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$: Exploring Comprehensive Diabetes Prevention and Care in Oregon · Exploring Comprehensive Diabetes Prevention and Care in Oregon March 16, 2016 . Bekah\爀屲**BEGING RECORDING**\爀屲This$
Exploring Comprehensive

Diabetes Prevention and Care in Oregon

March 16, 2016

Presenter

Presentation Notes

Bekah **BEGING RECORDING** This webinar is part of an on-going public health and primary care webinar series featuring public health experts who can offer valuable training and resources to primary care providers, and ideas and examples of how the two can work together to improve population health.

We Want To Hear From You!

Type questions into the Questions Pane at any time

during this presentation

Presenter

Presentation Notes

Bekah Include “heads up” on interactive pieces – questions, polling, hand-raising, etc. Before I turn things over to our expert I want to review a few things about the technology we’re using today. Since we have so many of you on the line everyone is and will remain on mute throughout the presentations. We do have plenty of time set aside to take your questions. We welcome you to submit questions via the question pane on your control panel. You can type away and I will read your question for any of our presenters to answer. Please also feel free to send me a message via the questions pane if you have technical issues and I will do my best to assist you. Please note that we will send all webinar participants a link to the recording, slides and additional materials after the webinar.

Patient-Centered Primary Care Institute

Online Modules Webinars Website Learning Collaboratives Trainings TA Network

Presenter

Presentation Notes

Bekah A few words first about the Patient Centered Primary Care Institute. The Institute is a public-private partnership launched in 2012 with the support of the Oregon Health Authority & Northwest Health Foundation it is currently managed by Q Corp. Together with the experts we partner with, our goal is to get primary care practices connected to a broad array of technical assistance as they work towards the patient-centered primary care home, or medical home, model of care. We work to serve practices at all stages of transformation and to build capacity and create alignment to support ongoing transformation and quality improvement in Oregon. We encourage you to visit our website (www.pcpci.org) to access resources, including previous webinars. You can sign up for our email list on the website, which is how we will announce additional web-based and in person training opportunities as well as future Institute programs.

Oregon’s PCPCH Model is defined by six core attributes, each with specific standards and measures • Access to Care “Health care team, be there when we need you” • Accountability “Take responsibility for making sure we receive the best

possible health care” • Comprehensive Whole Person Care “Provide or help us get the health care,

information and services we need” • Continuity “Be our partner over time in caring for us” • Coordination and Integration “Help us navigate the health care system to get

the care we need in a safe and timely way” • Person and Family Centered Care “Recognize that we are the most important

part of the care team - and that we are ultimately responsible for our overall health and wellness”

Learn more: http://primarycarehome.oregon.gov

PCPCH Model of Care

Presenter

Presentation Notes

Bekah As I mentioned, the Institute aims to help primary care practices achieve recognition as a primary care home through Oregon’s Patient-Centered Primary Care Home, or PCPCH program. The model is a set of standards organized under six core attributes which you see here. You can visit the PCPCH program website at primarycarehome.oregon.gov to learn more.

http://primarycarehome.oregon.gov/

Presented by:

Don Kain, M.A., R.D., C.D.E Registered Dietitian and Certified

Diabetes Educator Harold Schnitzer Diabetes Center

Oregon Health and Science University

Sarah Worthington, MPH, RD Healthy Communities Coordinator Deschutes County Health Services

