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DEaM Aims to Support Patients with Diabetes

Dr. Jon Schott is the physician champion of the DEaM initiative, chairman of the DEaM steering committee, and medical director for St. Luke’s Clinic Baker City.
By Dr. David C. Pate, News and Community
August 22, 2013


Diabetes is a common and ever-growing threat to the health of our communities. If we are going to be successful in our Triple Aim of better health (improving the health of our communities), better care (helping our patients achieve better control of their medical conditions), and lower costs (reducing the rate of increase in insurance premiums and ultimately, reducing the premiums to less than they are now), then we will have to find new ways to prevent and control diabetes. 

That is just what we are doing.  

I have asked Chereen Langrill, communications coordinator for SELECT Medical Network, to update you on our diabetes initiative: the DEaM program. The DEaM program is just one more example of how the SELECT network of physicians is working together to add value for patients.

All of these efforts roll up into our provision of accountable care. That is why St. Luke’s became Idaho’s only federally-designated Accountable Care Organization. We are putting new programs together and implementing innovative approaches to ensure that our patients receive care based on:

  • a single, electronic health record.
  • evidence-based best practices.
  • care coordination.
  • management of care transitions.
  • population health management, meaning that St. Luke’s takes responsibility for managing the health, care, and costs for entire populations of people. This is what we are working toward for the Medicare program through our participation in the Medicare Shared Savings Program.
I am so proud of everyone involved in our DEaM program. Just wait until you see what happened in the precursor of this program in the Wood River Valley – I couldn’t believe the result!

Recently, St. Luke’s Health System conducted its Community Health Needs Assessment.

The needs assessment uncovers our communities' health needs, and one of the key health issues identified was diabetes. Diabetes is the process, often related to obesity and a sedentary lifestyle, in which people have increased levels of blood sugar. Most patients diagnosed with diabetes usually require some form of medical treatment and lifestyle modification. 

In response to this identified need, we started a clinical integration Diabetes Education and Management initiative, known as DEaM, focused around identification, engagement, education, and better overall management approaches to help people with diabetes improve their lives and health.

To measure the effectiveness of the DEaM initiative, we are following the standards from the National Quality Forum and the Centers for Medicare and Medicaid Services.

Why is it important?

According to statistics from the Idaho Behavioral Risk Factor Surveillance System, people diagnosed with diabetes in Ada and Canyon counties climbed from 5.5 percent to 7.7 percent between 2002 and 2010. We also know that implementing a standardized process of management will help providers and patients better assess what works best.

This approach includes:

  • Diabetes education: Not all education needs to take place in a provider’s office, and, a provider’s office may not be the best place for much of the teaching. Diabetes is primarily a self-management disease, revolving around diet, exercise, and other support from families and friends. More appropriate may be group education and other support structures that empower patients to manage their own care.
  • Behavioral health specialists: Being diagnosed with a chronic disease like diabetes can be sobering. Addressing behavioral and mental health issues helps people manage the burden that changing lifestyles brings.
  • Care navigation: Sometimes a patient’s greatest hurdle to better health comes in the form of worries such as finances, transportation, support groups, or transitions from one care setting to another. Specialized care navigators can help improve outcomes by coordinating the efforts of health providers and other support resources.
  • Diabetes registries: A registry is a listing of people who have a particular condition or other issue. A diabetes registry can help providers know which patients they are responsible for and assure that each person receives optimal care. A registry for diabetes, could, for example, track a listing of exactly which of our patients with diabetes were due for a particular lab test. Using the registry assures that people do not fall through the cracks and miss some important component of their health care.
What’s the challenge?

At least 9.4 percent of Idahoans have diabetes. This means that at least 178,000 people in our state have diabetes. This disease, particularly if not well-managed, can be very costly to physical, mental, and financial health, and providers can only offer part of the solution to its best management.

According to statistics:

  • 86 percent of people with diabetes are overweight or obese.
  • Hospital costs for a person with diabetes are more than double the costs for someone without diabetes. This does not include medications and other costs outside of the hospital setting.
What’s the goal?

The ultimate goal of DEaM is better outcomes for people in our region who have diabetes.  We believe that appropriate standardization of diabetes care is a critical success factor to make this happen.

Standardized care does not mean “cookbook” care. Instead, it means that we use registries, formalize our strategies in a way that makes sense, provide resources in cost-effective settings, and have accountability expectations of our providers as well as our patients. 

Here's an example. An evaluation was conducted two years ago in our Wood River community. The results showed a need for a clinic in Hailey to better accommodate a large population of patients with diabetes who also struggled to pay for their care.  

After the need was identified, a grant helped establish a diabetes clinic focused on standardized care via a “diabetes day” approach. When patients visited the clinic for their “diabetes day,” they were guided through different stations to capture every aspect of diabetic care, including nutrition, lab, vaccination updates, medication review, and self-management skills.

Results showed that hemoglobin A1c levels (a marker of blood sugar control generally with a target less than 7) in this group dropped from 10.5 to 6.8!

Our overall goal with DEaM is to improve our Medicare Shared Savings Program (MSSP) composite score measure for diabetes to 28 percent by the end of FY 2014.

How will it make a difference for patients? What changes will they see?

Being diagnosed with a chronic disease can be a huge change, and diabetes, with its significant prevalence in our communities, is probably one of the most significant areas that we can focus upon to change long-term outcomes. As we standardize care, engage providers and patients, and measure our outcomes, we expect to see continual improvement.

What are the next steps?

We are deploying of our initial pilot efforts across our communities, and encourage providers, patients, communities, employers, insurers, and other stakeholders to rally around efforts such as DEaM. We expect to share additional information going forward concerning engagement in the process. 

What are the measures of success?

For many patients with diabetes, most providers capture a great deal of information. And from clinics that participate in electronic data-sharing, we can pool information on the following measures to determine if we have had a positive impact:

  • Diabetes composite measure, including statistics on:
    • Patients who have a hemoglobin A1c reading of 8 or lower (the American Diabetes Association suggests diabetics maintain a level of 7 or lower).
    • Patients who have an LDL below 100 (LDL is a measure of cholesterol).
    • Patients who have a blood pressure reading of less than 140/90.
    • Patients who don’t use tobacco.
    • Patients using aspirin if they also have a diagnosis of ischemic vascular disease.
  • The percentage of patients with a hemoglobin A1c greater than 9.
Diabetes is preventable and manageable.  Our hope is that, together, we can help our community gain control over this disease.

Editor's note: This is the first installment of a 10-part series introducing clinical integration initiatives that St. Luke's is involved in.

Clinical integration is a term used to describe health care providers working together in an interdependent and mutually accountable fashion to pool infrastructure and resources. By working together, providers develop, implement and monitor protocols, “best practices,’ and various other organized processes that enable them to furnish higher quality care more efficiently than could be achieved working independently.

St. Luke’s Health System is a participating provider in the SELECT Medical Network of Idaho, Inc. SELECT is a network of healthcare providers in southwest Idaho that is focused on a coordinated model of care delivery focused on providing enhanced quality and better value to individuals, employers, and insurers.  

In keeping with the clinical integration effort, 10 initiatives were developed for 2013 to help establish the standards of enhanced quality meant to help create a new vision for health care.

The initiatives are:

  • Diabetes
  • Tobacco treatment
  • Back program
  • Advance directives
  • Patient-centeredness
  • Care management
  • Medicine reconciliation
  • Hand hygiene
  • Pharmacy optimization
  • Shared analytics
 

 

About The Author

David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.