The Influence of Local Agencies in Scaling the National Diabetes Prevention Program Healthy Aging Summit June 7, 2018
Objectives 1 2 3 Define science, theory, and fidelity assurance behind the National Diabetes Prevention Program Describe State of Wisconsin Department of Health Services work around diabetes prevention strategies Learn how local communities are working to scale this program across Wisconsin
Partners healthtide MetaStar WI Collaborative for Healthcare Quality (WCHQ) WI Primary Health Care Association (WPHCA) WI Nurses Association (WNA) Pharmacy Society of WI UW Population Health Institute WI Academy of Nutrition and Dietetics WI Medical Society (WMS) WI Institute for Healthy Aging United Voices WI Department of Corrections WI Department of Instruction WI Community Health Fund WI Lions Foundation Local Health Departments And many more...
Now Prediabetes in Wisconsin National Diabetes Statistics Report, Centers for Disease Control and Prevention, 2014.
Future 2 out of 5 Wisconsin adults will develop type 2 diabetes in their lifetime The Lancet Diabetes and Endocrinology, 2014.
What is prediabetes? Higher than normal blood glucose (sugar) levels Can lead to heart disease, stroke, and type 2 diabetes Is reversible through moderate lifestyle change such as healthy eating, increased activity, and weight loss
Why prevent type 2 diabetes? Leads to serious health issues Heart attack Stroke Blindness Kidney failure Loss of toes, feet, or legs Expensive disease Average annual medical cost per person WITHOUT diabetes: $7,150 WITH diabetes: $16,750 (an increase of $9,600) Additional indirect costs include absenteeism and reduced productivity while at work, inability to work, and lost productivity due to premature deaths
National Diabetes Prevention Program (DPP) Structure: year-long, highly evidence-based lifestyle change program Goal: weight loss of 5%-7% from starting weight Eligibility: Age >18 and BMI >25 plus medical diagnosis of prediabetes, history of gestational diabetes, or positive screen on CDC Prediabetes Screening Test Evidence: reduced risk for developing type 2 diabetes by 58% (71% for age 60 or older) Fidelity: CDC s Diabetes Prevention Recognition Program (DPRP) assures program quality, develops and maintains a registry, provides technical assistance
National DPP Health Impact According to numerous studies, for every 100 high-risk adults (age 50) completing the program: Prevents 15 new cases of type 2 diabetes 1 Prevents 162 missed work days 2 Avoids need for blood pressure or cholesterol medications in 11 people 3 Adds equivalent of 20 years of perfect health 4 Avoids $91,400 in health care costs 5 1 DPP Research Group. N Engl J Med. 2002 Feb 7;346(6):393-403 2 DPP Research Group. Diabetes Care. 2003 Sep;26(9):2693-4 3 Ratner, et al. 2005 Diabetes Care 28 (4), pp. 888-894 4 Herman, et al. 2005 Ann Intern Med 142 (5), pp. 323-32 5 Ackermann, et al. 2008 Am J Prev Med 35 (4), pp. 357-363; estimates scaled to 2008 $US
4000 Growth of Diabetes Prevention Program Participation in Wisconsin, Jan 2015-Jan 2018 3500 3000 42 suppliers 3,510 participants 2500 2000 19 2,177 29 2,314 33 2,498 1500 1000 500 21 suppliers 657 participants 22 717 18 1,111 0 Jan-15 Jul-15 Jan-16 Jul-16 Jan-17 Jul-17 Jan-18
Wisconsin Diabetes Prevention Program Providers by CDC Recognition Status January 26, 2018 Full Recognition Pending Recognition Preparing to Apply
Are you at risk? Take the test! www.diabetes.org/risktest
Find Diabetes Prevention Programs Near You www.diabetes.org/prevention
Increasing awareness of prediabetes and enrollment in National DPP Increasing screening and testing of people with prediabetes and referrals to National DPP Increasing public (Medicaid, state employees) and private coverage for National DPP WI-DHS Support for National DPP Increasing availability of National DPPs in Wisconsin
Thrive Barron County: Coalition Collaboration to Offer National DPP in Rural Wisconsin Jeanine Schultz, BA Barron County Department of Health and Human Services (715) 537-6169 Jeanine.Schultz@co.barron.wi.us
Thrive Barron County: Chronic Disease Action Team
Background: 2012: Community Health Assessment Top health concern: Chronic Disease Prevention & Management. Specifically: Pre-diabetes Thrive BC Chronic Disease Action Team Formed 2014: Know Your Numbers Testing Event Data from participants with no previously diagnosed prediabetes or diabetes showed: 185 of 583 (31.7%) had fasting blood sugar readings between 100-125 mg/dl 13 of 583 (2.2%) had fasting blood glucose readings >126 mg/dl. 2015: Began Diabetes Prevention Program Exploration
Partnering to offer DPP in Barron County Thrive team meetings Sharing best practices & lessons learned Applied for grants DPP Lifestyle Coaches trained Ordered/distributed DPP materials together Decided on flat, county-wide fee for DPP participation Collaborative DPP promotions
Barron County DPP Today Thrive Barron County meetings DPP classes offered regularly Training more Lifestyle Coaches Educating healthcare providers about DPP Electronic Health Record referral systems and approaches being developed, implemented, and adjusted
Barron County DPP Going Forward Sustainability: Thrive team meetings Sharing best practices & lessons learned Offering DPP classes regularly Using/updating EHR referral systems Medicare approval of the MDPP
Iowa County Health Department: Collaborating with County Partners to Offer National DPP in Rural Wisconsin Kari Bennett, RN, BSN Iowa County Health Department (608) 930-9873 Kari.Bennett@iowacounty.org
Kari Bennett Then...
and Now. As a Public Health Nurse you are always prepared, whether it is for the Eclipse or Ebola.