Tracy Carver, MPA State Lead

Everyone with Diabetes Counts Acumentra Health

Presenter

Presentation Notes

BEKAH Don Kain Harold Schnitzer Diabetes Center Oregon Health and Science University Don is a registered dietitian and certified diabetes educator, as well as a master trainer of Lifestyle Coaches for the National Diabetes Prevention Program (DPP). Don joined the Harold Schnitzer Diabetes Health Center (HSDHC) in 2008 where his work has a clinical and community-outreach focus. Since 2013 the HSDHC and the Health Promotion & Chronic Disease Prevention section of the Oregon Health Authority Public Health Division have been working closely to scale the National DPP in Oregon. Tracy Carver, MPA Everyone with Diabetes Counts Acumentra Health Tracy is the Oregon state lead for Medicare’s Everyone with Diabetes Counts initiative and the Integrating Self-Management Education into Patient Care Special Innovation Project. Prior to joining Acumentra Health, Tracy worked for the Oregon Health Authority and was part of the state team that established the Stanford Chronic Disease Self-Management Program in Oregon. She has more than eight years of experience leading innovative quality improvement and population health initiatives. Tracy’s career has focused on working with Oregon communities to design systems that improve chronic disease management and self-management support, address health disparities, and improve medication safety. Tracy is experienced in working with a broad range of stakeholders and facilitating diverse organizations towards a common aim. She holds a Master of Public Administration degree from Portland State University. Sarah Worthington, MPH RD Deschutes County Health Services Healthy Communities Coordinator Sarah has been the Healthy Communities Coordinator with Deschutes County Health Services since July 2014. She is a trained leader and coordinator for Stanford’s Diabetes Self-Management programs in the tri-county region of Central Oregon. Sarah is a trained Lifestyle Coach for the Diabetes Prevention Program, and has partnered with two primary care clinics to bring the DPP to Central Oregon, launching their first cohort in January 2016. �

After this webinar participants will be able to:

• List the components and goals of the National Diabetes Prevention Program

• State the rationale for screening patients for prediabetes

• Differentiate between the DPP, Diabetes Self-Management Education (DSME) and the Stanford Diabetes Self-Management Program (DSMP)

• Describe the critical role that patient centered primary care homes can play in referring high risk patients in Oregon to the National DPP, DSME and DSMP

Objectives

On the Horizon…

Diabetes = 29 million Prediabetes = 86 million

(Estimated 1 million in OR) • 37% of US adults • 51% of US adults 65 years

old and older • 15-30% develop DM within 5

years if no action is taken CDC: A Snapshot of Diabetes in the

United States, 2014. 7

Presenter

Presentation Notes

If current trends continue 1 in 3 children born in the US will develop DM in their lifetime. 1 in 2 children if child is Latino or African American

What about Oregon?

Oregon Diabetes Report, January 2015. 8

Presenter

Presentation Notes

Diabetes by the Numbers

9

Age-adjusted Prevalence of Obesity and Diagnosed Diabetes Among US Adults

2013

2013

Obesity (BMI ≥30 kg/m2)

Diabetes

1994

1994

2000

2000

No Data <4.5% 4.5%–5.9% 6.0%–7.4% 7.5%–8.9% >9.0%

No Data <14.0% 14.0%–17.9% 18.0%–21.9% 22.0%–25.9% > 26.0%

10

Diabetes Prevention & Self-Management Programs

National Diabetes Prevention Program • CDC sponsored year-long program designed for individuals with

prediabetes

Diabetes Self-Management Education (DSME) • Comprehensive self-management program designed for individuals

with a diagnosis of diabetes • Blood glucose monitoring, healthy eating, physical activity,

medications, healthy coping

Stanford Diabetes Self-Management Program (DSMP) • An evidence-based peer-supported self-management program for

people with Type 2 diabetes designed to help participants gain confidence in controlling symptoms and in day-to-day self-management

11

Diabetes Prevention & Self-Management Programs Blood Sugar

Level Program Program Goals Program

Leader Prediabetes Diabetes Prevention

Program 7% weight loss 150 minutes of physical activity

Lay person or healthcare professional

Diabetes- New onset, poorly controlled, or in need of refresher

Diabetes Self-Management Education (DSME)

Healthy Eating Being active Monitoring Taking medication Healthy Coping

Healthcare professional

Diabetes- Needing support with implementing self-management behaviors

Stanford Diabetes Self-Management Program (DSMP)

