everyone with diabetes counts: emerging strategies in ... · everyone with diabetes counts:...
TRANSCRIPT
EveryonewithDiabetesCounts:EmergingStrategiesinRuralOregon
RuralPopulationHealthLearningCollaborativeApril25,2016
Objectives
• TellthestoryofhowtheQIN-QIOishelpingtobuildcapacityfordiabetesself-managementprogramsinOregon’sruralcommunities
• Sharepromisingpracticesforimprovingdiabetesself-managementsupportinruralcommunities
• HelpyouidentifyhowyourQIN-QIOcansupportyourgoalsforreducingtheburdenofdiabetesinyourcommunity.
2
Questionstorunon
• Whatwouldhealthandhealthcarelooklikeinyourcommunityifpeoplehadthesupporttheyneededtostayashealthyaspossibleforaslongaspossible?
• Howdoescommunity-basedself-managementeducationlookinthisfuture-statesystem?
3
Self-managementeducationinOregon
• Community-basedself-managementeducation– Infrastructuredecentralizedandlocallysupported– Stateresourcesarefocusedonimprovingsystems;limiteddirect$$availableforprograms.
– Fundingstreamsdiverse;mostlygrantbased– Notwelllinkedtoclinicalentitiesorvalue
• AADE/ADA-recognizedDSMEPrograms– Underutilized– Geographicandlanguagebarriers
• Opportunitiestoimproveaccess
4
Oregon’sQIN-QIOapproach
5
OregonEveryonewithDiabetesCounts(EDC)Communities
6
Frameworkforregionalhealthsystemdesign
7©ReThinkHealth,FieldGuideforMulti-StakeholderMobilizationandCoalitionBuilding,2014.Usedbypermission.
SixLeadershipPractices
• MotivatingVision:Creatingasharedstorythatmotivatespeopletoturnvaluesintoaction
• Buildingrelationships:Deliberateidentificationbytwo(ormore)partiesofsharedvaluesandcommoninterestsspecifyingmutualcommitmentstoexchangeresources
• EngagingNetworks:Intentionalmappingofactorsandassets tounderstandtheenvironmentyouroperatingin.
• Structuringteams:Designingandlaunchingself-governingteams,connectedasdistributedleadershipstructuresacrossmultiplelevelsofcoordination
• Strategizingcollectively:Collectivedecisionmakingaboutgoalsandinterdependentstrategydevelopment
• LearninginAction:Producingspecific,observable,andmeasurableresultstoevaluateprogress,exercisemutualaccountability,andadaptstrategybasedonexperience
8©ReThinkHealth,FieldGuideforMulti-StakeholderMobilizationandCoalitionBuilding,2014.Usedbypermission.
Integrated Diabetes Self-Management Education
MeasurableAim:IntegratedDSMEprogramsareactiveinthestateserving50%ofolderadultswhohavediabetes.
PEAK2:Corereferralsystemsinplace;enrollmentimproved
KICKOFF:InitialstatementofintentinplaceamongLeadershipteam;Leaderstrained
PEAK1:Firstprogramsareimplemented;collectiveexcitementishigh
FOUNDATION:Coalitionformed;collectiveaimidentified
PEAK3:Fullyintegratedwithsustainablefinancialsupport
Lowparticipantregistrations
Financialchallengesthreatenabilitytoofferregularprograms
9©ReThinkHealth,FieldGuideforMulti-StakeholderMobilizationandCoalitionBuilding,2014.Usedbypermission.
Usingdatatodrivechange
10
Measurementandreporting• Standardizeddatacollection
• Translatingdatatovalueandaction
DSMPCommunityDataReports
• Quarterlycumulativesummaryforeachcommunity
• AnnualanalysisofDSMPdata• Pre&PostPatientActivationSurvey– Howwelldoparticipantscopewiththeirdiabetes?–Whatknowledgehaveparticipantsgained?– Inthelastweek,howmanydays…
• ParticipantDemographicData• Future:ClinicalData
11
Patientconfidence insettingself-management goals
122015DataReportonOregon“EveryonewithDiabetesCounts”DSMPCommunities
Pre N=52 P-value: Yes: 0.001*Maybe:0.003*Post N=41 *statisticallysignificant
Managingstressrelatedtodiabetes
13
PreN=52 P-valuePostN=41 Yes:0.000*
Maybe:0.008*
2015DataReportonOregon“EveryonewithDiabetesCounts”DSMPCommunities*statisticallysignificantP-Value
Communicationwithprovider
14
PreN=52 P-valuePostN=41 Yes:0.036*
2015DataReportonOregon“EveryonewithDiabetesCounts”DSMPCommunities*statisticallysignificantP-Value
Clinical–communitypartnerships
• Clinical–communitylinkages– Aligningvaluewithqualityreporting
– Brokeringmeaningfulrelationshipsbetweenclinicalandcommunitypartners
15
Creatingclinical–community linkages
16
Communityexample:pre-partnership
• Historicalbarrierstobringingself-managementprogramstothecounty
• Acoupleofchampionsandsomecollectivewillalreadyexisted,buttheyneededhelporganizing
• Clinicalandnon-clinicalpartnerswerenottalking,buttheywereidentifyingsimilarneeds!
• Limitedresourcesforsustainability
17
Readiness forchange
• Collectivewillanddesireforself-managementeducation
• Localchampions• Agreementonneedfordiabetesself-managementeducation
• Linkingclinicalandcommunitypartners• Engagedpayer
18
Organizing forsuccess
What’sworking:• Partneringwithlocalleadership• Bringingdiverseclinicalandnon-clinicalpartnerstogetherinperson
• Engagingleadershipearlyandoften• Identifyingandbeingresponsivetodiversedriversforinvolvement
19
Organizing forsuccess
What’sworking:• Broadstakeholderinvolvement• CreatingawrittenstatementofintentwithclearcommitmentfromEVERYorganizationatthetable
• Leadershipcommitmenttoprovidingstafftime• Identifyingsustainabilitypartners• QIN-QIOresourcesfocusedonstart-upandcapacitybuilding
• JointPDSAactivities20
Organizing forsuccess
Whatarewestilllearning:• BeststrategiesforfillingclassesandreachingMedicarebeneficiaries
• Operationalizingclosed-loopreferralacrossclinicalandcommunityDSMEservices
• Aligningwithqualitymetricsandreferralpathwaysforsustainability
• Managingdiverseinterestsanddrivers• Financialmodelforlong-termsustainability
21
Contactme!
TracyCarver,[email protected]
(503)382-3931
22
ThismaterialwaspreparedbyHealthInsight,theMedicareQualityInnovationNetwork-QualityImprovementOrganizationforNevada,NewMexico,OregonandUtah,undercontractwiththeCentersforMedicare&MedicaidServices(CMS),anagencyoftheU.S.DepartmentofHealthandHumanServices.ThecontentspresenteddonotnecessarilyreflectCMSpolicy.11SOW-B2-16-18-OR4/25/16