Texas Diabetes Education & Care Management Project

Funded by Bristol-Myers Squibb

Foundation Bureau of Primary Health,

HRSA CDC Diabetes Prevention

(in-kind support)

TDECMP Steering Committee

Bristol-Myers Squibb Foundation HRSA/Bureau of Primary Health CDC/Division of Diabetes Translation UIC Midwest Latino Health Research, Training and

Policy Center Texas Department of Health Diabetes Council Migrant Health Promotion Texas Association of Community Health Centers

Overview

Project Goals & Objectives

Diabetes Education & Empowerment Program (DEEP) Training Sessions

Initial Training

Follow-up Trainings

Preliminary Patient Outcome Evaluation Results

Texas Diabetes Education & Care Management Project (TDECMP)

Goals

Conduct one initial train-the-trainer 3 day intensive training.

Train 160 community health workers in self care management using the DEEP curriculum.

Conduct five regional follow-up trainings in Lower Rio Grande Valley, Laredo, El Paso, San Antonio, and Houston.

Impact 16,000 diabetic patients or people at risk of diabetes by providing diabetes education using DEEP curriculum.

Patient Benefits:

•Improved standards of care for patient.•Off set complications.•Reduced HbA1c.•Overall better health.•Reduced Health Carecosts including ER.

Patient Empowerment:

•Provide Deep classes on weekly basis.

•Provide coordinated services to patients.

Framework for ImplementingDiabetes Self Care Management Program

Program Approach:

•Train team of Promotoras and Clinical staff on DEEP.

•Recruit patients for classes.

Three Step Process

24 health workers attended the initial training representing the five targeted

regions.

Experiential Learning focuses on both Process and Content

Process – teaches participants how to disseminate information using an interactive style of facilitation.

Participants learn how to read food labels

Typical food plates are converted into fats, sugars and sodium.

Texas Department of Health & Bristol-Myers Squibb staff participate in

training

TDECMP has helped community health centers and state health agencies change how they work with people who have diabetes.

Some content such as medication management is covered using

traditional methods

Patients

Recruitment

Promotora

Led Classes

Medical Providers

Involvement

DEEP Curriculum in Action

Diabetes Self Care Management ProgramDelivery Process

Clinical

Support Staff

Community Health CenterTop Five Medical Diagnosis Profile

Source 2002 UDS

2733

1305

1699

386181

0

500

1000

1500

2000

2500

3000

Diabetes Hypertension Otitis Media MentalDisorder

Asthma

Diagnosis

(43.3%)

(20.7%)

(26.9%)

(6.1%)(2.8%)

N=6304

*Gateway Community Health Center

Typical Payment Source Category

1210(9%)210 (1%)

3251(23%)

860 (6%)

8613 (61%)

Uninsured Medicaid Medicare Pvt.Insurance Other

Source 2002 UDS

N=14144

FemaleAge 43HispanicObese4 to 5 ChildrenUninsuredLow Social Economic StatusMultiple Family DwellingSixth Grade EducationHemoglobin A1C Higher than 7%Has a difficult time managing her diabetes

Typical Profile of a Patient with Diabetes

Preliminary Patient Outcomes

Base Line HbA1c before DEEP self-management class 9.1%

After Intervention

HbA1c after self-management course 7.4%

87% Class attendance rate

*Gateway Health Center Data from random chart audit (N=99 patients)

Process Evaluation Results

The goal of 160 was surpassed with a total of 177 health care staff completing the DEEP curriculum training.

A total of 7 trainings were completed exceeding the goal of 6 All five targeted regions participated in the trainings including Lower Rio Grande Valley, Laredo, El Paso, San Antonio, and Houston. Participants from Lubbock, Dallas, and Austin also attended.

Trainee satisfaction has been very positive with an evaluations mean score of 4.8 out of a 5.0 satisfaction scale.

Process Evaluation Results

While several trained health centers have not yet implemented the

program completely after being trained, the majority have committed

to implement a full DEEP self care management program once

project implementation funding is secured.

Trainee limit of 16-20 per session adjusted upwards to 28 per

session to meet demand.

Care Management Economic Impact

In collaboration with a third party evaluator, a budget impact model using data from the enrolled diabetic patients will demonstrate the near-term fiscal value attached to the reductions in HbA1c. Example of cost differentials for 1% changes in HbA1c over a 3-year period*^

Patient profile Change in HbA1c level (%)

10 to 9 9 to 8 8 to 7

Diabetes only $1,205 $869 $601

Diabetes with HTN $1,703 $1,260 $897

Diabetes with CVD $2,796 $2,088 $1,503

Diabetes with HTN and CVD $4,116 $3,090 $2,237

Given the number and likely comorbidities of the patient population in the program it is predicted that the savings generated for a State may be significant.* Reference available upon request^ Numbers are summative when one combines a HbA1c

Texas Care Management Chart Audit100 random records: 8 CHC’s

Assumes same risk stratification as Fla High Risk: 30% with HbA1c 10 reduced to 7

Yearly savings = 30 pts x $3,150 = $94,500

Moderate Risk: 20% with HbA1c 9 reduced to 7

Yearly savings = 20 pts x $ 950 = $19,000

Low Risk: 50% with HbA1c 8 reduced to 7

Yearly savings = 50 pts x $ 200 = $10,000

$123,500

Yearly Savings for 2,400 patients = $2,964,000

Yearly Savings for 10,000 patients = $12,350,000

Conclusions

It has become evident that teaching self care management education such as DEEP to people with diabetes is perhaps our only chance we have in helping reduce the onset of diabetes type 2 and preventing this chronic disease within affected families.

The DEEP curriculum has been well received by community health centers, Texas Department of Health and CDC. Requests for additional training continues throughout the State of Texas and across the United States.

Preliminary evaluation results clearly indicate a great benefit to patients with diabetes type 2.