Teach skills for daily self-management Increase patient activation/self-efficacy Promote effective communication with care team

Certified Leader: peer educator or healthcare professional

12

• People ≥ 45 years of age, especially if BMI ≥ 25 – Repeat in 3 years if normal

• Screen earlier and more often if BMI ≥ 25 plus – Physically inactive – 1st degree relative with type 2 diabetes – High risk ethnic group – Hypertensive (≥ 140/90 or on treatment) – HDL < 35 and/ or TG > 250 – History of cardiovascular disease – History of polycystic ovarian syndrome – History of gestational diabetes or baby ≥ 9 lb – Previous diagnosis of pre-diabetes

ADA Clinical Practice Recommendations. Diabetes Care 2013;35(Suppl 1):S11

Who Should be Screened for Diabetes?

13

Diabetes Risk Factors

Contributing Factors • Family history • Aging • Ethnicity • Obesity • Inactivity

Associated Risk • Low HDL, high triglycerides • Hypertension • Coronary Artery Disease • Peripheral Vascular

Disease • Gestational Diabetes

– Or having a baby ≥ 9 lbs

• Polycystic ovary syndrome • Prediabetes

14

National Diabetes Prevention Program

15

National Diabetes Prevention Program Original Research

Multicenter NIH Clinical Trial • 3,234 participants with prediabetes • 27 clinical centers in U.S.

Lifestyle • Reduced calories, low-fat diet • 150 minutes of exercise per week (30

minutes of walking 5 days per week) • Weight loss goal = 7% of body weight

Metformin • 850 milligrams BID

Placebo

DPP Research Group. New England Journal of Medicine. 346: 393-403, 2002.

Study Results Lifestyle • Risk for developing

diabetes decreased by 58%

Metformin • Risk for developing

diabetes decreased by 31%

16

Presenter

Presentation Notes

Awesome, ground breaking study. Drawback = labor to deliver program 1:1

What Did the DPP Research Study Show?

• Weight loss was the most important factor in lowering the risk for type 2 diabetes

• The effect of weight loss on the risk for type 2 diabetes was the same across the board – regardless of sex, socioeconomic status, race, or ethnicity

• Millions of people at risk for diabetes in the U.S. can prevent or delay type 2 diabetes through modest weight loss as part of a structured lifestyle program 17

Group Delivery of DPP

The same outcomes can be achieved if the Lifestyle Change

Program is: – Offered in community-

based settings – Delivered in a group – Facilitated by a trained

Lifestyle Coach without a health care background

– Offered without incentives

• DEPLOY Study • Special Diabetes Program

for Indians Diabetes Prevention Demonstration Project

• Montana Diabetes Prevention Program

• Minnesota I CAN Prevent Diabetes Program

18

Presenter

Presentation Notes

Program has been scaled to meet demand of large volume of people with PreDM

Eligible National DPP Participants

Overweight Adults: • Adult aged 18 years and older with a BMI of 24 or greater

(Asian Americans: 22 or greater)

Prediabetes: • Prediabetes diagnosed through blood test (Fasting blood

sugar, A1C, oral glucose tolerance test)

• OR history of gestational diabetes

• OR increased risk based on prediabetes risk quiz

https://doihaveprediabetes.org/pdf/Prediabetes_RiskTest_12.11.pdf 19

https://doihaveprediabetes.org/pdf/Prediabetes_RiskTest_12.11.pdf



National DPP Goals and Structure

• Weight Loss: 5-7% of starting body weight

• Increasing physical activity to 150 minutes

• 16 weekly sessions delivered once a week during months 1-6

• Monthly or bi monthly sessions during months 7-12

Program Goals Program Structure

20

Presenter

Presentation Notes

Review the two goals of the program and the structure with an emphasis on the length of the program Remind trainees that these goals and the structure mirror the DPP study and therefore organizations seeking pending recognition/seeking to replicate the success of the DPP need to deliver the program as designed.