Iowa County of Wisconsin Southwest corner of Wisconsin Population: 23,813 as of 2015 One hospital Upland Hills Health Points of Interest: Governor Dodge State Park, House on the Rock, Oldest Courthouse in Wisconsin
Iowa County Health Department Sue Matye RN BSN, Health Office/Director Kari Bennett RN BSN, Staff Nurse Ann Thompson RN BSN, Staff Nurse Kathy Key, Administrative Assistant
This is where it all started. From: Kari Bennett <Kari.Bennett@iowacounty.org> Date: Tue, Jul 12, 2016 at 11:34 AM Subject: Lifestyle Coach training To: Pamela Geis (WI-DHS) <Geis.Pamela@gmail.com> Hi Pamela, I am interested in the training for the lifestyle coach training for the diabetic prevention program. Do you have information on the training?
November 2016: nursing staff of 3 completes National Diabetes Prevention Program Lifestyle Coach Training November 2016: Iowa County Health Department applies for recognition with the Center of Disease December 2016: CDC awards Iowa County Health Department pending recognition status
January 2017: begin first class with 10 Iowa County Employees June 2017: Approach Lands End using resources from CDC s Diabetes and the Workplace and Workplace Health Promotion October 2017: Decide not to charge Lands End November 2017: Lands End agrees employees can attend class over lunch period; extend lunch hour 30 minutes to make one hour for class December 2017: Iowa County employee T2 class ends with 9 members; Lands End begins recruiting for T2 class
Pam invited us to attend a Diabetes Prevention State Engagement Meeting. We were hoping for this...
But instead we got this...
January 2018: Start T2 class at Lands End with 10 participants Distribute waiting room triggers developed from the AMA/CDC Provider Referral Toolkit to ALL Iowa County medical clinics February 2018: Meet with Upland Hills Health Registered Dietician/Certified Diabetic Educator She had many thoughts of how to refer patients to our program March 2018: Meet with Upland Hills again; Dr. Hartline recommends Smart Phrase development for Epic health records system A person with a prediabetes diagnosis will receive Smart Phrase as part of take home print off at end of their office visit
April 2018: Develop Smart Phrase Incorporate Smart Phrase into Upland Hills Health Epic system To-date one person has called to join next class Distribute information on T2 program in countywide News and View paper published by Aging and Disability Resource Center Email about the T2 program sent to all Iowa County Employees Planning begins for a new class series to start in June 2018
Smart Phrase Screenshot
Lands End Group... I have learned the value of writing things down. After years of dieting without keeping track of calories consumed on a daily basis, being accountable by looking at the numbers has been the key to losing weight. This has allowed me to lose 7% of my original weight in just under 4 months. Mike Instruction is great! She s so non-judgmental! I learned I need to keep writing my food down in order to stay on track. Cathy Great experience! It is a thinking process I am now more aware of what I eat and portions. How environment around me affects my choices. Great conversations and respect for others in the group. Cathy This class has helped me be more aware of portion sizes and calorie intake. This class also helped with better food choices. Julie I have lost 16 pounds by just watching my portions, making better food choices and getting more active. This class has taught me lots of little tricks that are adding up to real results. Jessica
What s Next?
How Can Local Agencies Create Awareness about Prediabetes? Create awareness of prediabetes in your communities Use available tools to help promote awareness Become a supplier or be the community convener
Risk Test Flyer
Posters www.doihaveprediabetes.org
Posters www.doihaveprediabetes.org
Radio PSA www.doihaveprediabetes.org
TV PSAs www.doihaveprediabetes.org
Ad Council Campaign Risk Test Hedgehogs :60 Type 2 Diabetes Prevention https://www.youtube.com/watch?v=n2vybneax7e Bacon Lovers Type 2 Diabetes Prevention https://www.youtube.com/watch?v=3ywiat0g65e
QUESTIONS?
For More Information Pamela Geis, BA Health Promotion Specialist (contracted) Chronic Disease Prevention Program State of Wisconsin, Division of Public Health www.dhs.wisconsin.gov/disease/chronic-disease.htm (262) 573-3983 Geis.Pamela@gmail.com Thank You! Jeanine Schultz, BA Public Health Specialist, Public Health Unit Barron County Dept. of Health and Human Services (715) 537-6169 Jeanine.Schultz@co.barron.wi.us Kari Bennett, RN, BSN Staff Nurse Iowa County Health Department www.iowacounty.org/departments/health/health.shtml (608) 930-9873 Kari.Bennett@iowacounty.org