Diabetes Equity ProjectDallas, Texas<br />CDC 2011 Diabetes Translation Conference<br />Minneapolis, MN<br />April, 2011<b...
Diabetes Equity Project (DEP)<br />Primary Goals<br />To support physician volunteerism in Dallas County by providing a st...
Diabetes Equity Project (DEP):Interventional Strategy<br />Intervention Program<br />Patient Relationship Expansion<br />C...
DEP Early Results:Race & Ethnicity Demographics - 2010<br />4<br />68.7% Hispanic<br />N = 475 (10/1/09 – 9/30/10)<br />
DEP Early Results:Preferred Primary Language - 2010<br />5<br />N = 514 (10/1/09 – 9/30/10)<br />
DEP Early Results:  Educational Level Achieved - 2010<br />6<br />N = 161 (10/1/09 – 9/30/10)<br />
<ul><li>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/...
HealthTexas Provider Network Decision Support EHR Audit Report Dashboard.  Percentage of Patients with A1c Control.Include...
DEP Early Results:Glucose Control - Dec.09 – Nov.10 <br />8<br />N=351<br />N=233<br />N=131<br />N=73<br />N=43<br />*   ...
DEP Early Results:Disparity Reduction – Dec.09 – Nov.10<br />DEP helps avoid disparities in diabetes care:<br />No differe...
DEP Early Results:Patient Attrition Rate - Sept.09 – Nov.10<br />Attrition Rate = 18.5% (123 patients)<br />No Show – 40.7...
<ul><li>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 wit...
HealthTexas Provider Network Decision Support EHR Audit Report Dashboard. Includes patients with two or more patient visit...
DEP Early Results:Improving Service Quality – Top Box Scores<br />12<br />4 question survey administered to all patients a...
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Diabetes Equity Project, Dallas, Texas

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Aligning to Improve Outcomes: The Alliance to Reduce Disparities in Diabetes

A presentation from a symposium at the Centers for Disease Control and Prevention’s (CDC) Division of Diabetes Translation's (DDT) 34th annual Diabetes Translation Conference on April 11-14, 2011 in Minneapolis, Minnesota.

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Diabetes Equity Project, Dallas, Texas