National Diabetes Prevention Program How it Works…

Relies on self-monitoring, goal setting, group process

• One hour sessions

• Self-monitoring of weight, food intake, minutes of physical activity

• Goal/action plan set at each session

• Lifestyle Coach leverages group process to allow group to problem-solve and support change

21

Presenter

Presentation Notes

Self monitoring of food intake, physical activity, and wt. Group process is true strength of program.

National Diabetes Prevention Program

1. Welcome 2. Be a Fat and Calorie Detective 3. Three Ways to Eat Less Fat and Fewer Calories 4. Healthy Eating 5. Move Those Muscles 6. Being Active: A Way of Life 7. Tip the Calorie Balance

8. Take Charge of What’s Around You 9. Problem Solving 10. Four Keys to Healthy Eating Out

11. Talk Back to Negative Thoughts 12. The Slippery Slope of Lifestyle Change 13. Jump Start Your Activity Plan 14. Make Social Cues Work for You 15. You Can Manage Stress 16. Ways to Stay Motivated

Skills

Controlling the external environment

Psychological and emotional

Content- 1st 16 weeks of program

22

https://public.health.oregon.gov/PreventionWellness/SelfManagement/Documents/oregon_dpp_contacts.pdf

Diabetes Prevention in Oregon Find a Program

Clatsop Multnomah

Tillamook

Jackson

Klamath

Lake

Harney Malheur

Deschutes

Morrow

Umatilla Wallowa

Union

Baker Jefferson

Wasco

Wheeler

Grant

Sherman Gilliam

Coos

Curry

Josephine

Douglas

Crook

Clackamas

Hood River

Marion

Linn

Lane

Lincoln

Polk

Benton

Diabetes Prevention Program

No program

23

Presenter

Presentation Notes

Programs represented are National DPP and YDPPs in Oregon

Prediabetes Awareness PSA Campaign

www.doihaveprediabetes.org

24

Presenter

Presentation Notes

Reference ADA Risk Test https://www.youtube.com/channel/UCFG5XgDdJHkz2aW7UJ2jn7A www.doihaveprediabetes.org

https://www.youtube.com/watch?v=s020q-FE0H4

Helping Patients at Increased Risk

Begin screening patients for prediabetes • Fasting blood sugar • A1C (no fasting required) If patient tests positive for prediabetes (FBS: 100-125; A1C: 5.7-6.4) refer that patient to a DPP in your community Don’t have a DPP in your community? • Consider having one of your staff trained as a DPP Lifestyle Coach

• Coordinate with local community organization to have one their staff

trained as a DPP Lifestyle Coach

25

Presenter

Presentation Notes


Next Steps- Resources for Screening & Referral

Prevent Diabetes STAT (Screen/Test/Act Today) Initiative http://www.cdc.gov/diabetes/prevention/lifestyle-program/deliverers/screening-referral.html • Resources for Screening, Testing & Referral

• Materials to Engage Patients

• Materials to Share with Colleagues & Healthcare Team

26

Presenter

Presentation Notes

In an average primary care practice it is likely that one-third of the patients over 18, and half over 65, have prediabetes https://www.youtube.com/channel/UCFG5XgDdJHkz2aW7UJ2jn7A www.doihaveprediabetes.org

http://www.cdc.gov/diabetes/prevention/lifestyle-program/deliverers/screening-referral.html






DPP IN CENTRAL OREGON 2016 PILOT PROGRAM

S A R A H W O R T H I N G T O N M P H , R D D E S C H U T E S C O U N T Y H E A L T H S E R V I C E S

27

ABOUT DESCHUTES COUNTY HEALTH SERVICES

• Living Well Central Oregon: Crook, Deschutes, Jefferson • CDSMP (Chronic Disease Self-Management Program) • DSMP(Diabetes Self-Management Program) • Tomando Control • Spanish DSMP (Diabetes Self-Management Program) • Living Well with Chronic Pain (coming soon)

