Texas Diabetes Education

1
Texas Diabetes Education Care Management
Project

• Funded by
• Bristol-Myers Squibb Foundation
• Bureau of Primary Health, HRSA
• CDC Diabetes Prevention
• (in-kind support)

2
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

3
Overview

• Project Goals Objectives

• Diabetes Education Empowerment Program (DEEP)
  Training Sessions
• Initial Training
• Follow-up Trainings

• Preliminary Patient Outcome Evaluation Results

4
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.

5
Framework for ImplementingDiabetes Self Care
Management Program
Three Step Process

• Patient Empowerment
• Provide Deep classes
• on weekly basis.
• Provide coordinated
• services to patients.

• Program Approach
• Train team of Promotoras
• and Clinical staff on DEEP.
• Recruit patients for
• classes.

• Patient Benefits
• Improved standards
• of care for patient.
• Off set complications.
• Reduced HbA1c.
• Overall better health.
• Reduced Health Care
• costs including ER.

6
24 health workers attended the initial training
representing the five targeted regions.
7
Experiential Learning focuses on both Process and
Content

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

8
Participants learn how to read food labels

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

9
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.

10
Some content such as medication management is
covered using traditional methods
11
DEEP Curriculum in Action Diabetes Self Care
Management Program
Delivery Process
Patients Recruitment
Promotora Led Classes
Medical Providers Involvement
Clinical Support Staff
12
Community Health Center Top Five Medical
Diagnosis Profile
(43.3)
(26.9)
(20.7)
(6.1)
(2.8)
N6304 Gateway Community Health Center
Source 2002 UDS
13
Typical Payment Source Category
N14144
Source 2002 UDS
14
Typical Profile of a Patient with Diabetes

• Female
• Age 43
• Hispanic
• Obese
• 4 to 5 Children
• Uninsured
• Low Social Economic Status
• Multiple Family Dwelling
• Sixth Grade Education
• Hemoglobin A1C Higher than 7
• Has a difficult time managing her diabetes

15
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 (N99 patients)

16
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.

17
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.

18
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
19
Texas Care Management Chart Audit100 random
records 8 CHCs

• 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
20
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.