Prevent Diabetes STAT Hannah Herold, MPH, MA, CHES Chronic Disease Prevention Program Wyoming Department of Health Partnering with Wyoming Primary Care Association
Objectives • Understand the prevalence and burden of type 2 diabetes in Wyoming. • Review the Prevent Diabetes STAT toolkit developed by the American Medical Association and Centers for Disease Control and Prevention. • Learn how to identify patients at risk for diabetes, refer them to an appropriate Diabetes Prevention Program (DPP), and increase enrollment and participation in DPPs. • Identify resources available to health care professionals to help you Screen, Test, and Act Today!
Prevalence of Diabetes in Wyoming Source: 2011-2015 Wyoming BRFSS, retrieved from https://health.wyo.gov/publichealth/prevention/chronicdisease/data/
Cost of Diabetes in Wyoming Total Inpatient Costs: $232,825,610 People with diabetes incur an average of $7,900 in medical costs per year.
WHAT IS THE NATIONAL DIABETES PREVENTION PROGRAM?
Polling Question Have you ever heard of the National Diabetes Prevention Program?
NDPP Overview • A lifestyle change program following an evidence-based, CDC-approved curriculum • Designed for people who have prediabetes or are at risk for type 2 diabetes • Consists of 16 weeks of intervention (Core Phase) followed by 6 months of maintenance and follow-up (Core Maintenance Phase) • Focuses on healthy habits
Standard NDPP Curriculum Core Phase (16 Weeks over 6 months) Program Overview/Introduction Manage Stress Get Active to Prevent T2 Find Time for Fitness Track Your Activity Cope with Triggers Eat Well to Prevent T2 Keep Your Heart Healthy TrackYour Food Take Charge of Your Thoughts Get More Active Get Support Burn More Calories Than You Take In Eat Well Away from Home Shop and Cook to Prevent T2 Stay Motivated to Prevent T2
Standard NDPP Curriculum Core Maintenance Phase (6 Months) When Weight Loss Stalls Get Back on Track Take a Fitness Break Prevent T2 – For Life! Stay Active to Prevent T2 Stay Active Away from Home More AboutT2 More About Carbs Have Healthy Food You Enjoy Get Enough Sleep
NDPP Outcomes NDPP is a result of a major clinical research study designed to test whether lifestyle changes (diet and physical activity) could prevent or delay onset of type 2 diabetes. National Institute of Health (NIH)-funded Outcome – 3 years 3-arm Randomized Control Trial Intervention Group 2 Control Intervention Intervention A 5-7% body weight loss reduced the risk of Group Group 1 Group 2 developing type 2 diabetes by 58% in those with prediabetes ( 71% in those 60+ years). Intensive Lifestyle Placebo Metformin Coaching* Outcome – 10 years *Individual counseling and motivational support Intervention Group 2 on effective diet, exercise, and behavior 34% decrease in prevalence of type 2 modification diabetes.
NDPP Outcomes Reduction in Risk of Developing Type 2 Diabetes 12 11 31% per 100 person-years 10 58% T2DM incidence 7.8 8 6 4.8 4 2 0 Metformin Placebo Intensive lifestyle 850 mg BID (n=1082) intervention (NDPP) (n=1073) (n=1079)
NDPPs in Wyoming Find NDPP Sites through the CDC NDPP Registry: https://nccd.cdc.gov/DD T_DPRP/Registry.aspx Find Online Programs: https://nccd.cdc.gov/DD T_DPRP/Programs.aspx
Polling Question Have you ever referred patients to a NDPP?
HOW CAN I HELP PREVENT DIABETES STAT?
Screen / Test / Act Today
Prevent Diabetes STAT • A guide to refer your patients with prediabetes to an evidence-based diabetes prevention program • Developed by the American Medical Association (AMA) and Centers for Disease Control and Prevention (CDC) • Contains tools for healthcare providers to complete each of the three steps to Prevent Diabetes STAT: • Screen patients for prediabetes • Test patients for prediabetes • Act Today by referring patients with prediabetes to a Diabetes Prevention Program • www.preventdiabetesstat.org
Overview of Tools
Overview of Tools
Chatbox Question What information do you need to know about a community-based program before you consider referring patients to it?
