Strengthening Community Health Systems_Henry Perry_5.8.14
4AM_DSME Presentation
1. Living Well
With Diabetes
Samantha Strassburg,
M.S., R.N., MPRO
Anne Hein, B.A., MPRO
Mary Ablan, M.A., MSW,
Area Agencies on Aging
Association of Michigan
May 8, 2015
6. 6
Lake Superior QIN
Initiatives
Cardiac care
Diabetes
Adult Immunizations
Meaningful use of electronic health records
Care coordination
Quality reporting
Healthcare-associated infections
Healthcare-acquired conditions in nursing
homes
7. 7
Learning & Action Network
• Learning sessions (e.g., webinars,
teleconferences, etc.)
• Audience
• Health care providers, office staff, community health workers,
Medicare beneficiaries
• Topics
• Best practices
• Diabetes self-management education (DSME) referrals and
office workflow
• Diabetes clinical outcome measures
8. 8
Everyone With Diabetes
Counts
National initiative by the Centers for Medicare
& Medicaid Services (CMS) to improve health
outcomes and reduce health disparities among
people with diabetes
9. 9
Lake Superior QIN Goals -
Michigan
1. Increase DSME graduates
• 4,200 Medicare beneficiaries by July 31, 2019
1. Increase number of certified DSME trainers
2. Increase number of certified DSME workshop
sites
3. Improve clinical outcomes related to diabetes
11. 11
Evidence-Based
“Subjects who took the Program, when compared to
those who did not, demonstrated significant
improvements in exercise, cognitive symptom
management, communication with physicians, self-
reported general health, health distress, fatigue,
disability, and social/role activities
limitations.” (Stanford School of Medicine)
http://patienteducation.stanford.edu/programs/cdsmp.html
16. 16
Lake Superior QIN Strategy
Phase One
• Fill the seats of existing Diabetes PATH workshops
Phase Two
• Expand workshops throughout Michigan focusing on areas
with the greatest need
Phase Three
• Statewide promotion
17. 17
Provider Referrals
DSME Provider Toolkit
• Explains what DSME is, how it’s different from diabetes self-
management training (DSMT), how the office can incorporate
DSME referrals into their workflow and how they can host
workshops in their office
Technical Assistance
• Teach providers how they align their work with CMS
electronic health record (EHR) incentive programs
• Utilize EHR tools such as:
• Patient reminders, patient portals, etc.
18. 18
Lake Superior QIN Strategy
Working with regional
PATH coordinators to
promote workshops
across Michigan
19. 19
Lake Superior QIN Strategy
Marketing tactics
• Fliers*
• Posters*
• “Prescription” pads*
• Provider toolkit (in development)
• E-newsletter
• News release template
• Newsletter article template
• Social media posts
*Available in English and Spanish
25. 25
Lake Superior QIN DSME
Recap
• Collaborating with Area Agencies on Aging
Association of Michigan (4AM) and other
partners to promote DSME throughout
Michigan
• Working with provider offices to increase
DSME referrals
• Identifying barriers and finding solutions
26. 26
Area Agencies on Aging
Association of Michigan
Empowering Older Adults
•GREAT At Any Age: Powered by Michigan’s
Area Agencies on Aging (AAA)
•Funded by Michigan Health Endowment Fund
27. 27
Evidenced-Based Programs
• Expands two evidence-based programs to
scale
• A Matter of Balance
• Diabetes Self Management Program (Diabetes
PATH)
• Target population: 60+
28. 28
Partners & Strategies
• 16 AAAs will expand both programs
• Michigan Hospital Association will generate
referrals
• Resource Link will achieve sustainability
• Public Sector Consultants will evaluate
• Martin Waymire will market programs
29. 29
Goals for Diabetes PATH
• 4,000 60+ graduates in two years
• Increase certified trainers by 250 percent
• Increase number of workshops by 300 percent
• Increase graduates by 500 percent
• Improve clinical outcomes – evaluation
Moving the needle!
32. 32This material was prepared by the Lake Superior Quality Innovation Network, under contract with the Centers for Medicare & Medicaid Services (CMS), an
agency of the U.S. Department of Health and Human Services. The materials do not necessarily reflect CMS policy. 11SOW-MI-B2-15-36 042715
Follow us online @LakeSuperiorQIN
MPRO represents Michigan in the Lake Superior Quality Innovation
Network.