• Electronic Health Record Referrals with FQHC • May 2014

• New Director Jane Smilie

28

Presenter

Presentation Notes

Deschutes County Health Services was formed in 2009 as a consolidation of the County’s Health Department and Mental Health Department. We offer services throughout the county and including Bend, La Pine, Redmond and Sisters. Within our Prevention Unit, funding from various sources (including OHA, general funds, pacific source, etc) supports our Chronic Disease Prevention activities. A large component of these activities is the coordination and administration of Stanford’s self-management programs in the tri-county region. My colleague Brenda Johnson and I are both trained leaders, and Brenda is a master trainer who often travels throughout the state to train new leaders. Strong partnerships with multiple agencies- have helped us to grow and sustain our offerings. Currently we offer CDSMP, DSMP, Tomando, DSMP-Spanish, and soon will offer LW with Chronic Pain. In particular we have worked with one FQHC, Mosaic Medical, to establish Electronic Health Record referrals for patients to these programs, and offer the workshops on site at their locations in Madras, Prineville, Redmond, and Bend. In May of 2014, our new director Jane Smiley took the reins. She came to us from the state Health Department in Montana, where DPP has been up and running successfully for 8 years. Many of us here have heard her say that, failure to offer Diabetes Prevention Programs is akin to public health malpractice- (the evidence of effectiveness is so robust and the need so great). Bringing DPP to Central Oregon has been a major priority for our agency over the last 2 years.

SELF-MANAGEMENT IN CENTRAL OREGON

Tri County Map of Central Oregon Living Well 29

LAYING THE GROUNDWORK

• Capacity Building at Deschutes County Health Services • Lifestyle Coach Training • Knowledge building • Drafted proposals for 1 to 3 year pilot programs

• SRCH (Sustainable Relationships for Community Health) • Key Partners and Champion Supporters

30

Presenter

Presentation Notes

Over the last year and a half or so we have been engaged in various activities to build our capacity to offer DPP. Brenda and I got trained by Don in December 2014. We reached out to others in Oregon and in Montana to learn from their experiences. We created draft proposals for programs from 1-3 years, really laying out the details of how we would put this together. A key development was when we were awarded the SRCH grant. The goal of SRCH is to streamline closed loop referrals to self management programs, specifically by bringing CCO’s and Public health agencies together. We focused many of our discussions around DPP. Ultimately we were able to leverage some of our SRCH funds to support implementation of DPP so we began reaching out to our community partners. Our proposal was to request that each of them refer patients to this program which DCHS is committed to providing in the initial year at no cost to participants. The obvious first partner was mosaic medical, where in the redmond clinic they have been developing a robust panel management workflow for Diabetes patients. We have a key supporter who is the population health specialist that advocated for this very busy agency to help with DPP. Mosaic provided staff time to a panel management assistant to identify eligible patients. Another key supporter was referred by our partner at COHC. A staff psychologist at St. Charles Family Care in Redmond, she was very interested in bringing this program to her patients. They ended up agreeing to provide the conference room space for the class, which is next door to Mosaic Medical’s Redmond clinic.

REFERRAL PROCESSES

• Developed Resources provided to both clinics • St. Charles Family Care

• Presented DPP at physician’s monthly meeting • Providers sent fax referrals to DCHS

• Mosaic Medical • Ran a query to identify patients with prediabetes • Identified patients during office visits • Referrals Center faxed patient information to DCHS

31

Presenter

Presentation Notes

I provided a collection of resources for each of our clinic partners: Brochures for patients, a script for describing the program, and Fax Referral Forms that included diagnostic criteria for referral. The process for each clinic was slightly different. At St. Charles, the physician who is our champion presented the program at a provider meeting. She did a great job selling it- and many docs came on board. They received the program information and forms and I began receiving referrals within the week. At Mosaic Medical, the panel management assistant ran a query to identify eligible patients and actually spoke with each of them to assess their interest/readiness for the year long program. For those that were good candidates, she made a referral in their EHR which triggered the referrals center to fax me the patient information.

