edc overview with emphasis on deep
TRANSCRIPT
DEBORAH F. CHRISTIAN, PA-CDiabetes Self-Management Education Program Manager
Health Services Advisory Group (HSAG)
Everyone with Diabetes Counts:Diabetes Self-Management Education
HSAG: Your Partner in Healthcare Quality
• HSAG is the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for California, Arizona, Florida, Ohio, and the U.S. Virgin Islands.
• QIN-QIOs in every state and territory are united in a network administered by the Centers for Medicare & Medicaid Services (CMS).
• The QIN-QIO program is the largest federal program dedicated to improving health quality at the community level.
2
HSAG’s QIN-QIO Responsibility
3
HSAG is the Medicare QIN-QIO for Arizona, California, Florida, Ohio, and the U.S. Virgin Islands.
Nearly 25 percent of the nation’s Medicare beneficiaries
QIO Task Areas
4
Improve Coordination
of CareImprove
Medication Safety
Improve Nursing Home
Quality
Reduce Hospital
Infections
Improve Health Through Health
Information Technology
Improve Cardiac Health
Prevent and Manage Diabetes
Patient is at the center of care.
5
Everyone with Diabetes Counts (EDC)
• Diabetes was the seventh leading cause of death in the US• Nearly 30 million Americans have diabetes.• 8.1 million Americans are undiagnosed• Upwards of 86 million Americans prediabetes• Among the Older Adults
– More than 25 percent of Americans age 65 and older have diabetes.– 51 percent are estimated to have pre-diabetes.
• 11th Scope of Work– Reduce health disparities – Initiative: Everyone with Diabetes Counts or EDC– Economic burden $245 billion annually (2012)
Data Source: CDC National Diabetes Statistics Report, 2014, available at: http://www.cdc.gov/diabetes/pdfs/data/2014-report-estimates-of-diabetes-and-its-burden-in-the-united-states.pdf
6
The Burden of Diabetes in California
• Over 4 million Californians have diabetes (13.4% of adult population)
• Over 11 million Californians have pre-diabetes (38% of adult population)
• Diabetes costs an estimated $37.1 billion / year– Direct medical expenses $27.6 billion in 2012– Indirect cost $9.5 billion in 2012
Data Source: Centers for Disease Control & Prevention (CDC)
• African Americans• Hispanics/Latinos• American Indians/Native
Americans/Alaska Natives• Asians/Pacific Islanders• People living in rural
areas
• California Incidence– AA & Hispanics: 14%– Asian population
• Filipino: 15%• South Asian: 16%• Pacific Islanders: 18%
Disparities Exist in Diabetes Care
7
8
HSAG’s Role in EDC
• Increase adoption and implementation of diabetes self-management education (DSME)– Diabetes Self-Management Program, Stanford University– Project Dulce, Scripps Health Whittier Diabetes Institute– Diabetes Empowerment Education Program™ (DEEP),
University of Illinois at Chicago (UIC)• Train organizations & individuals statewide to offer
DSME• Provide assistance to organizations offering DSME• Impact more than 7,000 Medicare beneficiaries with
diabetes or pre-diabetes
9
Goals and Target Population
Goals:– Reduce diabetes care disparities– Prevent and/or reduce adverse health outcomes
related to diabetes– Reduce risk factors associated with diabetes– Increase self-management skills– Facilitate short- and long-term behavioral change
Special consideration for:– Includes low-health literacy and low-literacy individuals
10
DEEP
Program Description– Evidence-based program– Six weekly workshops– Each class is two hours long– Taught by one certified DEEP Peer Educator– Can be delivered in any language– FUN
• Interactive, hands-on, group learning activities, and games, including visual aids and demonstrations
DEEP Modules
• Diabetes risk factors and complications• Nutrition• Physical activity• Use of the glucose meter • Medications• Building partnerships with diabetes healthcare team• Psychosocial effects of illness• Problem-solving strategies• How to access community diabetes resources
11
“Tell me and I forget,teach me and I may remember,
involve me and I learn.”-Benjamin Franklin
12
13
Why DEEP Works
• Incorporates adult education, empowerment principles, and participatory techniques
• Speeds changes in knowledge and behavioral and clinical indicators
• Meets the needs of participants in real time
• Connects the dots in easy-to-understand language
14
Interactive Demonstrations
Understanding a Food Label
15
Visualizing Fats and Carbohydrates
16
Cheeseburger Cola Soda FriesTotal Fat 24 g = 6 teaspoons 0 g 29 g = 7 teaspoons
Total Sodium 897 mg = .16 teaspoons 15 mg = negligible 328 mg = .06 teaspoonsTotal Carbs 39 g = 8 teaspoons 35 g = 7 teaspoons 63 g = 13 teaspoons
Total Fat, Salt, and Carbs13 teaspoons of lard
½ teaspoon of sodium28 teaspoons of sugar
17
• Certified peer educator/ workshop leader• Only one leader required to lead workshop• Allows for make-up sessions
Program Delivery Method
18
Training Requirements
• Attend a three-day, train-the-trainer workshop, and receive certification to facilitate DEEP workshops as a peer educator.
