clinic Staff Survey • Assess the resources and willingness of the staff to help with the development and implementation of a DSME program
Methods Patient Clinic Survey EHR Staff Review Survey DSME Implementation Plan
Outline Results/ Background Objectives Methods Impact
Outline Results/ Background Objectives Methods Impact
Results of EHR Review (Data from July 2014 to Dec 2014) • Estimated # of patients: 5200 • Total number of diabetic patients seen: 342 • Gender • Age • 59% females • Average: 62 • 41% males • Min: 15 • Max: 96
Results of EHR Review Age and Gender Distributions 80 70 Number of patients 60 50 40 30 20 10 0 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-100 F 2 1 6 17 42 67 44 21 2 M 9 26 35 36 26 8 Age Ranges
Results of EHR Review • Total number of visits: 858 • Average of 2.5 visits per patient • Max # of visits: 10 # Patients with 250.00 (C) and 250.02 (UC) Only Only Both 250.00 250.02 102 202 38 (30%) (59%) (11%)
Results of EHR Review Controlled vs. Visits with Complications Uncontrolled Visits 1 1 1 1 1 246, 29% 592, 71% 15 250.30 (coma, C) 250.50 (eye, C) 250.00 (controlled) 250.52 (eye, UC) 250.60 (neuro, C) 250.02 (uncontrolled) 250.62 (neuro, UC) 250.92 (unspecified, UC)
Results To be continued…
Impact • Needs assessment of the diabetic patient population at Pickens County Primary Care • Selection of the best curriculum for the clinic • Preliminary plan of implementation for a DSME Program
Acknowledgements • Dr. Lea G. Yerby • Partially supported by the Alabama Family Practice Rural Health Board
References Map of Alabama highlighting Pickens County, Courtesy of Wikimedia Commons, accessed on 1. 4/13/15 US Department of Health & Human Services, Health Resources and Services Administration, Area 2. Health Resource File. Courtesy: Community Commons, January 24, 2015, date retrieved. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and 3. Health Promotion. Courtesy: Community Commons, April 3, 2015, date retrieved. Strine TW , Okoro CA, Chapman DP, Beckles GL, Balluz L, Mokdad AH. The impact of formal 4. diabetes education on the preventive health practices and behaviors of persons with type 2 diabetes. Prev Med. 2005 Jul;41(1):79-84. Epub 2004 Nov 19. PubMed PMID: 15916996. Healthy People 2020. (2015). Retrieved from https://www.healthypeople.gov/2020/topics- 5. objectives/topic/diabetes/objectives American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), 6. American College of Physicians (ACP), American Osteopathic Association (AOA). Joint principles of the patient-centered medical home. http://www.aafp.org/dam/AAFP/documents/ practice_management/pcmh/initiatives/PCMHJoint.pdf . Accessed January 24, 2015. Haas L, Maryniuk M, Beck J, Cox CE, Duker P, Edwards L, Fisher EB, Hanson L, Kent D, Kolb L, 7. et al. National standards for diabetes self-management education and support. Diabetes Care. 2014 Jan;37 Suppl 1:S144-53. doi: 10.2337/dc14-S144. PubMed PMID: 24357210; PubMed Central PMCID: PMC4181074. Fitzgerald JT, Davis WK, Connell CM, Hess GE, Funnell MM, and Hiss RG, "Development and 8. Validation of the Diabetes Care Profile," Evaluation and the Health Professions, 1996; 19(2): 209-231.
Questions? Contact Information: Elizabeth Junkin, MS3 eajunkin@uab.edu
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