IMPROVING CARE AND REDUCING COST: A COMMUNITY-BASED APPROACH FOR MANAGING TYPE 1 DIABETES FOR CHILDREN LIVING IN RURAL ARIZONA

Transcription

1 IMPROVING CARE AND REDUCING COST: A COMMUNITY-BASED APPROACH FOR MANAGING TYPE 1 DIABETES FOR CHILDREN LIVING IN RURAL ARIZONA DEVYN R. THURBER, MSN, MPH, PNP-BC CHIRICAHUA COMMUNITY HEALTH CENTERS ARIZONA RURAL HEALTH CONFERENCE JULY 26, 2018

2 AGENDA 1 Type 1 Diabetes 2 Barriers to Care 3 The Chiricahua Model

3 I. Type 1 Diabetes

4 TYPE 1 DIABETES (T1D) Art by Mike Natter

5 STATS In 2009, 1/518 (2%) youth <20 years had T1D in the US Between , new cases of T1D in youth increased by: 1.8% each year for all youth 4.2% each year for Hispanic youth The average cost for a DKA hospital admission = $7,500 In rural areas, there are many barriers to achieving and maintaining good glucose control

6 II. Barriers to Care

7 GEOGRAPHICAL

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9 SOCIOECONOMIC

10 85-90% Medicaid patients Uninsured patients Single parent households Working multiple jobs Split families Decreased health literacy/numeracy

11 CULTURAL

12 Language barriers High carbohydrate diet Concurrent obesity Resistance to medication

13 III. The Chiricahua Model

14 THE CHIRICAHUA MODEL INTENSIVE PRIMARY CARE COMMUNITY OUTREACH CONNECTION TO SPECIALISTS

15 INTENSIVE PRIMARY CARE

16 DIABETES CONTROL AND COMPLICATIONS TRIAL (1993) Intensive treatment with the goal of maintaining blood glucose concentrations close to normal range decreases frequency and severity of diabetes complications. More frequent visits = better glucose control = less long-term issues

17 PROVIDER SPECIALISTS Devyn Thurber, PNP Darlene Melk, MD

18 PROVIDER SPECIALISTS Monthly diabetes follow-ups Monthly A1c Download software On-site pump trainings Primary care/acute visits

19 PROVIDER TRAININGS

20 MOBILE MEDICAL UNITS

21 INTEGRATED HEALTH NUTRITION BEHAVIORAL HEALTH DENTAL

22 CARE COORDINATION

23 PHARMACY

24 340B PROGRAM FOR UNINSURED PATIENTS Medication Retail Cost Sliding Fee Savings Price Pen Needles Test Strips Humalog Levemir Total Monthly Cost For a 90-day supply of insulin: Retail price = > $2,000 Sliding fee price = $10

25 TRANSLATION

26 FUTURE: HOME VISITATION

27 CONNECTION TO SPECIALISTS

28 PATIENT-CENTERED MEDICAL HOME

29 TELEMEDICINE

30 FUTURE: VISTING SPECIALISTS

31 COMMUNITY OUTREACH

32 TRAININGS FOR LOCAL NURSES

33 504 PLAN MEETINGS

34 SUPPORT GROUP

35 SUPPORT GROUP

36 LIBRARY EXCHANGE

37 CONNECTION TO GREATER TYPE 1 COMMUNITY

38 CONNECTION TO GREATER TYPE 1 COMMUNITY

39 SO, HOW DO WE MEASURE UP?

40 LOW ED/HOSPITAL UTILIZATION Each year, approximately 7% of patients with T1D are admitted for DKA. Between 2017 and 2018, 3.3% of our patients with T1D were admitted for DKA. Between 2017 and 2018, our 30 patients were seen in the ED a total of 2 times for issues related to their diabetes.

41 IMPROVING ED/HOSPITAL UTILIZATION According to our Medicaid claims data, between 2017 and 2018, our 15 patients with type 1 diabetes had a: 20% reduction in number of hospital admissions 31% reduction in days spent in the hospital 51% reduction in number of ED visits

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43 DECREASED COST TO THE SYSTEM For one of our patients with T1D: 2017: 1 ED visit, 1 hospital admission = $3,117 PMPM cost 2018: 0 ED visits, 0 hospital admissions = $459 PMPM cost For a total cost savings of: $2,558 per month $30,696 per year

44 FUTURE RESEARCH

45 QUESTIONS?

46 REFERENCES Diabetes Control and Complications Trial (DCCT) Research Group. (1993). The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The New England Journal of Medicine, 329, doi: /nejm Hamman, R. F., Bell, R. A., Dabelea, D. (2014). The SEARCH for diabetes in youth study: rationale, findings and future directions. Diabetes Care, 37, Ilkowitz, J. T., Choi, S., Rinke, M. L, Vandervoot, K., Heptulla, R. A. (2016). Pediatric Type 1 Diabetes: Reducing Admission Rates for Diabetes Ketoacidosis. Quality Management in Health Care, 25, doi: /QMH Maldonado, M. R., Chong, M. A. O., Balasubramanyam, A. (2003). Economic impact of diabetic ketoacidosis in a multiethnic indigent population: Analysis of costs based on the precipitating cause. Diabetes Care. doi: /diacare Mayer-Davis, E. J., Lawrence, J. M., Dabelea, D., Divers, J. D., Isom, S., Dolan, L., (2017). Incidence Trends of Type 1 and Type 2 Diabetes among Youth, New England Journal of Medicine, 376, doi: ?NEJMoa

47 IMPROVING CARE AND REDUCING COST: A COMMUNITY-BASED APPROACH FOR MANAGING TYPE 1 DIABETES FOR CHILDREN LIVING IN RURAL ARIZONA DEVYN R. THURBER, MSN, MPH, PNP-BC CHIRICAHUA COMMUNITY HEALTH CENTERS ARIZONA RURAL HEALTH CONFERENCE JULY 26, 2018