* Supported by funding from NIDDK

1. PRISM Project: Promoting Realistic Individual Self-Management for DiabetesBillings Clinic Center for Clinical Translational ResearchSeptember 1, 2009 * Supported by funding from NIDDK

3. What is Translational Research? Translational research examines how people access health care, how much care costs, and what happens to patients as a result of this care. The main goals of translational research are to identify the most effective ways to organize, manage, and deliver high quality care, reduce medical errors, and improve patient quality.

4. CTR PRISM Team Members • Valerie Caton, MN, FNP-C, Nurse Practitioner, Team Leader • Diane Kersten, LCSW, Social Worker • Stephanie Selzler, LD, RD, Dietitian • Karen Gransbery, RN, CDE, Diabetes Educator • Barbara Holloway, RN, CDE, Diabetes Educator • Jude Russell, MSN, CDE, Diabetes Educator • Patricia Coon, MD, Medical Director • Chris Sorli, MD, Endocrinologist Consultant

5. Study Objective • Evaluate the effectiveness of an NP-led multi-disciplinary team approach to diabetes self-management on achieving American Diabetes Association (ADA) guidelines for diabetes disease control, patient satisfaction and patient self-management in the urban and rural primary care setting.

6. Methods: Study Participants • Participants: • 259 adult patients • Type 2 diabetes mellitus (DM) • At least one uncontrolled risk factor (HbA1c, BP or LDL-C)1 • Seen by PCP in past year • Study Sites: • One urban primary care clinic: • Billings Clinic with 48 PCPs who manage ~5,000 diabetes patients • Five rural community clinics in Eastern Montana • 2 to 9 providers per site serving 30 to 300 diabetes patients 1Standards of medical care in diabetes--2009. Diabetes Care 2009;32 Suppl 1:S13-61.

7. Study Sites

8. Traditional Care Content driven education Provider recommends preferred course of action PRISM Patient driven education Motivational Interviewing techniques (Patient decides action) Patient-Centered Care

9. Traditional Care Patient is either “compliant” or “noncompliant” Passive Patient Expert providers work separately PRISM Readiness for change Active Patient Team working for improved healthcare, including patient Patient-Centered Care

10. All Team Members Responsibilities • Empowerment of patient. • Determine barriers to self-management, including psycho-social issues, teach problem solving skills. • Help patients to develop and implement realistic self-management goals. • Facilitate behavior change. • Participate in weekly team meetings.

12. Perceived Challenges • Establishing trust • Nonverbal communication • Difficulty discussing sensitive issues • Managing the technology

13. Services Provided • Individual and Dual Sessions • Patient Care Conferences • Education and Support Groups • Create Your Weight Group

14. Education Groups

15. Support Groups

16. Create Your Weight • 10 week Adult Weight Management Program based on guidelines from the ADA* which encompassed nutrition education, physical activity and the role of behavioral therapy in weight management • Adapted the class to PRISM participants and the use of telemedicine • Provided two series and 18 urban, 21 telemedicine and 15 family members participated. * American Diabetes Association

17. Results

18. Ciemins EL, Holloway B, Coon PJ, McCloskey-Armstrong T, Min SJ. Telemedicine and the Mini-Mental State Examination: Assessment from a distance. Telemedicine and e-Health, 2009;15(4): 325-327.

19. Patient Satisfaction with PRISM Program

20. Patient Satisfaction with Technology • 111 patient surveys • 100% were satisfied with their telehealth sessions • 100% felt comfortable with learning health information using this technology and said they understood as if it were in person • 99% felt picture and sound were clear • 99% felt equal comfort with in-person encounters and felt comfortable discussing personal information • 96% felt their privacy was protected

21. Staff Satisfaction with Technology • 177 staff surveys • 98% felt telehealth equipment worked properly and with clear sound • 95% felt they had a clear picture • 96% felt they had adequate access to patients’ medical records and tests prior to appointment • 99% felt patients’ privacy was protected • 98% felt patients were satisfied • 96% were satisfied with the consultations • 97% felt telehealth was a useful tool for teaching patients about Diabetes management

24. Pending Projects • Expansion of Diabetes Care to Rural Communities via Telehealth • Using Telehealth to Enhance Shared Diabetes Medical Appointments in Rural Communities • Supporting Rural Caregivers Using Telehealth Technology