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An Innovative Approach to Managing Diabetes in a Large Public Health System

An Innovative Approach to Managing Diabetes in a Large Public Health System. Donna J. Calvin, PhD, FNP-BC, CNN Post Doctoral Research Associate University of Illinois at Chicago College of Nursing Department of Health Systems Science October 29, 2012. Fantus Clinic. Oak Forest Hospital.

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An Innovative Approach to Managing Diabetes in a Large Public Health System

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  1. An Innovative Approach to Managing Diabetes in a Large Public Health System Donna J. Calvin, PhD, FNP-BC, CNN Post Doctoral Research AssociateUniversity of Illinois at ChicagoCollege of NursingDepartment of Health Systems ScienceOctober 29, 2012

  2. Fantus Clinic Oak Forest Hospital Englewood Health Center Woodlawn Health Center

  3. Background Disparity in the Prevalence of Diabetes in Chicago

  4. Background Chicago Diabetes Death Ratesper 100,000 CDPH, 2004

  5. Background Diabetes Hospitalizations by Chicago Zip Codes, 2007 Chicago Plan for Public Health System Improvement, 2012-2016

  6. Background • Access • Cultural incongruence • Lack of knowledge • - Provider • - Patient

  7. United States • 13 million • Mean A1C 7.6% • 50% < 7 • 25% > 9.0 • Chicago-County Clinics • 40,000 • Mean A1C 8.8% • 18% < 7.0% • 60% > 9.5% 2001 data

  8. PurposeTo determine the impact of a system-level quality assurance program aimed to improve diabetes outcomes among an urban minority population. • GoalReduce the average blood glucose level (A1C) among a low income, predominately African American and Hispanic population. Optimal HbA1c (A1C) <7.0 % A measure of chronic glucose control, and reflects the prevailing level of glycemia over the past three months.

  9. Significance • Cost of managing diabetes:$174 billion total • $116 billion medical expenditures • $58 billion in reduced national productivity

  10. Significance Benefits of Decreasing A1C by 1% 14% 40% Decrease in risk of all Diabetes complications Decrease in risk of microvascular diseases

  11. Significance • Decreasing A1C Prevents: • Blindness • Kidney Failure • Amputation

  12. What Should We Do?

  13. Our Evidence-Based Program Network Diabetes Program

  14. Our Evidence-Based Program Physician/NURSE Providers Social Worker & Psychologist Pharmacists Patient Dieticians Ophthalmologists Podiatrists Family/Friends .

  15. Our Evidence-Based Program Provider-Level Strategies: Nurses receive three days of intensive education • Motivational interviewing • Apply multidisciplinary approach • ABC goals • Signs, symptoms and treatment of hyper/ hypoglycemia self-management of hypo and hyperglycemia • Glucometer (prepare for testing and action if meter breaks or not functioning)

  16. Our Evidence-Based Program Provider-Level Strategies: Physicians receive two days of intensive education • Motivational interviewing • -self management • The use of insulin in diabetes management • - “Clinical inertia” • Treat to target • - Implementing the ABCs of Diabetes • Foot exams

  17. Our Evidence-Based Program • Patient-Level StrategiesMulticultural staff provide one-on-one encounters: • Knowledge Test • Basic discussion of diabetes • Review of lab results • Assessment of: dietary habits, lifestyle, psychosocial problems

  18. Our Evidence-Based Program • Patient-Level Strategies • Adjustment of diabetes medication • Referral to: PCP, ophthalmology, podiatry, social worker and/or psychologist as needed • Appointment to attend diabetes class

  19. Our Evidence-Based Program stroke Retinopathy ESRD Heart disease carbohydrates HbA1c Eating out Foot care Diabetes Class (Spanish & English) • Overview of diabetes • Basic self-management skills • Glucose monitoring • A personal consultation after the group class to discuss concerns and misperceptions

  20. Our Evidence-Based Program System-Wide Activities • Nurses • Physicians • ABC goals implementations throughout system • Annual Update • “Sugar Beat,” a quarterly diabetes publications with updates in diabetes management

  21. Results System-Level Data 2001 2008 A1C Mean A1C: 8.8% Mean A1C:7.8% < 7% > 7%

  22. Results System-Level DataA1C over 9.5% 2008 2001 < 9.5 > 9.5

  23. Results NDP Data - More Complex PatientsCrossectional Analysis 2001-2012 A1C N=4,589

  24. Summary of QA Program Our Evidence-based Program is Effective: • Meeting national goals • American Diabetes Association (ADA) recognition • Continuity of care

  25. Future Directions • Lifestyle Center • Last chance clinic • Diabetes Group visits • Collect and analyze data to determine what aspect of our program has the greatest impact

  26. Elements of the Program • Treating difficult patients • Enhancing provider’s skills • Uniform management in the system (ABC)

  27. Thank You! Model for other publicly financed primary health care systems

  28. Thank You! Questions?

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