IT Advances Help Growing Diabetes Population Self-manage

More than 25 million people in the U.S. have diabetes driving $245 billion in costs and making the condition ripe for improvements in care coordination, treatment adherence, patient engagement and more.

The Southeast Michigan Beacon Community (SEMBC) focused much of its efforts on diabetes because of its prevalence in the area. “When we looked at national, state, county and city statistics, we found the rates here were going up,” says Scott Turske, director of marketing and communications.

To achieve improved outcomes with high-impact quality measure interventions, including A1c testing, LDL testing, foot exams, blood pressure less than 140/90 and eye exams, SEMBC used a multipronged approach, says Susan Hashisaka, director of clinical transformation.

Identifying new patients

Southeast Michigan has an “actively disengaged population,” Turske says. SEMBC employed patient health navigators to work with those patients not accessing the system or not following their care plans. The organization had to work practice by practice to help the 46 practices and health centers in its region track these measures. Since each EHR system works differently, they helped deploy prompts and alerts for A1c levels over 8.0 and eye and foot exams. 

SEMBC also utilized Txt4Health for diabetes risk assessment and teaching patients methods to avoid risk by simply receiving three to five text messages a week. The messages are tailored to the assessment each patient receives when he or she enters the program. The organization worked with other Beacons, the American Diabetes Association and the Centers for Disease Control & Prevention to create the 14-week sequence of messaging.

It was a “fantastic endeavor,” says Turske, drilling down to the zip code level to reach the areas with the highest prevalence. “Texting is increasingly growing and is definitely another way to reach out to patients.” The more engaged patients became in their care, the more receptive they were to the Txt4Health effort.

Establishing exchange

SEMBC helped build a health information exchange (HIE) in Wayne County which didn’t exist before the Beacon grants were issued. “Our overarching goal was to infuse health technology into care delivery to improve outcomes,” says Hashimaka. “It was quite a task to get everybody going in the same direction. It takes a long time to make the value proposition and get the interest of the health systems.”

Today, all of the area health systems are participating at varying levels, she says. Because they have millions of dollars already invested in their own systems, participation is an ongoing effort. But, the area’s patient population is quite dynamic with transient patients who are sporadically on the Medicaid roster, changing clinics and visiting emergency departments (EDs). “There is a lot of movement so we need a neutral platform that all the practices and systems can connect to to share great data.”

SEMBC emphasized practice transformation efforts, says Hashimaka, including patient-centered medical home certification and Meaningful Use. “We tried to impress upon the practices that we weren’t trying to be another new program but help them improve across the board so they could meet the requirements for the various initiatives they were participating in.”

The organization also implemented an ED diabetes point-of-care testing program. “We know there are a lot of patients in the region going to the ED for nonemergent services as well as true emergencies,” says Turske. The program focused on A1c testing and assistants who would educate patients about their risk of diabetes. The effort resulted in testing of more than 25,000 individuals across three institutions and found a prevalence rate of 35 percent of diabetes and prediabetes. Those patients were offered classes, community resources, recommendations for treatment and referrals to the navigator program.

One of the three participating facilities found that when it compared its subset of people identified with diabetes or prediabetes, six months before and six months after the intervention, there was a 57 percent drop in frequency of ED visits. “That’s a pretty impactful number,” says Turske.

Through the course of the three-year Beacon project, SEMBC was able to reach its goal of improving by at least 5 percent all of its top five quality measures except for eye exams.

Going virtual

Further east, Joslin Everywhere is a comprehensive initiative centered around virtual care management, says Ed Charbonneau, chief information officer of the Joslin Diabetes Center in Boston. The program includes several aspects of diabetes care including a web-based module for weight management, based on Joslin’s clinically effective Why Weight? program. “We have taken what we’ve learned in the clinical setting and translated that into something engaging and compelling for patients to use,” says Charbonneau.

Joslin isn’t a primary care facility but rather works with patients’ primary care providers to make sure they are getting the most appropriate care, says Charbonneau. The organization is working on connectivity with primary care providers and has launched an internal patient portal both for their benefit and for Joslin’s ongoing compliance with Meaningful Use and other programs. “We’re giving them access for secure messaging with professionals here, the ability to view components of their records and the ability to receive online education.”

The patient portal allows patients to view their medical information and have a secure dialogue with their Joslin medical team. These critical elements let them be active participants in their healthcare. “Most patients with diabetes are active participants—they have to be by nature of the disease. They’re managing their condition every day so we know we need to give them tools and access to support them 24/7.” The right tools and education also are necessary to help them appropriately self-manage. Looking ahead, Joslin is interested in pursuing social media and gamification that keep patients “contextually engaged so they get a good level of benefit.”

Connectivity is an ongoing challenge, Charbonneau says. Electronic engagement with primary care providers has not been consistent because not all have a fully operational EHR and the ability to exchange information. “Our first order of business is making sure we can support the patient so sometimes we default to what’s available. We will work with practices to see if they can accommodate us and move to a higher level of connectivity over time.”

Tech partnerships

Joslin has and will continue to explore partnerships to advance health IT, Charbonneau says. That includes working with partners to develop telemedicine capabilities and mobile apps. “If we want to have success with the patient it has to be convenient and ever-present.”

Most people, for example, already carry a cell phone all day which can be used to send messages to Joslin and upload glucose readings. “We see that as very important in the relationship to help them manage going forward and give them timely feedback,” Charbonneau says. Given the questions about federal oversight of medical devices, he says Joslin is making sure to “take the appropriate steps and build the appropriate controls as we look at interacting in the mobile environment.”

The goals and needs of the organization depend on limited resources, however. “We are a small IT organization,” he says. Joslin has two developers on staff but most of their time is consumed with operational support and research. “We try to keep focused on the business at hand which is running the diabetes center.”
With the ever-increasing population of diabetes patients, that business also will continue to grow.