Successful Implementation of Diabetes Self- Management Education [DSME] in your Community Health Center

Transcription

1 Successful Implementation of Diabetes Self- Management Education [DSME] in your Community Health Center Bonnie Hollopeter, LPN, CPHQ, CPEHR State Quality Improvement Lead, Health Services Advisory Group March 1, 2017

2 Objectives Review Health Services Advisory Group and the Everyone with Diabetes Counts (EDC) program. Celebrate successes to date Discuss successful strategies and lessons learned by North East Ohio Neighborhood (NEON) who has implemented a Diabetes Management Empowerment Program Discover ways to implement diabetes selfmanagement in your practice 2

3 HSAG: Your Partner in Healthcare Quality HSAG is the Medicare Quality Innovation Network- Quality Improvement Organization (QIN-QIO) for California, Arizona, Florida, Ohio, and the U.S. Virgin Islands. QIN-QIOs in every state and territory are united in a network administered by the Centers for Medicare & Medicaid Services (CMS). The QIN-QIO program is the largest federal program dedicated to improving health quality at the community level. 3

4 HSAG s QIN-QIO Responsibility Nearly 25 percent of the nation s Medicare beneficiaries HSAG is the Medicare QIN-QIO for Arizona, California, Florida, Ohio, and the U.S. Virgin Islands. 4

5 QIO Task Areas Prevent and Manage Diabetes Improve Coordination of Care Improve Medication Safety Improve Cardiac Health Patient is at the center of care. Improve Nursing Home Quality Improve Health Through Health Information Technology Reduce Hospital Infections 5

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7 Disparities Exist in Diabetes Care African Americans Hispanics/Latinos American Indians/Native Americans/Alaska Natives Asians/Pacific Islanders People living in rural areas/appalachia Dual-Eligible beneficiaries Low income housing 7

8 Everyone with Diabetes Counts (EDC) More than 25 percent of Americans ages 65 and older have diabetes. 51 percent are estimated to have pre-diabetes. 8.1 million Americans are undiagnosed with diabetes. Diabetes was the seventh leading cause of death in the United States in Diabetes can be treated, managed, and prevented. Data Source: CDC National Diabetes Statistics Report, 2014, available at: 8

9 HSAG s Role in EDC Increase adoption and implementation of diabetes self-management education (DSME) Diabetes Self-Management Program, Stanford University Diabetes Empowerment Education Program (DEEP), University of Illinois at Chicago (UIC) Project Dulce, Scripps Health Whittier Diabetes Institute Train organizations statewide to offer DSME Provide assistance to organizations offering DSME Impact almost than 4,000 Medicare Beneficiaries with diabetes or pre-diabetes 9

10 Goals and Target Population Goals: Reduce diabetes care disparities Prevent and/or reduce adverse health outcomes related to diabetes Reduce risk factors associated with diabetes Increase self-management skills Facilitate short- and long-term behavioral change Target Audience: Individuals living with or at risk of diabetes Includes low-health literacy and low-literacy individuals 10

11 DEEP Program Description Evidence-based program Six weekly workshops Each class is two hours long Taught by one certified DEEP Peer Educator Can be delivered in any language Interactive, hands-on, group learning activities, and games, including visual aids and demonstrations Weekly Module evaluations allowing Peer Educator to adjust delivery, address challenges of participants, etc. 11

12 DEEP Modules Diabetes risk factors and complications Nutrition Physical activity Use of the glucose meter Medications Building partnerships with diabetes healthcare team Psychosocial effects of illness Problem-solving strategies How to access community diabetes resources 12

13 Why DEEP Works Incorporates adult education, empowerment principles, and participatory techniques Speeds changes in knowledge and behavioral and clinical indicators Meets the needs of participants in real time Connects the dots in easy-tounderstand language 13

14 Tell me and I forget, teach me and I may remember, involve me and I learn. -Benjamin Franklin 14

15 Interactive Demonstrations 15

16 Understanding a Food Label 16

17 Visualizing Fats and Carbohydrates Cheeseburger Cola Soda Fries Total Fat 24 g = 6 teaspoons 0 g 29 g = 7 teaspoons Total Sodium 897 mg =.16 teaspoons 15 mg = negligible 328 mg =.06 teaspoons Total Carbs 39 g = 8 teaspoons 35 g = 7 teaspoons 63 g = 13 teaspoons Total Fat, Salt, and Carbs 13 teaspoons of lard ½ teaspoon of sodium 28 teaspoons of sugar 17

18 Program Delivery Method Certified peer educator/ workshop leader Only one leader required to lead workshop Allows for make-up sessions 18

19 Training Requirements Attend a three-day, train-thetrainer workshop, and receive certification to facilitate DEEP workshops as a peer educator. Peer educator training is taught by lead trainers. Lead trainer training is taught by senior trainers. No-cost training offered. 19

