Prevent Diabetes STAT Hannah Herold, MPH, MA, CHES Chronic Disease Prevention Program Wyoming Department of Health Partnering with Wyoming Primary

Transcription

1 Prevent Diabetes STAT Hannah Herold, MPH, MA, CHES Chronic Disease Prevention Program Wyoming Department of Health Partnering with Wyoming Primary Care Association

2 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!

3 Prevalence of Diabetes in Wyoming Source: Wyoming BRFSS, retrieved from

4 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.

5 WHAT IS THE NATIONAL DIABETES PREVENTION PROGRAM?

6 Polling Question Have you ever heard of the National Diabetes Prevention Program?

7 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

8 Standard NDPP Curriculum Core Phase (16 Weeks over 6 months) Program Overview/Introduction Get Active to Prevent T2 Track Your Activity Eat Well to Prevent T2 TrackYour Food Get More Active Burn More Calories Than You Take In Shop and Cook to Prevent T2 Manage Stress Find Time for Fitness Cope with Triggers Keep Your Heart Healthy Take Charge of Your Thoughts Get Support Eat Well Away from Home Stay Motivated to Prevent T2

9 Standard NDPP Curriculum Core Maintenance Phase (6 Months) When Weight Loss Stalls Take a Fitness Break Stay Active to Prevent T2 Stay Active Away from Home More About T2 More About Carbs Have Healthy Food You Enjoy Get Enough Sleep Get Back on Track Prevent T2 For Life!

10 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 3-arm Randomized Control Trial Control Group Intervention Group 1 Placebo Metformin Intervention Group 2 Intensive Lifestyle Coaching* *Individual counseling and motivational support on effective diet, exercise, and behavior modification Outcome 3 years Intervention Group 2 A 5-7% body weight loss reduced the risk of developing type 2 diabetes by 58% in those with prediabetes (71% in those 60+ years). Outcome 10 years Intervention Group 2 34% decrease in prevalence of type 2 diabetes.

11 T2DM incidence per 100 person-years NDPP Outcomes Reduction in Risk of Developing Type 2 Diabetes % % Placebo (n=1082) Metformin 850 mg BID (n=1073) Intensive lifestyle intervention (NDPP) (n=1079)

12 NDPPs in Wyoming Find NDPP Sites through the CDC NDPP Registry: T_DPRP/Registry.aspx Find Online Programs: T_DPRP/Programs.aspx

13 Polling Question Have you ever referred patients to a NDPP?

14 HOW CAN I HELP PREVENT DIABETES STAT?

15 Screen / Test / Act Today

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17 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

18 Overview of Tools

19 Overview of Tools

20 Chatbox Question What information do you need to know about a community-based program before you consider referring patients to it?

21 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

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23 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

24 Engaging Patients

25 Engaging Patients

26 Engaging Patients

27 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

28 Polling Question Does your practice have a standardized procedure for identifying patients at risk for diabetes and referring them to appropriate resources?

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30 MAP: Measure Two ways to measure patients: 1. Point-of-Care Method 2. Retrospective Method

31 MAP: Act Two ways to Act: 1. Point-of-Care Method 2. Retrospective Method

32 MAP: Partner Two ways to partner: 1. With DPPs 2. With Patients

33 Point-of-Care MAP

34 Point-of-Care MAP

35 Point-of-Care MAP

36 Retrospective MAP

37 Retrospective MAP

38 Retrospective MAP

39 Polling Question Which method of measuring are you more likely to use in your practice? (Point-of-Care, Retrospective, or Both)

40 Activity Developing a MAP Looking at the MAP provided by the Prevent Diabetes STAT Toolkit: 1. Identify whether your practice could use point-of-care measurement, retrospective measurement, or both to identify patients at-risk for diabetes. 2. Then, identify WHO is responsible for each of the selected tasks for both measuring and acting. 3. Next, note HOW your practice will complete the selected tasks what tools will you use? What tools or information do you still need? 4. Finally, identify your partners. 5. Compile your MAP into a standardized procedure for your clinic.

41 Chatbox Question What is the most challenging aspect of screening, testing, and referring patients at risk for diabetes?

42 WHY IS THIS IMPORTANT?

43 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, evidencebased clinical decision support, etc. Increased income Value to community Healthier population and workforce

44 Other Helpful Resources Patient Letter/ 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

45 Billing/Coding Resources CPT Code Description Preventive Visit - New Patient - Commercial/Medicaid Preventive Visit - Established Patient - Commercial/Medicaid G0438 G QW Annual Wellness Visit - Initial - Medicare Annual Wellness Visit - Subsequent - Medicare Office-based Hemoglobin A1C testing Office-based finger stick glucose testing

46 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 (adult) Z68.4x Body mass indexes >= 40.0 (adult)

47 Chatbox Question What does your practice need help with to best meet the needs of your patients at risk for diabetes?

48 QUESTIONS?