Engaging Clinicians • Understand what a NDPP is and how a patient would benefit from it. • Use Clinician Fact Sheet • Understand who is eligible for referral to a NDPP • *Prevent Diabetes STAT Toolkit has old eligibility guidelines
NDPP Eligibility All participants MUST: • Be 18+ years old • Have a Body Mass Index (BMI) of ≥25 kg/m2 (≥23 kg/m2 , if Asian American ) All of a program’s participants must be considered eligible based on either: • A recent (within the past year) blood test meeting one of these specifications: • Fasting glucose of 100 to 125 mg/dl • Plasma glucose measured 2 hours after a 75 gm glucose load of 140 to 199 mg/dl • A1c of 5.7 to 6.4 • Clinically diagnosed gestational diabetes mellitus (GDM) • A positive screening for prediabetes based on the Prediabetes Screening Test *Participants cannot have a previous diagnosis of type 1 or type 2 diabetes prior to enrollment
Engaging Patients
Engaging Patients
Engaging Patients
Prevent Diabetes STAT in your Practice • Preventing Diabetes STAT is more than just posters and handouts – it requires engagement from the entire practice team. • Create a MAP for screening, testing, and referring patients in your practice. • MAP: Measure, Act, Partner. • Use a MAP to determine roles and responsibilities for identifying patients at risk for diabetes and referring them to appropriate service.es
Polling Question Does your practice have a standardized procedure for identifying patients at risk for diabetes and referring them to appropriate resources?
MAP: Measure Two ways to measure patients: Point-of-Care Method 1. Retrospective Method 2.
MAP: Act Two ways to Act : Point-of-Care Method 1. Retrospective Method 2.
MAP: Partner Two ways to partner : With DPPs 1. With Patients 2.
Point-of-Care MAP
Point-of-Care MAP
Point-of-Care MAP
Retrospective MAP
Retrospective MAP
Retrospective MAP
Polling Question Which method of measuring are you more likely to use in your practice? (Point-of-Care, Retrospective, or Both)
Activity – Developing a MAP • Looking at the MAP provided by the Prevent Diabetes STAT Toolkit: Identify whether your practice could use point-of-care measurement, 1. retrospective measurement, or both to identify patients at-risk for diabetes. Then, identify WHO is responsible for each of the selected tasks for both 2. measuring and acting. Next, note HOW your practice will complete the selected tasks – what tools will 3. you use? What tools or information do you still need? Finally, identify your partners. 4. Compile your MAP into a standardized procedure for your clinic. 5.
Chatbox Question What is the most challenging aspect of screening, testing, and referring patients at risk for diabetes?
WHY IS THIS IMPORTANT?
Importance of Preventing Diabetes STAT • Value to patients • Improved health outcomes • Reduced incidence and prevalence of diabetes • Better patient satisfaction • Improved quality of life • Value to clinic • Patient-Centered Medical Homes require team-based care, care coordination, evidence- based clinical decision support, etc. • Increased income • Value to community • Healthier population and workforce
Other Helpful Resources • Patient Letter/Email and Phone Script • Standardized Referral Forms • Cowboy Up to Prevent Diabetes Toolkit • Printed and bound Prevent Diabetes STAT Toolkit • Laminated prediabetes risk tests • Full-size prediabetes awareness posters • To order, fax order form to 307-777-8604
Billing/Coding Resources CPT Code Description 99381-99387 Preventive Visit - New Patient - Commercial/Medicaid 99391-99397 Preventive Visit - Established Patient - Commercial/Medicaid G0438 Annual Wellness Visit - Initial - Medicare G0439 Annual Wellness Visit - Subsequent - Medicare 83036QW Office-based Hemoglobin A1C testing 82962 Office-based finger stick glucose testing
Billing/Coding Resources ICD-10 Code Description Z13.1 Encounter for screening for diabetes mellitus R73.09 Other abnormal glucose R73.01 Impaired fasting glucose R73.02 Impaired glucose tolerance (oral) R73.9 Hyperglycemia, unspecified E66.01 Morbid obesity due to excess calories E66.09 Other obesity due to excess calories E66.8 Other obesity E66.9 Obesity, unspecified E66.3 Overweight Z68.3x Body mass indexes 30.0-39.9 (adult) Z68.4x Body mass indexes >= 40.0 (adult)
Chatbox Question What does your practice need help with to best meet the needs of your patients at risk for diabetes?
QUESTIONS?
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