20 Goals are Outcomes-Based and Data-Driven HSAG will help track and analyze data. HSAG tracks pre- and post-activation measures. HSAG tracks clinical outcomes for 10 percent of participants: HbA1c Lipids Blood pressure Weight Foot exams Eye exams 20

21 Data Collection and Sharing Demographics Including health insurance Kind of diabetes Ethnicity/Race/Language spoken How long you ve had diabetes Education level Pre/Post Surveys -Evaluates learning/behavior change What is a retinal exam/nephropathy? In the last week, how many days did you eat fruits/vegetables exercise take your medicine check your blood sugar check your feet? Do you feel comfortable communicating with your Care Team? 21

22 Pre- and Post-Patient Activation Survey 14 total questions 4 questions: Diabetes knowledge 5 questions: Coping with diabetes 5 questions: Self-care methods Administered during first week and then again at the sixth week 22

23 Coping Questions 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 45% 86% 72% 91% 92% 96% Handling stress Asking for support Asking doctor questions about treatment plan 73% 89% Ability to make a plan to control diabetes Pre-PAS Post-PAS 23

24 Knowledge Questions 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 92% 93% 90% 92% 87% 80% 81% How exercise How to take care of affects blood sugar? feet? Pre-PAS What is a retinal exam? Post-PAS 88% How do carbohydrates break down in body? 24

25 Number of Days Empowerment Questions In the last week, average number of days doing self-care Eating Fruits and Vegetables Exercising 30 Minutes Pre-PAS Testing Blood Sugar Post-PAS Taking Medications Checking Feet 25

26 Patient Centered Medical Home (PCMH) 2014 PCMH 2 Team-Based Care Element B Medical Home Responsibilities Factor 4: The care team provides access to evidence-based care, patient/family education and self-management support. PCMH 3 Population Health Management Element D: Use Data for Population Management At least annually the practice proactively identifies populations of patients and reminds them, or their families/caregivers of needed care based on patient information, clinical data, health assessments and evidence-based guidelines. NCQA Patient-Centered Medical Home (PCMH)

27 PCMH continued 2014 PCMH 4 Care Management and Support Element E: Support Self-Care and Shared Decision Making Factor 5 Offers or refers patients to structured health education programs, such as group classes and peer support PCMH 6 Performance Measurement and Quality Improvement Element C: Measure Patient/Family Experience Whole-person care/self-management support 2014 NCQA Patient-Centered Medical Home (PCMH) 27

28 Partners Ohio Department of Aging Area Agencies on Aging Ohio Association of Community Health Centers Federally Qualified Health Centers Rural Health Clinics Physician Offices Health Plans Community Organizations Senior Housing Senior Centers Faith-Based Community Evi-Base 28

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30 NORTHEAST OHIO NEIGHBORHOOD HEALTH SERVICES (NEON) DIABETES MANAGEMENT EMPOWERMENT PROGRAM Rhonda S. McLean, MBA Associate Director of Health Services

31 NEON WHO? NEON is a Federally Qualified Health Center started in Originally called Hough Norwood. Currently has seven health center sites on the east side of Cleveland and East Cleveland. NEON provides comprehensive Primary Care, Dental and Behavioral Health Care to over 30,000 patients annually. Additional services include Optometry, Podiatry, Nutrition, Social Work, Pharmacy, Mammography, x-ray and lab. These services are provided regardless of the patient's insurance status. Many patients are now covered by Medicaid, Medicare, and the ACA. Uninsured patients are covered under the sliding-fee-scale based on income and family size

32 NEON FINANCIAL MIX Self Pay 10.80% Medicaid 69.46% Medicare 4.47% Medicare FQHC 5.54% Commercial 6.82% Commercial Job Corp 1.02% Dental Contracts 1.69% Others 0.20%

33 Diabetes Patients As of 11/1/2016 NEON has 2,625 diagnosed diabetes patients Ages Number of Patients Percentage % % ,473 56% %

34 Components The four components of the Diabetes Management Empowerment Program 1) Chronic disease management 2) Coordinated shared appointments 3) Group empowerment education 4) Pharmacy consultation visits

35 Challenges Transportation Large printed materials not available Following up with a next step so they don t fall back into old habits. Billing for shared appointments

36 Successes and Rewards Two staff members trained Held five workshops to date Graduated 32 beneficiaries Control A1C s Patients becoming advocates of the program Letters and cards of thanks Data and feedback as to how to reach more people.

37 Graduate Feedback Open discussion, round table approach, I learned something the first day! Knowing that exercise is a big part of being a diabetic. [He] explains thoroughly and I have experience lower blood sugar since I ve been in this class. I like the way everything was presented. I ve learned so much. The Activities It physically showed what goes on in our bodies. Very informative, a great class! These classes have been very helpful and I m getting results, good results! Thanks 37

38 Thank you!

39 This material was prepared by Health Services Advisory Group, Inc., the Medicare Quality Innovation Network-Quality Improvement Organization for Arizona, California, Florida, and Ohio, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. QN-11SOW-XC