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Diabetes Equity Project

Dallas, Texas
CDC 2011 Diabetes Translation Conference
Minneapolis , MN
April , 2011

www.alliancefordiabetes.org
Diabetes Equity Project (DEP)

• Primary Goals

– To support physician volunteerism in


Dallas County by providing a
standardized approach to diabetes
self-management training &
advocacy for diabetic patients
receiving care in volunteer charity
clinics

– To expand the role of Community


Health Workers to a chronic disease
management support/adjunctive
function
http://www.youtube.com/watch?v=jYr2IkB0UZc


This project was supported by a grant from The Merck Company Foundation through its Alliance to Reduce Disparities in Diabetes program.

Diabetes Equity Project (DEP):
Interventional Strategy

• Intervention Program
• Patient Relationship Expansion
• Community Diabetes Education Program (CoDE™)
• One-on-One format - Up to 7 patient contacts per
year
• Culturally competent relationship-based program delivery
• Treatment adherence & disease control
troubleshooting
• Knowledge Transfer Expansion
• ADA Standards of Care & AADE’s 7 Self-Care
Behavior Education
• System Expansion
• Disease registry management – Targeted patient
recall (VIPs)
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• Regular physician reporting – Fax, Scanned, HIE
DEP Early Results:
Race & Ethnicity Demographics -
2010

68.7% Hispanic

N = 475 (10/1/09 – 9/30/10) 4


DEP Early Results:
Preferred Primary Language - 2010

N = 514 (10/1/09 – 9/30/10)


5
DEP Early Results:
Educational Level Achieved - 2010

N = 161 (10/1/09 – 9/30/10)


6
DEP Early Results:
Diabetes Control – Dec.09 – Mar.11

•DEP Data from DiaWeb and includes patients enrolled through 2/24/11 and patient visits up through 3/11/10.
•Minnesota Community Measurement and Minnesota Department of Health. 55.0% (A1c < 7) 2009 data - Includes patients from 1/1/2008 through 12/31/2009 with two
or more visits coded with a diabetes ICD-9 code, and has been seen within 7/1/2008 through 12/31/2009 once regardless of any diagnosis code . Measured annually.
http://www.health.state.mn.us/diabetes/pdf/FactSheet2010.pdf.
•HealthTexas Provider Network Decision Support EHR Audit Report Dashboard. Percentage of Patients with A1c Control. Includes patients with two or more
patient visits at least 7 days apart. December 2010 Audit
DEP Early Results:
Glucose Control - Dec.09 – Nov.10

N=351 N=233 N=131 N=73 N=43

* For patients with at least two A1c measurements. Change from baseline is statistically significant (p-value <.001) at 3,
6, 9, and 12 months. 8
DEP Early Results:
Disparity Reduction – Dec.09 – Nov.10

• DEP helps avoid disparities in


diabetes care:
• No differences in “improvement” of Diabetes
Control between:
– “Minorities and Non-Minorities”
– Males and Females
– Persons of different age groups
– Location where DEP operated

Non-Minority = White & Non-Hispanics; Minority = Non-White & Hispanics 9


DEP Early Results:
Patient Attrition Rate - Sept.09 –
Nov.10

• Attrition Rate = 18.5% (123


patients)
– No Show – 40.7%
– Ineligible – 24.4%
– Patient Relocated – 17.9%
– Scheduling Conflicts – 5.7%
– Patients opted out – 4.1%
– Lack of Transportation – 2.4%
– Mortality – 2.4%
– Other – 2.4%

*Note: For patients that left the program, the average of the most recent A1c measure was
8.5. Specifically, for those patients who had 2 or more visits, the average of the most recent
10
A1c measure was 8.1.
DEP Early Results:
Blood Pressure Control - 2010

•DEP Data from DiaWeb and includes patients enrolled and patient visits through 12/31/2010.
•Minnesota Community Measurement and Minnesota Department of Health. Includes patients from 1/1/2008 through 12/31/2009 with two or more visits coded with a
diabetes ICD-9 code, and has been seen within 7/1/2008 through 12/31/2009 once regardless of any diagnosis code . Measured annually.
http://www.health.state.mn.us/diabetes/pdf/FactSheet2010.pdf.
•HealthTexas Provider Network Decision Support EHR Audit Report Dashboard. Includes patients with two or more patient visits at least 7 days apart. December 2010
Audit
DEP Early Results:
Improving Service Quality – Top Box
Scores

N 121 82 133 108 62 65 221 151 165 154 194 216 224 165

4 question survey administered to all patients after each visit.


1.Were you treated with respect today?
2.During today’s visit, did you increase your understanding of diabetes care for
yourself?
3.Do you feel that you could call the DHP to ask questions about the care of your
diabetes?
4.How likely would you be to recommend this program to one of your friends or family
who has diabetes? 12
•Comments for staff improvement?

Diabetes Equity Project (DEP):
Next Steps - #1

• Reduce % of DEP enrollees with A1c >


9%
– Utilize diabetes registry to identify
patients with Hgb-A1c > 9%
– Leverage patient relationship to identify
“new levers” influencing adherence &
compliance
– Link patients with clinic-based
Advanced Nurse Practitioners
increasing RX management efficiency
• “Case management” approach utilizing
Diabetes Health Promoters (pilot 2
sites in 2011) 13
DEP Early Results:
Reduced Patients in “Poor Control”

.
•DEP Data from DiaWeb and includes patients enrolled through 2/24/11 and patient visits up through 3/11/10.
Diabetes Equity Project (DEP):
Next Steps - #2

• Results suggest promise for


applying DEP to privately insured
patient population
– Introduced to Baylor’s private physician
practices (HealthTexas – 450+
physicians)
– HTPN Disease Management Committee
approved interventional pilot project
• Pilot with Hispanic ethnicity
• Work-flow changes referring Hispanic
patients to Diabetes Health Promoters
(~246 patients)
• Track changes in disease control between
Hispanic & Non-Hispanic patients
(A1c<7%) 15

Diabetes Equity Project (DEP):
For additional details, please contact

Jim Walton, DO, MBA


Vice President & Chief Health Equity Officer
Baylor Health Care System

jameswa@baylorhealth.edu

or

Chris Snead, RN, BSN


Health Equity Manager
Office of Health Equity
972-860-8614
christine.snead@baylorhealth.edu