  1. 1. Diabetes Equity ProjectDallas, Texas<br />CDC 2011 Diabetes Translation Conference<br />Minneapolis, MN<br />April, 2011<br />
  2. 2. Diabetes Equity Project (DEP)<br />Primary Goals<br />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<br />To expand the role of Community Health Workers to a chronic disease management support/adjunctive function <br />http://www.youtube.com/watch?v=jYr2IkB0UZc<br />This project was supported by a grant from The Merck Company Foundation through its Alliance to Reduce Disparities in Diabetes program. <br />
  3. 3. Diabetes Equity Project (DEP):Interventional Strategy<br />Intervention Program<br />Patient Relationship Expansion<br />Community Diabetes Education Program (CoDE™)<br />One-on-One format - Up to 7 patient contacts per year<br />Culturally competent relationship-based program delivery<br />Treatment adherence & disease control troubleshooting<br />Knowledge Transfer Expansion<br />ADA Standards of Care & AADE’s 7 Self-Care Behavior Education<br />System Expansion<br />Disease registry management – Targeted patient recall (VIPs)<br />Regular physician reporting – Fax, Scanned, HIE<br />3<br />
  4. 4. DEP Early Results:Race & Ethnicity Demographics - 2010<br />4<br />68.7% Hispanic<br />N = 475 (10/1/09 – 9/30/10)<br />
  5. 5. DEP Early Results:Preferred Primary Language - 2010<br />5<br />N = 514 (10/1/09 – 9/30/10)<br />
  6. 6. DEP Early Results: Educational Level Achieved - 2010<br />6<br />N = 161 (10/1/09 – 9/30/10)<br />
  7. 7. <ul><li>DEP Data from DiaWeb and includes patients enrolled through 2/24/11 and patient visits up through 3/11/10.
  8. 8. 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.
  9. 9. 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</li></ul>DEP Early Results:Diabetes Control – Dec.09 – Mar.11<br />
  10. 10. DEP Early Results:Glucose Control - Dec.09 – Nov.10 <br />8<br />N=351<br />N=233<br />N=131<br />N=73<br />N=43<br />* For patients with at least two A1c measurements. Change from baseline is statistically significant (p-value <.001) at 3, 6, 9, and 12 months. <br />
  11. 11. DEP Early Results:Disparity Reduction – Dec.09 – Nov.10<br />DEP helps avoid disparities in diabetes care:<br />No differences in “improvement” of Diabetes Control between:<br />“Minorities and Non-Minorities”<br />Males and Females<br />Persons of different age groups<br />Location where DEP operated<br />Non-Minority = White & Non-Hispanics; Minority = Non-White & Hispanics<br />* P-Value < 0.0001<br />
  12. 12. DEP Early Results:Patient Attrition Rate - Sept.09 – Nov.10<br />Attrition Rate = 18.5% (123 patients)<br />No Show – 40.7%<br />Ineligible – 24.4%<br />Patient Relocated – 17.9%<br />Scheduling Conflicts – 5.7%<br />Patients opted out – 4.1%<br />Lack of Transportation – 2.4%<br />Mortality – 2.4%<br />Other – 2.4%<br />10<br />*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 A1c measure was 8.1. <br />
  13. 13. <ul><li>DEP Data from DiaWeb and includes patients enrolled and patient visits through 12/31/2010.
  14. 14. 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.
  15. 15. 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</li></ul>DEP Early Results:Blood Pressure Control - 2010<br />
  16. 16. DEP Early Results:Improving Service Quality – Top Box Scores<br />12<br />4 question survey administered to all patients after each visit.<br />Were you treated with respect today?<br />During today’s visit, did you increase your understanding of diabetes care for yourself?<br />Do you feel that you could call the DHP to ask questions about the care of your diabetes?<br />How likely would you be to recommend this program to one of your friends or family who has diabetes?<br /><ul><li>Comments for staff improvement?</li></li></ul><li>Diabetes Equity Project (DEP):Next Steps - #1<br />Reduce % of DEP enrollees with A1c > 9%<br />Utilize diabetes registry to identify patients with Hgb-A1c > 9%<br />Leverage patient relationship to identify “new levers” influencing adherence & compliance<br />Link patients with clinic-based Advanced Nurse Practitioners increasing RX management efficiency<br />“Case management” approach utilizing Diabetes Health Promoters (pilot 2 sites in 2011)<br />13<br />
  17. 17. . <br />DEP Early Results:Reduced Patients in “Poor Control”<br /><ul><li>DEP Data from DiaWeb and includes patients enrolled through 2/24/11 and patient visits up through 3/11/10.</li></li></ul><li>Diabetes Equity Project (DEP):Next Steps - #2 <br />Results suggest promise for applying DEP to privately insured patient population <br />Introduced to Baylor’s private physician practices (HealthTexas – 450+ physicians)<br />HTPN Disease Management Committee approved interventional pilot project<br />Pilot with Hispanic ethnicity<br />Work-flow changes referring Hispanic patients to Diabetes Health Promoters (~246 patients) <br />Track changes in disease control between Hispanic & Non-Hispanic patients (A1c<7%)<br />15<br />
  18. 18. Diabetes Equity Project (DEP):<br />For additional details, please contact<br />Jim Walton, DO, MBA<br />Vice President & Chief Health Equity Officer<br />Baylor Health Care System<br />jameswa@baylorhealth.edu<br />or <br />Chris Snead, RN, BSN<br />Health Equity Manager <br />Office of Health Equity<br />972-860-8614<br />christine.snead@baylorhealth.edu<br />

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