South Carolina s Diabetes Prevention Toolkit for Physicians and Health Care Teams. Gerald Wilson, MD

Transcription

1 South Carolina s Diabetes Prevention Toolkit for Physicians and Health Care Teams Gerald Wilson, MD

2 About the Presenter Dr. Wilson Chair of SC Diabetes Advisory Council (DAC) There are no financial relationships that may pose a conflict of interest

3 Objectives 1. Become familiar with the components of the Diabetes Prevention Toolkit for Physicians and Health Care Teams (Diabetes Prevention Toolkit) and the evidence-based best practices to evaluate, test and treat prediabetes. 2. Learn how to leverage the different components of the Diabetes Prevention Toolkit with your health care team 3. Engage patients in the National Diabetes Prevention Program and/or other interventions to address prediabetes

4 Topics Why a Toolkit? What is the Diabetes Prevention Toolkit? How can I implement the toolkit most effectively in my practice? Where can I get the Diabetes Prevention Toolkit?

5 Why A Toolkit? REFERENCES Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, Atlanta, GA: U.S. Department of Health and Human Services; American Diabetes Association. Economic Costs of Diabetes in the U.S. in Diabetes Care. 2013;36(4): Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death on CDC WONDER Online Database, released December, Data are from the Multiple Cause of Death Files, , as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at on April 4, Mayer-Davis EJ, Lawrence JM, Dabelea D, Divers J, Isom S, Dolan L, et al. Incidence Trends of Type 1 and Type 2 Diabetes among Youths, N Engl J Med. 2017;376:

6 The Clinical Team Plays a Critical Role in Stopping the Progression Frank s disease progression 2003 Prediabetes age Type 2 Diabetes 2010 Retinopathy 2012 Chronic Kidney Disease 2016 MI and Death because we can stop the progression

7 The Diabetes Prevention Toolkit Addresses a Need Studies have found that physician knowledge and interventions for prediabetes highlight a gap that needs to be filled Risk factors (6% responded correctly) * Cut off range in tests (fasting glucose and hemoglobin A1c) (17% responded correctly)* Referral to behavioral weight loss programs (11% referred)* Patient follow-up for prediabetic range blood glucose (<50%)** *Tseng E, et al, J Gen Intern Med 2017; ** Marshal C, et al, Womens Health Issues 2017:

8 Topics Why a Toolkit? What is the Diabetes Prevention Toolkit? How can I implement the toolkit most effectively in my practice? Where can I get the Diabetes Prevention Toolkit?

9 The Purpose of the Toolkit Provide information and tools to facilitate the evaluation, testing and treatment of prediabetes to physicians and their health care team Reinforce evidencebased best practices Educate patients Facilitate referral to a Diabetes Prevention Program where available

10 The Toolkit has Three Major Sections

11 For the Clinician and Health Care Team Algorithm for Evaluating, Testing, and Treating Prediabetes Patient Summary form BMI chart Example Workflow Commonly Used Codes Referral form for the NDPP How to Talk with Patients How to Implement Prediabetes Best Practices

12 Evaluate, Test, &Treat for Prediabetes years old Use this algorithm to identify who should be evaluated for diabetes, what tests should be used and treatment guidelines. Real impact - Diabetes incidence in 10 years (compared to placebo) + 34% in the lifestyle group (Diabetes Prevention Program) 18% in the metformin group dietitian Make copies for your workstations and/or embed the algorithm into your Electronic Health Records (EHR).

13 Prediabetes & Diabetes Patient Summary Form Age This form helps you and your staff capture information relevant to evaluating, testing, and treating a specific patient with prediabetes. Make copies to include in your patient s chart and/or create a prediabetes data entry form and order set in your EHR.

14 Body Mass Index (BMI) Chart The BMI Chart provides a quick reference for determining your patient s BMI. Make copies for your workstation or leverage your EHR to calculate this value for you.

15 Example Workflow for Evaluating, Testing, and Treating Patients for Prediabetes The workflow provides an example of actions, information exchange and decision points for evaluating, testing, and treating patients. Review and modify the workflow to meet the needs of your staff and setting.

16 Commonly used CPT and ICD-10 Codes Can help you better document and report the services/tests performed to evaluate for prediabetes and diabetes.\ R73.03 is a diagnostic code for prediabetes Review/confirm coverage with insurance companies and incorporate into the process to ensure optimal documentation for reimbursement.

17 Referral Form for the National Diabetes Prevention Program (National DPP) This referral form provides the patient the documentation they need to participate in the National DPP. Determine if there are locations in your area for your patients. If so, fill in your practice information on the electronic form. Make copies to provide to patients diagnosed with prediabetes as part of their treatment plan.