Contact Us
Samantha Strassburg, MPRO
sstrassb@mpro.org
Anne Hein, MPRO
ahein@mpro.org
Mary Ablan, Area Agencies on
Aging Association
ablan@iserv.net
Notes de l'éditeur
SAM: Good morning. I’m Samantha Strassburg. I’m from MPRO, which is also a part of Lake Superior Quality Innovation Network or “QIN”. I am a registered nurse and have a master’s degree in nursing business and health systems. I work at MPRO as a clinical application coordinator. I am also a certified diabetes self-management education leader.
ANNE: I’m Anne Hein. I’m also from MPRO and a certified diabetes self-management leader. I’m a communications specialist and have been with MPRO for almost three years.
Prior to working in health care, I was a TV news producer.
We are joined today by Mary Ablan, executive director of the Area Agencies on Aging Association of Michigan. Mary?
We are happy to be here today to talk about some of the initiatives taking place in Michigan centered around Diabetes Self-Management Education or DSME.
Anne, and I will be covering the Centers for Medicare and Medicaid Services (CMS) initiative called Everyone with Diabetes Counts and Mary will be talking about the initiative funded by the MI Endowment Fund called Empowering Older Adults. We will also touch on how we are collaborating together to inform seniors with about these programs.
For those of you not familiar with MPRO, MPRO is a nonprofit organization working to improve the quality, safety and efficiency across the health care continuum.
We work with health care providers across many different care settings, including private practices, physician organizations, nursing homes, home health agencies and hospitals.
We provide: consultative services, medical review and data analysis to federal agencies, Medicaid and public health agencies, health care facilities, health plans and other third party payers.
For 30 years, MPRO was the federally designated Quality Improvement Organization or QIO for the state of Michigan. Last summer, CMS changed the structure of the program from state-based to regional. There are now 14 regional Quality Innovation Network-Quality Improvement Organizations also known as QIN-QIOs. MPRO is part of Lake Superior QIN, which represents Michigan, Minnesota and Wisconsin.
QIN-QIOs bring Medicare beneficiaries, providers, and communities together in data-driven initiatives that increase patient safety, make communities healthier, better coordinate post-hospital care, and improve clinical quality.
QIN-QIOs are skilled in creating opportunities for providers to learn from each other by applying advanced improvement and analytical methods, engaging patients and families, and structuring processes for sustaining positive change.
Our funding from CMS started last August and will run through July 2019.
Lake Superior QIN is working on 8 programs covering a wide variety of areas and settings. Examples of these programs include improving cardiac care, improving diabetes care and access to DSME workshops, immunizations, electronic medical records and health information technology, improving the transition between care settings, assisting providers with quality reporting, reducing infections in hospitals, improving the quality of life for those in nursing homes.
I won’t go into detail on all of them but if you are interested in learning more, feel free to come to our table to pick up a program catalog or chat with Anne or myself.
A key feature of each of our programs is what we call a Learning & Action Network (LAN).
Anyone in Michigan is invited to participate in the LANs. During monthly webinars, participants will be able to learn from peers and experts who share best practices that have worked for them to improve health care quality.
Our Diabetes LAN will include topics on DSME engagement and workflows in provider offices as well as how to improve diabetes related clinical outcomes measures.
Our diabetes program is based on the national initiative by CMS called Everyone with Diabetes Counts.
The goal of the initiative is to work together with providers, community partners and health care consumers to empower Medicare beneficiaries to effectively self-manage diabetes. Empowerment is gained through diabetes self-management education (DSME).
After piloting the program in a handful of states, CMS chose to include EDC has part of our most recent contract and implement the program nationally.
EDC is supported by many partners both nationally and within the state. Some supporters include the AAA’s, Federally Qualified Health Centers, American Diabetes Association, American Association of Diabetic Educators, colleges that train community health workers, faith-based organizations, and senior centers. We are continually looking for new partnerships to promote DSME throughout the state.
The goals of EDC are very simple: We want to
1) Increase # of Medicare beneficiaries & caregivers attending DSME workshops. Our Goal: Enroll and graduate 4,200 participants by July 31, 2019.
2) Increase number of certified DSME Trainers
3) Increase number of certified DSME training sites. Workshops can be held in churches, senior centers or assisted living facilities and even provider offices.
4) Improve clinical outcomes related to diabetes and chronic disease management. Specific outcomes being looked at are rates of HbA1c, eye exams, foot exams, and blood pressure.
Just to recap, Diabetes Self-Management Education (DSME) is a FREE or low cost program that helps people with diabetes take better care of their health
The program helps people to understand their diabetes and its risks, as well as emphasize the importance of diet, exercise, keeping regular physician exams, receiving annual foot and eye exams, managing medications and more
DSME is designed to complement other types of diabetes education, including diabetes self-management training (DSMT). The workhsops are focused on lifestyle and self management techniques. Participants are referred to their physicians for all personal medical related questions.
