Going DEEP into Oklahoma with the Diabetes Empowerment Education Program Margaret Enright, MPH, CDE, CPHQ Quality Improvement Consultant TMF Health Quality Institute margaret.enright@tmf.org (405) 641-0756 Panelists: {Certified DEEP Educators}: Adrianna Halstead, RD/LD (Lincoln County Health Dept.) Mary Overall, BS, MSN (Family Life Learning Centers, Inc.) Carrie Smith, BS (Primaris Health Quality Improvement Organization)
Program Objectives: Participants in this session will Have an increased understanding of the current gap in medically-underserved people with diabetes receiving appropriate and comprehensive diabetes self-management education (DSME) which is designed to meet their needs Gain knowledge about the evidence-based DEEP (Diabetes Empowerment Education Program) curriculum, which was designed to meet the particular needs of people with diabetes who have low literacy skills or who live in remote areas where DSME is very difficult to access Learn about TMF Health Quality Institute's Train-the-Trainer project, which provides training/certification/licensure at no charge for people who serve rural areas who wish to become certified to deliver the DEEP curriculum within their own communities in Oklahoma
TMF Health Quality Institute The CMS-funded Quality Improvement Organization (QIO) for Oklahoma, Arkansas, Missouri, Texas, and Puerto Rico which form the Quality Improvement Network (QIN) for our region TMF is a private non-profit organization, whose mission is to continually improve health quality and healthcare resources in our region TMF forms working partnerships with multiple healthcare entities, such as hospitals, nursing homes, physician offices, home health care agencies, state organizations, medical associations, and community-based organizations to accomplish our quality improvement goals The DEEP project is a community-based project and strives to provide effective, evidence-based diabetes education in underserved communities
How Widespread is Diabetes??
Fast Facts on Diabetes 29.1 million people or 9.3% of the U.S. population have diabetes DIAGNOSED 21.0 million people UNDIAGNOSED 8.1 million people (27.8% of people with diabetes are undiagnosed). All ages, 2012 Source: Centers for Disease Control and Prevention All ages, 2012
Age-adjusted * Percentage of People Aged 20 Years or Older with Diagnosed Diabetes, by Race/Ethnicity, United States, 2010 2012 American Indian/ Alaska Natives 15.9 Non-Hispanic Blacks 13.2 Hispanics 12.8 Asian Americans 9.0 Non-Hispanic Whites 7.6 Source: Centers for Disease Control & Prevention *Based on the 2000 U.S. standard population. Source: 2010 2012 National Health Interview Survey and 2012 Indian Health Service s National Patient Information Reporting System.
Oklahoma Diabetes-related Statistics: In 2012, over 330,000 Oklahoma adults reported having been diagnosed with diabetes: Males 12.3% and Females 10.6% Non-Hispanic American Indian 16.4% Non-Hispanic African American 12.3% Non-Hispanic Caucasian 11.6% Non-Hispanic Multi-racial 9.5% Hispanic 7.6% In 2012, Oklahoma ranked the 9 th highest diabetes prevalence in the nation Oklahomans have the 6 th highest percentage of obesity, and are eighth in the nation in lack of regular physical activity {Source: BRFSS}
Co-morbidities of Diabetes Individuals living with Type 1 or Type 2 diabetes are at increased risk for other chronic diseases such as hypertension, elevated cholesterol, kidney disease, visual impairments, depression, anxiety, and eating disorders. Comorbidities of diabetes compromise adherence to treatment and thus increase the risk for serious short- and long-term complications, which can result in blindness, amputations, heart disease, stroke, cognitive decline, decreased quality of life, and premature death. When comorbidities and diabetes go undiagnosed and untreated, the financial cost to society and health care systems is substantial, as are the morbidity and health consequences for patients and families. Diabetes self-management education is an underused and very important part of treatment for diabetes and its co-morbidities! {Source: JAMA, Lee Ducat 1 ; Louis H. Philipson, MD, PhD 2 ; Barbara J. Anderson, PhD 3 JAMA. 2014;312(7):691-692. doi:10.1001/jama.2014.8040}
Overview of the DEEP Program: Developed by the University of Illinois at Chicago.The Diabetes Empowerment Education Program (DEEP) is evidence-based and proven effective Training of facilitators targeting healthcare professionals and skilled volunteers who are close to the target populations who are not currently receiving adequate (or any) DSME services Educational curriculum designed to engage participants in learning how to better care for themselves and how to work more effectively with their care providers It s a very interactive and fun program! UIC- Midwest Latino Health Research, Training and Policy Center
What is Empowerment? Empowerment is a process and an outcome. Allows people to master their personal situations and make smart decisions that affect their own lives Participants in DEEP learn how to effectively set goals and conquer barriers to reaching their goals!
Big Picture Goals of DEEP: To significantly reduce diabetes care disparities among minority populations and special needs populations in the US To prevent or at least delay the onset of diabetes-related complications To empower PWDs with multiple useful strategies and tools which they can employ in their own lives! UIC- Midwest Latino Health Research, Training and Policy Center
Primary Objectives of DEEP: To reduce diabetes complications and modifiable risk factors, including obesity, hypertension, hyperlipidemia, and tobacco use; and to better manage other chronic diseases by improving blood glucose control To increase knowledge of diabetes and promote improved coordination of care with medical professionals To increase self-management skills such as self-monitoring, healthier eating, reasonable exercise plan, stress management, and appropriate use of medications (prescription and OTC) To better manage psychosocial issues To facilitate short- and long-term behavioral change
DEEP Modules Content: 1. Beginning session- Understanding the human body 2. Understanding diabetes and its risk factors 3. Monitoring your body (BP, weight, BMI, waist circumference, glucose monitoring) 4. Get up and Move! The importance of physical activity 5. Health management through sensible nutrition guidelines 6. Diabetes complications: Identification and prevention 7. Medication and medical care Improving communications with your provider(s) 8. Stress and Coping - Mobilizing your family and friends. UIC- Midwest Latino Health Research, Training and Policy Center
DEEP Program rules of thumb : DEEP instructors are not teaching everything about diabetes. They concentrate heavily on teaching empowerment and helping program participants with behavior changes which help them achieve their self-management goals. Instructors are taught to ALWAYS address the action plans in each class; and spend time discussing solutions to barriers. Participants in DEEP have FUN while they learn!
Our Target Participants for the DEEP Six-session Courses: People with diabetes who have low literacy/numeracy skills, & may be dealing with other serious chronic diseases; and who fall within the DSME service gap, either from lack of accessibility, lack of knowledge about the importance of DSME, &/or financial constraints to attendance Medicare coverage (for at least a portion of the participants in a class), because that satisfies requirements from our funders People who are able to participate in a lively and interactive class, where they will engage in discussions, activities, and information sharing with other participants Classes are offered free of charge to all participants!!
Organizations Who Partner With TMF on the DEEP Program Generally have an interest in assisting their clients with achieving improved control of diabetes; and are willing to commit staff time devoted to teaching DEEP classes Have staff members who meet the DEEP program trainee s criteria and who wish to become certified DEEP educators, and who will commit to providing DEEP courses for their clientele at least four times annually Are willing to sign a Memorandum of Agreement (MOA) with TMF which outlines the benefits and responsibilities associated with having staff members &/or volunteers trained and certified to deliver the evidence-based DEEP classes
Introduction of Panelists: Adriana Halstead, RD/LD, Lincoln County Health Department Mary Overall, BS, MSN (Family Life Learning Centers, Inc.) Carrie Smith, BS (Primaris Health QIO)