PARTICIPANT ENROLLMENT

• Initial Contact Call • Intake Interview

• Demographic-medical • Diabetes Risk Test • Participant Contract

• Program Documentation • Montana software program • OR Compass Portal (soon to be

released) 32

Presenter

Presentation Notes

I contacted each referred patient to discuss the program in depth. Each call would take from 5 to 15 minutes. I made sure to inform them about a few key points: the goal of DPP- which is 7% weight loss, and how we achieve that- through keeping track of healthy eating and working towards the goal of 150 weekly minutes of physical activity. Side note –it was a huge help for us in this pilot that we are not charging for the program, starting in January it is a time of year when many people are looking at Weight Watchers or gym memberships. For each patient who enrolled, I set up a time to have an intake meeting. We met for up to half an hour and I had each person fill out a couple of forms. Both of these were somewhat modeled on forms they have been using in Montana where they have published many studies on participant outcomes. The first form asks for socio-economic info, some self-reported medical history, any disabilities, tobacco use and weight history. The second form is a participation contract which essentially asks people to rate the level of importance to this program and their level of confidence in completing it. I also asked each person to sign an ROI so that I could request their blood lipids, blood pressure, HBA1C and that info to track that information over the course of the program. We were fortunate to be given access to an online tool that Montana had developed for documenting participant information and progress throughout the program. This also gives us the ability to provide letters updating providers on patient progress at intervals we choose throughout the year. OHA is also soon to be launching the Compass online portal which will be available for agencies throughout the state to manage self-management programs including DPP.

CURRENT STATE OF DPP CENTRAL OREGON

• 16 people registered • First Workshop held

January 27, 2016 • 5 people have not

continued for various reasons

• 11 are going strong!

33

Presenter

Presentation Notes

5 referred from St. Charles 6 referred from Mosaic Medical 5 were friends or family members of referred patients! We are in week 8 (on March 16) Got a job An injury requiring intensive treatment Felt overwhelmed with making changes Schedule conflict

FUTURE OF DPP IN CENTRAL OREGON

• Deschutes County • DCHS: continues to pursue funding opportunities

• Focus: Redmond, Bend • La Pine Community Health Center

• Crook and Jefferson County • Mini-grants for training lifestyle coaches

34

QUESTIONS?

35

Diabetes Self Management Education (DSME)

36

Diabetes Self Management Education (DSME)

Diabetes is a complex burdensome chronic disease that requires making numerous daily decisions regarding food, physical activity, medications, and more

• A person with diabetes is in charge of his/her own diabetes care 99.9% of the time

• To many patients having diabetes feels like having a second job

37

DSME Defined

• The process of facilitating the knowledge, skill & ability necessary for diabetes care

• It is the position of the American Diabetes Association (ADA) that all individuals with diabetes receive DSME at diagnosis and as needed thereafter

38

Concrete Examples of DSME

39

Who Delivers DSME?

Primary instructor responsible for designing and planning DSME must be a nurse, dietitian, pharmacist or other trained or credentialed healthcare professional (Certified Diabetes Educator)

• Other DSME contributors may include: practice-

based care managers, social workers and mental health counselors, trained community health workers, peers and family members

40

Is DSME Reimbursable?

Centers for Medicare & Medicaid Services (CMS) and many private payers reimburse for delivery of DSME

• CMS reimburses for 10 hours of initial DSME within 12 months of first DSME visit and for 2 hours of DSME each subsequent year

• For reimbursement, entity delivering DSME must be accredited by either the ADA, American Association of Diabetes Educators (AADE), or the Indian Health Service (IHS)

41

Other DSME Reimbursable Services

CMS also reimburses for the delivery of the following discipline-specific counseling:

• Medical Nutrition Therapy (MNT) provided by a registered dietitian

• Medication therapy management delivered by pharmacists

• Psychosocial counseling offered by mental health professionals

42

Is DSME Effective?