• Peer educator training is taught by lead trainers.
• Lead trainer training is taught by senior trainers.
• No-cost training offered.
19
Goals are Outcomes-Based and Data-Driven
• HSAG will help track and analyze data.• HSAG tracks pre- and post-activation measures.• HSAG tracks clinical outcomes for 10 percent of participants: – HbA1c– Lipids– Blood pressure– Weight– Foot exams– Eye exams
20
• 1,124 Medicare beneficiaries with diabetes or pre-diabetes graduated from a DSME workshop.
• 470 Medicare beneficiaries completed both the Pre- and Post-Patient Activation Surveys.
• Gender– Male: 27 percent– Female: 73 percent
• Average age: 72
• Reported Health Conditions– High Blood Pressure: 61 percent– High Cholesterol: 52 percent– Arthritis: 35 percent– Eye Disease: 18 percent– Heart Disease: 14 percent– Lung Disease: 5 percent
California Demographics (January 2015 to April 2016)
21
California Demographics (cont’d)
Ethnicity
52% Not Hispanic
or Latino
48% His-panic or
Latino
Race• White: 29 percent• African American: 15 percent• Asian: 13 percent• American Indian: 6 percent• Native Hawaiian: 2 percent• Other: 35 percent
22
Pre- and Post-Patient Activation Survey
• 14 total questions– 4 questions: Diabetes knowledge– 5 questions: Coping with diabetes– 5 questions: Self-care methods
• Administered during first week and then again at sixth week
23
Diabetes Knowledge
0%20%40%60%80%
100%78%
64%80% 71%
97% 94% 92% 90%
Pre-PAS Post-PAS
24
Coping with Diabetes
Feeling over-
whelmed
Handling stress Asking for support
Asking doctor questions about treatment plan
Ability to make a plan to control
diabetes
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
40% 43%
70%
81%
68%
40%
84%
92% 95%90%
Pre-PAS Post-PAS
25
Self-Care Measures
0
1
2
3
4
5
6
7
5
4.1
5
6.7
5.65.7
4.8
5.9
6.7 6.4
Pre-PAS Post-PAS
In the last week, average number of days doing self-care
Num
ber o
f Day
s
26
DEEP Retention Rate in California: 79 Percent
27
Program Costs
• Organizational License: $600/five-year license • Peer Educator Certification: $100/three-year certification • Training Cost (for UIC): – Peer educator training fee: $800 per person– Off-site training fee: $10,500, plus travel expenses
• Training Cost (for HSAG): None • Participant Cost: None
28
Program Costs (cont.)
For a limited time, HSAG will provide:• Leader training at no charge to organizations committed
to offering this program in their community.• Materials for conducting workshops.• Licensing and certification fees may also be provided.• $40 per DSME completer who meets
contract requirements:– Medicare beneficiary (65+) and– Has diabetes or pre-diabetes and– Completes five of six classes
29
Will You Join Us?
• Offer DEEP internally• Outsource DEEP to partnering organizations• HSAG will provide training and assistance to your organization and your community partners.
This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for California, under contract with the Centers for
Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.
Publication No. CA-11SOW-B.2-08162016-01
CMS Disclaimer