Texas Diabetes Education & Care Management Project

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 • Program Approach: • Train team of Promotoras • and Clinical staff on DEEP. • Recruit patients for • classes. • Patient Empowerment: • Provide Deep classes • on weekly basis. • Provide coordinated • services to patients. • 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 Clinical Support Staff Medical Providers Involvement

12. Community Health Center Top Five Medical Diagnosis Profile (43.3%) (26.9%) (20.7%) (6.1%) (2.8%) N=6304 *Gateway Community Health Center Source 2002 UDS

13. Typical Payment Source Category N=14144 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 (N=99 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 99 to 88 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 CHC’s • 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.