• Improves A1C by as much as 1%

• Reduces onset and/or advancement of diabetes complications

• Improves quality of life

• Improves lifestyle behaviors such as – Healthy eating – Engaging in physical activity

Powers, M. A., et al. Diabetes Care. Published online before print June 5, 2015, doi: 10.2337/dc15-0730

43

Is DSME Effective?

• Enhances self efficacy & empowerment

• ↑ healthy coping

• ↓ presence of diabetes-related distress & depression

44

Is DSME Well Utilized?

The number of people who receive DSME is low:

– Only 6.8% of those newly diagnosed, who have private health insurance receive DSME

– Only 4% of eligible Medicare participants access DSME

Powers, M. A., et al. Diabetes Care. Published online before print June 5, 2015, doi: 10.2337/dc15-0730 45

Improving DSME Access in Oregon

Referrals for DSME must be made by a health care provider

– To locate a DSME provider near you please visit:

• http://professional2.diabetes.org/erp_zip_search.aspx

• http://www.diabeteseducator.org/ProfessionalResources/accred/Programs.html

46

http://professional2.diabetes.org/erp_zip_search.aspx

http://professional2.diabetes.org/erp_zip_search.aspx

http://www.diabeteseducator.org/ProfessionalResources/accred/Programs.html

http://www.diabeteseducator.org/ProfessionalResources/accred/Programs.html

Supporting Self-Managers

• Diabetes is a complex and burdensome disease

• In order for people to be effective self-managers, DSME lays the foundation, but requires ongoing support to maintain gains made during education

47

Stanford University Diabetes Self-Management Program

48

Presenter

Presentation Notes


Quality Innovation Network-Quality Improvement Program: Everyone with Diabetes Counts Initiative

• Centers for Medicare & Medicaid Services (CMS) national initiative to improve access to diabetes self-management education in underserved communities

• Objectives:

– Increase access and improve referral pathways to diabetes self-management education programs and services.

– Work with clinics to improve diabetes care and monitoring and optimize billing Medicare for DSMT and MNT.

49

Stanford’s Diabetes Self-Management Program

(DSMP)

• Evidence-based intervention • Peer-supported model • 2.5 hours per week; 6 weeks • 10–15 participants • Trained peer leaders • Part of Stanford suite of programs

50

7 Tenets of Self-Care Behavior

AADE7® Self-Care Behaviors Diagram by Nevada Wellness For more information, visit: https://www.diabeteseducator.org/patient-resources/aade7-self-care-behaviors

51

Presenter

Presentation Notes

https://www.diabeteseducator.org/patient-resources/aade7-self-care-behaviors










DSMP Topics and Tools

Physical Activity

Medications

Decision-Making

Action Planning

Breathing Techniques

Understanding Emotions

Problem-Solving

Using Your Mind

Sleep

Communication

Healthy Eating

Weight Management Working with Health Professionals

Self-Management Tool Box

2012 Stanford Chronic Disease Self-Management Program Workshop Leader Manual 52

Oregon DSMP: Early results

Oregon “Everyone with Diabetes Counts” DSMP Communities 2015 data:

• Pre-post surveys collected from participants

in 11 workshops: – 73 graduates – 33 non-graduates

53

Self-reported health conditions

2015 Data Report on Oregon “Everyone with Diabetes Counts” DSMP Communities 54

Patient confidence in setting self-management goals

2015 Data Report on Oregon “Everyone with Diabetes Counts” DSMP Communities

Pre N=52 P-value: Yes: 0.001* Maybe: 0.003* Post N=41 *statistically significant

55

Managing stress related to diabetes


Pre N=52 P-value: Yes: 0.000* Maybe: 0.008* Post N=41 *statistically significant

56

Communication with provider


Pre N=52 P-value: Yes: 0.036* Post N=41 *statistically significant

57

DSMP in Oregon

More information on DSMP programs in Oregon: • Upcoming workshops by county:

http://www.acumentra.org/resources/diabetes-self-management-program-calendar/

• Stanford Self-Management Program contacts by county:

http://public.health.oregon.gov/DiseasesConditions/ChronicDisease/LivingWell/Documents/Programs/countynmbrs.pdf

