Everyone with Diabetes Counts Geneva M. Wilgus Diabetes - - PowerPoint PPT Presentation

Everyone with Diabetes Counts

Geneva M. Wilgus Diabetes Self-Management Regional Lead

1

General Desired Outcomes

• To improve clinical outcomes of HbA1c, Lipids, Blood Pressure

and Weight control for Medicare beneficiaries.

• To decrease the number of beneficiaries who require lower

extremity amputation due to complications resulting from poorly controlled diabetes.

• To improve health literacy and self-efficacy of Medicare and

dual-eligible beneficiaries with diabetes.

• To create and implement a sustainability plan to increase the

numbers of DSME leaders, DSME sites, and improve access via referrals of beneficiaries to DSME classes.

2

Implementation

3

• Free, six week class
• Class meets 1x per week
• Class is 2.5 hours long
• Always led by two peer facilitators
• Small group of 8-18 participants
• Multiple class settings—community (senior centers, churches,

libraries), retirement communities, physician offices, hospitals.

Mid Coast Hospital, Maine, June 2016 Class

4

Curriculum

New England Regional Approach

6

• Regional Leadership
• State-based teams organize and deliver classes
• Taught by state teams
• Assist partners with class implementation
• Provide licensing and fidelity checks to other organizations
• Bi-Weekly “We’re Better Together” conference call for New England

diabetes team

• Deliverables are completed by individual state program coordinator,

except the narrative portion is created by the Regional Lead

7

Quarterly Deliverable Elements

8

• Task Narrative
• Addressing Sustainability, Successes, Barriers & Mitigation, Lower

Extremity Amputation Rates, and aggregate number of graduates

• Beneficiaries – what’s required to “count”?
• Graduates (completed at least 4/6 classes)
• With Medicare & Diabetes (any type)
• 90% of completers must be from target disparate population: dual

eligibility, rural, low-income, and/or minority ethnic groups.

• Each state has a set target based on population. Range for New

England is 210-450 total beneficiaries by end of contract.

Quarterly Deliverable Elements

continued

9

• Clinical Data
• Pre and Post class clinical data to measure change in A1C, weight,

BP, Cholestorol, etc

• Each state required to obtain clinical data on 10% of total target by

end of contract

• Eligible Providers
• Recruitment has ended, all six states have met or exceeded this

target.

• Report on EP’s referrals to DSME, AADE/ADA certification,

technical assistance offered, etc.

New England’s Numbers

(As of April 30, 2017)

• 1,351 – program graduates (Aggregate # of all graduates)
• 1,064 – Medicare beneficiary graduates who “count”

(Contract goal: 1,795)

• 81 – peer leaders
• 18 – master trainers
• 106 – beneficiaries with clinical data collected (Contract goal:

179.5)

• 137 – physicians recruited (Contract goal: 113)

10

Why we’re successful:

• Advertising, physician office engagement and referrals, lots of phone

time with potential students

• Good leaders
• Fun, engaging, assertive, upholds fidelity of the program
• Mix of students in class
• Everyone is welcome regardless of age, payor, diagnosis
• Solid, evidence-based curriculum
• Maintained fidelity of program delivery and content
• Simple educational props—flip charts, book, pen & paper activities
• Low reading comprehension and low health literacy appropriate

11

New England Demographics

(April 30, 2017)

12

13

New England

Patient Activation Survey Results

(April 30, 2017)

71.3 74.3 86.5 80.9 93.6 95.3 92.3 89.8

0.0 20.0 40.0 60.0 80.0 100.0

How does exercise help your blood sugar? Which one is the best way to take care of your feet? What is a retinal exam? Carbohydrates (starches and sweets) break down in your body to what?

Knowledge Questions - % Correct Answers: NE

Pre EDC Post EDC

14

New England

Patient Activation Survey Results

(April 30, 2017)

15.1 40.5 71.5 89.2 69.2 10.2 86.4 91.7 95.1 89.1

0.0 20.0 40.0 60.0 80.0 100.0

How often in the last week have you felt

• verwhelmed by living with diabetes (Always,

Most of the time)? Do you know of healthy ways to handle the stress related to your diabetes (Yes)? When you need it, do you feel you can ask for support on how to live with and take care of your diabetes (Yes)? Do you feel you can ask your doctor questions about your treatment plan (Yes)? Do you feel you can make a plan with goals that will help control your diabetes (Yes)?

Coping Questions - % of Positive Responses: NE

Pre EDC Post EDC

15

New England

Patient Activation Survey Results

(April 30, 2017)

47.3 30.1 68.0 93.7 57.2 66.8 54.0 77.6 95.4 75.3

0.0 20.0 40.0 60.0 80.0 100.0

In the last week, did you eat five or more servings of fruits or vegetables more than 3 days/week? In the last week, did you exercise for at least 30 minutes more than 3 days/week? In the last week, did you test your blood sugar more than 3 days/week? In the last week, did you take your diabetes medication as ordered by your doctor more than 3 days/week? In the last week, did you check your feet more than 3 days/week?

Behavior Questions - % of healthy behaviors: NE

Pre EDC Post EDC

Stories

• Video
• Newspaper
• Class reunions
• School bus
• Spanish
• Reunions

16