18 How to Talk with Patients About Their Prediabetes Diagnosis This information provides some guidance on motivational interviewing and the Dos and Don ts. Learn how to use these tools to enhance lifestyle change counseling, especially if your area does not have a National DPP site.

19 How to Talk with Patients About Their Prediabetes Diagnosis (page 2) Information around shared decisionmaking; motivational interviewing and the 5 A s behavioral change model. Learn how to use these tools to enhance lifestyle change counseling. These tools can be used for other health topics beyond prediabetes.

20 How to Implement Prediabetes-related Best Practices Highlights of the major steps in implementing the prediabetes best practices into your workflow in a sustainable way. Get buy-in from your team and identify a champion.

21 How to Implement Prediabetes-related Best Practices (page 2) Also consider leveraging this activity for Practice Improvement opportunities to payment. It is important to sustain the changes in your practice and celebrate the impact you have had on the lives of your patients.

22 For the Patient So You Have Prediabetes Now What? What is the National Diabetes Prevention Program? Setting Your Health Goal Prediabetes Screening Tests

23 So You Have Prediabetes Now What? Patient handout to help them understand what it means to have prediabetes. Make copies and provide to patients with prediabetes and/or if available, upload to your patient portal.

24 So You Have Prediabetes Now What? (page 2) Electronic resources to other information is provided and can be added to your patient portal if you have one.

25 What is the National DPP? Patient handout to help them learn about the National DPP and the time commitment. Make copies and provide to patients with prediabetes and/or if available, upload to your patient portal.

26 Setting Your Health Goal This patient handout guides them to developing smart goals. Make copies and provide to patients with prediabetes and/or if available, upload to your patient portal.

27 Setting Your Health Goal (page 2) This handout also provides links to resources that might prove helpful to patients. Consider providing these links on your patient portal.

28 Prediabetes Screening Tests The American Diabetes Association and the CDC Prediabetes Screening Tests are being provided to individuals across South Carolina to help them if they may be at risk for prediabetes Consider providing a screening test in your clinic.

29 Prediabetes Screening Tests (page 2)

30 For More Information About the National DPP References & Resources Contact information The American Diabetes Association and the CDC Prediabetes Screening Tests are being provided to individuals across South Carolina to help them if they may be at risk for prediabetes Consider providing a screening test in your clinic.

31 Topics Why a Toolkit? What is the Diabetes Prevention Toolkit? How can I implement the toolkit most effectively in my practice? Where can I get the Diabetes Prevention Toolkit?

32 Getting Started Using the Toolkit Identify a champion for implementing best practices related to prediabetes (the toolkit) Assess the current state of your practice, for example: Query for diagnosis and age Number of patients you have with a diagnosis of obesity (E66) who are between yo Number of patients with a diagnosis of prediabetes (R73.03) Query lab results Number of patients whose Fasting Serum Glucose is between mg/dl or Hemoglobin A1c % or Oral Glucose Tolerance Test is mg/dl Query treatment Number of patients with prediabetes referred to lifestyle intervention program (National DPP, nutritionist, etc.) Number of patients with prediabetes given metformin What are your clinic s practices relating to prediabetes best practices?

33 Getting Started Using the Toolkit (part 2) Define future state. For example: Assess the algorithm Who is responsible for evaluation, documentation, doing the testing, patient follow-up, confirmation test (if first is positive), referrals, billing? Is there a National DPP program your patients can go to? If not, does the practice want to become one? If an EHR is available, can templates be created? Alerts for at risk patients? Standing orders? Work with the health care team to optimize workflow Determine if this can be part of a practice improvement process for payment, for MOC, for CME Will the process start by reaching out to patients proactively or as they come in to be seen? What materials will be provided to patients with prediabetes?

34 Getting Started Using the Toolkit (part 3) Commit and Plan Obtain buy-in and commitment from the entire team Develop an implementation plan Cover all the details - what needs to be done, by whom, and when Implement and Refine Implement your plan Assess how it is working and improve what doesn t work Track results number of patients evaluated, tested and treated Are lab results and BMI values improving? How many patients are committing to participate in the National DPP How many are taking metformin? Sustain Celebrate successes and track measures to prevent slippage!

35 Topics Why a Toolkit? What is the Diabetes Prevention Toolkit? How can I implement the toolkit most effectively in my practice? Where can I get the Diabetes Prevention Toolkit?

36 Accessing the Toolkit and Print-Ready Handouts

37 For More Information About Diabetes Advisory Council of South Carolina (DAC) Rachel Kaplan 2711 Middleburg Dr., #301 Columbia, SC Phone: (919) Fax: (864) For more information about this toolkit, to provide feedback or for additional questions Sandra Anderson Division of Diabetes, Heart Disease, Obesity and School Health S.C. Dept. of Health & Environmental Control Phone: (803) Feel free to contact me if you have any questions, ideas, resources or comments! Dr. Gerald Wilson