National and International Licensed Organizations: • http://patienteducation.stanford.edu/organ/dsmpsites.html

58






http://patienteducation.stanford.edu/organ/dsmpsites.html

http://patienteducation.stanford.edu/organ/dsmpsites.html

DSMP Programs in Oregon

59

Medical Nutrition Therapy (MNT)

Referral to Diabetes Self-Management Education

Pre-diabetes

Diabetes Prevention

Program (DPP)

Diabetes Self-Management Training (DSMT)

Diabetes

Stanford Diabetes Self-Management Program (DSMP)

Newly diagnosed

This material was prepared by HealthInsight, the Medicare Quality Innovation Network-Quality Improvement Organization for Nevada, New Mexico, Oregon and Utah, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-B2-16-10-OR 3/1/16 60

DSMP and DSME Partnership

Benefits of partnering with DSME and DSMP Nevada Wellness DSME Toolkit

61

Contact us!

Tracy Carver, MPA [email protected]

(503) 382-3931

Don Kain, MA, RD, CDE [email protected] (503) 494-5249

Sarah Worthington MPH, RD [email protected]

(541) 322-7446

mailto:[email protected]



What Questions Do You Have?

Type questions into the Questions Pane at any time

Thank You! Please complete post-webinar survey

Resources • Centers for Disease Control and Prevention (CDC), A Snapshot of Diabetes in the United

States, 2014 • Oregon Health Authority, Oregon Diabetes Report, 2015 • American Diabetes Association (ADA), Clinical Practice Recommendations: Diabetes Care,

2013 • Ad Council, So…Do I have Prediabetes? • American Association of Diabetes Educators, AAED7 Self-Care Behaviors, 2010 • Stanford Diabetes Self-Management Program • State of Nevada, Nevada Wellness DSME Toolkit, 2016 • Center for Medicare & Medicaid Services Everyone with Diabetes Counts Initiative Schedules & Contacts • National Diabetes Prevention Program, Oregon Contacts, 2016 • Acumentra Health, Upcoming DSMP workshops by county • OHA Public Health, Stanford Self-Management Program contacts by county, 2015

Presenter

Presentation Notes

THANK YOU FOR LISTENING IN TODAY

http://www.cdc.gov/media/dpk/2014/images/diabetes-report/Infographic1-web.pdf

http://www.cdc.gov/media/dpk/2014/images/diabetes-report/Infographic1-web.pdf

https://public.health.oregon.gov/DiseasesConditions/ChronicDisease/Diabetes/Documents/OregonDiabetesReport.pdf

http://professional.diabetes.org/content/clinical-practice-recommendations

http://www.doihaveprediabetes.org/


http://patienteducation.stanford.edu/programs/diabeteseng.html

http://nevadawellness.org/wp-content/uploads/2015/06/6349-NV-Wellness_DSME-Toolkit_C1R4F_A.pdf

http://qioprogram.org/edc

https://public.health.oregon.gov/PreventionWellness/SelfManagement/Documents/oregon_dpp_contacts.pdf








Journals

• Lefevre, M. on behalf of the U.S. Preventive Services Task Force. (2014). Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults with Cardiovascular Risk Factors: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 161:587-593.

• Lorig K, Ritter PL, Villa FJ, Armas J, Community-based peer-led diabetes self-management: a randomized trial. Diabetes Educator, 35(4):641-651, 2009.

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