In addition to providing education, its been amazing to watch the relationships form between participants. The workshop really turns into a support group of sorts where people are cheering each other on and sharing personal stories of things that have helped them mentally and physically to manage their diabetes. The emotions shared are raw and genuine and therapeutic for all.
The most popular form of DSME in Michigan uses a curriculum that was developed through the Division of Family and Community Medicine at Stanford University and based on a more general Chronic Disease Self-Management Program.
5 year research grant and conducted randomized controlled trials using the program.
Subjects who took the Program, when compared to those who did not, demonstrated significant improvements in exercise, cognitive symptom management, communication with physicians, self-reported general health, health distress, fatigue, disability, and social/role activities limitations.”
If you are interested in learning more about the research behind the Stanford curriculum, I’d be happy to help direct you to published articles and research.
Lorig K, Ritter PL, Villa FJ, Armas J. (2006). Community-based peer-led diabetes self-management: a randomized trial. Diabetes Educator (35): 641–651
Norris, L. et al. (2002). Increasing diabetes self-management education in community settings: A systematic review. American Journal of Preventive Medicine (22): 39-66
Diabetes PATH is a six-week workshop for adults with type 2 diabetes, their family members and caregivers.
The workshops meet once a week for 2 ½ hours in community settings (e.g., senior centers, libraries, churches, etc.) and sometimes physician offices or health system conference rooms.
Two trained leaders guide the workshops – Leaders do not have to be health care professionals. Often are lay leaders who have diabetes or care for someone with diabetes. Community health workers and DSME graduates are encouraged to become leaders.
Taught in group sessions with no more than 20 people per workshop.
The workshop is available in Spanish.
Topics include:
Techniques to deal with problems such as frustration, fatigue, pain and isolation
Appropriate exercise for maintaining and improving strength, flexibility and endurance
Appropriate use of medications
Communicating effectively with family, friends and health professionals
Nutrition
Participants report less pain, fatigue and depression, more energy, better communication with their physicians, better overall health and increased confidence in managing their health.
It’s important to point out that Diabetes PATH does not change the treatment plans of participants. The program encourages participants to follow their doctor’s orders and helps them learn new ways to talk to their health care team and help manage diabetes.
MDHHS posts all PATH workshop information at www.mihealthyprograms.org. On this website, consumers can find a workshop scheduled near them. Future leaders can find Leader trainings in their area. And Current leaders can access tools and resources for their workshops.
There are many key stakeholders working to facilitate Diabetes PATH workshops across the state of Michigan. These are just a couple that Lake Superior QIN is currently working with and we are always open to partnering with others.
We are all working toward the same goals of empowering individuals with diabetes to successfully manage their disease so they can do the things they deem important to them.
Michigan department of health and human services
Area Agencies on Aging Association of Michigan
National Kidney Foundation of Michigan
Practice Transformation Institute
Adult Well-Being Services
Community & Faith-based organizations (food banks, senior centers, churches, etc.)
Ford Resource & Engagement Center
St. Mary’s QOC
Westland Friendship Center
As I mentioned before, there are several major initiatives in Michigan raising awareness and participation in Diabetes PATH. This graphic shows an overlap of EDC and Empowering Older Adults initiatives. Together we have the common goals of Increasing the number of grads, trained leaders and workshops throughout the state. We are both also working to raise awareness to health care providers and consumers about the availability of Diabetes PATH.
We are working collaboratively with Michigan Department of Health and Human Services to streamline the data collection process of these workshops. We’ve combined data forms with existing Diabetes PATH forms to meet needs of both programs. MDHHS is expected to release the new forms and Leader instructions on May 27th at the annual PATH meeting. One new element for Leaders to be aware of is the addition of a Pre and Post Survey for Diabetes PATH participants. The surveys will assess what participants have learned and the effectiveness of the workshops. Stay tuned for more details on the new data forms from MDHHS.
As you can see in this graphic, while our programs are aligned in many ways, there are some differences. For example, in EDC we are required to engage Medicare beneficiaries while Empowering Older Adults will target all seniors. EDC has a goal of nearly 4200 DSME graduates in Michigan by July 2019. Empowering Older Adults aims to graduate 2000 seniors by 2017.
As mentioned, both initiatives are using the Stanford University evidenced based DSME curriculum which in Michigan we refer to as Diabetes PATH.
Given MPRO’s history and long standing relationships with physician offices, our primary strategy is to engage providers to increase referrals to Diabetes PATH. Empowering Older Adults is taking a more community and consumer focused approach.
