Utah Educates Diabetes Patients to Better Manage the Condition Using Online DSMES

Written by: Ravyn Towns

Case Study

Utah Educates Diabetes Patients to Better Manage the Condition Using Online DSMES to Accomplish Goals

Background

According to the Utah Department of Health, in 2013 diabetes was the direct underlying cause of death for more than 550 Utah residents. Approximately 201,025 people, or 10.4% of the adult population, has diabetes (American Diabetes Association, 2019). Additionally, 619,000 people in Utah, or 32.7% of the adult population, has prediabetes with blood glucose levels higher than normal but not yet high enough to be diagnosed as diabetes. Diabetes is managed by Utah’s Healthy Living Through the Environment, Policy, and Improved Clinical Care Program, also known as EPICC. This program offers various resources for diabetes patients and healthcare professionals throughout the state. The overall aim is to reduce the incidence of diabetes, heart disease, and stroke by targeting risk factors such as obesity, poor physical activity routines and nutritious food choices (EPICC, 2019).

Diabetes Self-Management Education and Support (DSMES) programs help both patients and their healthcare teams prevent or delay diabetes complications. But for the Utah state administrators, getting people to the training has been problematic. To address this, the Utah Department of Health and the EPICC program is initiating an online diabetes education pilot that will help the residents of Utah living with diabetes better manage the condition. This will result in reduced healthcare costs, improved quality of life, and minimizing the complications diabetes causes. The online diabetes education pilot is intended to reach residents who live in rural areas along with residents who are otherwise unable to attend in-person sessions. This case study documents Utah’s current challenges, implementing a new solution and projected outcomes.

The Challenge

According to the American Diabetes Association, diabetes and prediabetes costs an estimated $1.7 billion in Utah each year. Total direct medical expenses for diagnosed and undiagnosed diabetes, prediabetes and gestational diabetes in Utah was estimated at $1.3 billion in 2012 (ADA, 2019). An additional $384 million was spent on indirect costs from lost productivity due to the disease. Just three years ago, the Division of Diabetes Translation at the Centers for Disease Control and Prevention (CDC) spent $2,509,808 on diabetes prevention and educational programs in Utah. In addition to this being a costly epidemic for the state and the nation, it was time for the Utah Department of Health to propose a solution to eliminate two major barriers for its diabetes population: time and transportation. Utah’s diabetes patients have explained these burdens as barriers from attending in-person DSMES programming. Many patients travel 45 minutes to an hour just to see their educator, if they even have transportation available to them. Because diabetes educators often lack enough time to reach patients, this challenge is twofold.

The Solution – Online Patient Education

Evidence has shown, better health management helps people with diabetes live longer, more productive and healthier lives. Through DSMES programming, people living with diabetes and their healthcare teams prevent and delay diabetes complications. To eliminate the barriers plaguing Utah’s rural diabetes population and residents with both travel and scheduling conflicts, the Utah Department of Health sought dMeetings as the best method to address these issues. dMeetings is an online DSMES curriculum that, in conjunction with health coaching and oversight, leverages online education to help patients better manage their diabetes. Patients, and healthcare payers, who manage diabetes effectively benefit by having lower healthcare costs and improved quality of life.

The dMeetings model consists of 10 online sessions derived from the AADE’s 7 core behaviors of managing diabetes. Each session is about 30 minutes in length and is accompanied by a quiz and self-study resources. The education is taken within a Learning Management System (LMS) that allows health coaches and administrators the ability to track progress and measure comprehension throughout the series. This information is particularly relevant as coaches work with patients in follow-up and/or telemedicine sessions to help the patient apply concepts learned. At the successful conclusion of the training, a certificate of completion is awarded that the patient can leverage in a variety of ways including in health and wellness and reimbursement programs.

The Environment – Pilot Facilities

The Utah Department of Health selected three programs to implement the online DSMES pilot. By selecting these three programs, outcomes will be measured from the various angles. This allows the Department of Health to understand the exact benefits and effects of online DSMES versus in-person DSMES. Further, partnerships are essential to success in public health. Partners extend the reach, leverage resources, and help administrators achieve essential objectives such as increasing enrollment and participation. The programs selected are existing partners and include the Uintah Basin Medical Center, Maple Mountain Pharmacy, and Summit County Health Department.

Uintah Basin Medical Center, the largest rural healthcare system within Utah, has progressively expanded by adding locations, physicians and specialties. The facility’s main objective is to provide more specialized healthcare services locally, so residents do not have to travel long distances to the Wasatch Front. It is also home to a Diabetes Education and Training Program that is accredited by the American Association of Diabetes Educators.

Maple Mountain Pharmacy, Mapleton, Utah’s locally owned community pharmacy, offers individualized care to all its patients. Maple Mountain’s pharmacists are easily accessible in the community and have ongoing relationships with the patients they serve. Like many of their patients, Maple Mountain’s pharmacists live in the same neighborhoods.

As a community pharmacist in a rural setting, many of their employees have also adopted the roles of confidant and friend. In addition to providing information about prediabetes and diabetes, Maple Mountain Pharmacy also delivers the DSMES program services and benefits.

Summit County Health Department currently offers prevention classes for Type 2 Diabetes. In February of this year, the health department welcomed its first Certified Diabetes Educator, SaRene Brooks. Achieving certification status demonstrates to people with diabetes and employers that health care professional possesses distinct and specialized knowledge about diabetic health, thereby promoting quality of care for people with diabetes. Brooks has been working towards her CDE certification for the past three and a half years. She will use her certification to educate Summit County residents about managing and understanding diabetes.

Expectations

Overall, the Utah Department of Health is anticipating four potential outcomes throughout their state-wide diabetes populations:

· The reduction of diabetes-related complications in patients

· The reduction of direct and in-direct healthcare costs for both patients and stakeholders.

· For the Utah diabetes population to live longer, more productive and fulfilling lives

· For Utah diabetes patient population to, in the end, just feel better.

With the presence of positive outcomes with both patients and educators alike, this pilot could lead the UDH to offering online diabetes education on a larger scale. With the pilot beginning in October 2019, Utah will use two methods to measure performance and success.

By using the dMeetings evaluation model in contrast to existing models in each program, outcomes can then be compared and measured. According to the UDH, an evaluation process is in place and the heads of each program will monitor and assist in all aspects of program’s implementation, use and conclusion. The department is confident the pilot will be beneficial for not only patients but also for Utah’s health coaches, Certified Diabetes Educators (CDE’s) and administrators. In combination with the online sessions, health professionals will now have more time to offer specific, more targeted instruction on individual levels improving program efficacy.