I could probably stand up here all day talking about the structure, research, and efforts of Diabetes PATH, but until you see and experience a workshop for yourself, it’s hard to appreciate the impact this program on individual people.
Last Monday, we completed Session 6 of a Diabetes PATH workshop in New Baltimore at a faith-based organization. I’ll let the video speak for itself.
Anne
To raise awareness about and participation in Diabetes PATH, MPRO as part of Lake Superior QIN, is taking a three phase approach.
We will first focus on filling the seats of existing diabetes PATH workshops across the state.
We will then focus on increasing the number of workshops and certified leaders in counties in Michigan with the greatest prevalence of diabetes,
The final step is to increase diabetes PATH workshops and leaders throughout the state.
I’ll now go into our marketing strategy to help us accomplish our goals.
One of our main areas of focus is to educate providers about Diabetes PATH and how they can incorporate referrals into their workflow.
We are currently developing a toolkit to be distributed to physician offices across Michigan. It will also teach them how they can host workshops in their office or community.
((change))
In exchange for increasing referrals to diabetes PATH, MPRO will offer a variety of technical assistance. We not only help providers align their work with different CMS electronic health record incentive programs, such as PQRS and Meaningful Use, but help them use EHR tools such as patient reminders and portals.
In the end, this all helps to improve the quality, safety and efficiency of health care in Michigan.
As I previously mentioned, we are working with PATH coordinators across the state to increase the number of participants, workshops and leaders.
This map illustrates the different PATH regions of Michigan. The seven target counties are outlined in black.
To help meet our goals, we have developed a variety of marketing tactics including: fliers, posters, prescription pads and the provider toolkit.
We also have a newsletter and templates for news releases and articles, which can be customized. In addition, we are promoting diabetes PATH on both MPRO’s and Lake Superior QIN’s social media accounts, which include Facebook and Twitter.
In the next few slides I will show you some examples of our tactics.
Many are currently available in English and in Spanish. And, if requested, we can make more materials in Spanish.
This two sided infographic explains what DSME is, the program structure, how to set up and workshop and, if interested, how to become a leader.
The target audience is any person or organization interested in hosting a workshop. This includes churches, community centers, senior apartments, health systems, employers, social clubs and so on.
We have samples of this flier and others on the MPRO Lake Superior QIN table in the exhibitor area.
This is our so-called prescription pad. It’s designed to be used by health care providers, including doctors, nurses and medical assistants. On the front, is a “prescription”to refer people with pre-diabetes or diabetes to a specific workshop in the area. The back side has easy to understand information about diabetes and how it affects a person’s entire body. It also offers tips to help manage diabetes and prevent complications.
This is an example of one of our large 11 by 17 posters.
These posters are available both electronically and hard copy. You can either type in or hand write the workshop location, time and dates. Or MPRO can do this for you.
We suggest hanging these posters in high traffic areas, near the location of the workshop.
For previous workshops, we hung posters in provider waiting rooms, community bulletin boards, libraries, pharmacies and even popular senior hangouts, including diners and donut shops.
This is one of our smaller 8 and a half by 11 posters. It’s one sided. And like all of our materials is available electronically and in hard copy. It can also be filled in by hand or computer.
We made smaller posters that can be easily printed from the standard home or office printer.
These are our half page fliers. They are two sided and are meant to be placed on a table or handed out to individuals.
We’ve stuffed these fliers into church bulletins, slid under doors at senior apartments and handed out at health fairs. Of course, with permission.
Again, we have samples available at our table and if you’d like more copies sent to you electronically or in the mail, please let me know!
Just to recap.
MPRO, as part of Lake Superior QIN is collaborating with partners to promote DSME throughout Michigan.
Our primary focus is Working with provider offices to increase DSME referrals.
We need your help in identify barriers and finding solutions.
Here is what we need from you:
How do we get people with diabetes to attend these classes?
What are the barriers?
Once we get them there, how do we keep them engaged?
Do you have any successful strategies from other programs you can share?
Please feel free to contact Sam or myself or give us some feedback during the Q and A at the end of the presentation or during one of the breaks.
Now, I’m going to turn it over to Mary Ablan, executive director of the Area Agencies on Aging Association of Michigan. Mary?
ANNE:
Thank you for your time today. We’re excited to work with 4-A-M and all of you to improve diabetes self-management in Michigan.
Again – if you have any questions, suggestions or would like marketing samples, please stop by our table or contact Sam or myself. Our emails are on the screen.
We also invite you to like and follow MPRO and Lake Superior QIN on social media.
