How are Diabetes Educators REVITALIZING DSMES Programs Before They Close? Jodi Lavin-Tompkins MSN, RN, CDE, BC-ADM Director of Accreditation American Association of Diabetes Educators Chicago, Illinois Disclosure to Participants Notice of Requirements For Successful Completion Please refer to learning goals and objectives Learners must attend the full activity and complete the evaluation in order to claim continuing education credit/hours Conflict of Interest (COI) and Financial Relationship Disclosures: Presenter: Jodi Lavin-Tompkins, MSN, RN, CDE, BC-ADM No COI/Financial Relationship to disclose Non-Endorsement of Products: Accredited status does not imply endorsement by AADE, ANCC, ACPE or CDR of any commercial products displayed in conjunction with this educational activity Off-Label Use: Participants will be notified by speakers to any product used for a purpose other than for which it was approved by the Food and Drug Administration. Diabetes Education Accreditation Program DEAP Over 800 programs/ 2000+ sites Last year we saw 112 programs close for various reasons Reimbursement Lack of referral No Value perceived Speakers and Programs 1. Lynn M Kihm, RN,CDE Helen Newberry Joy Hospital and Healthcare Center, Newberry, MI 2. Megan Barriger, MA, RD, LD, CDE, MLDE Norton Healthcare, Louisville, KY 3. Julie Pierantoni, MSN, RN, CDE Sentara RMH Medical Center, Harrisonburg, VA 4. Becki Thompson, RN, BSN, CDE, MLDE & Kim Coy DeCoste RN, MSN, CDE,DE MLDE, FAA Department for Public Health Frankfort, Kentucky 1
Lynn M Kihm, RN,CDE Care Coordinator / Diabetes Specialist Helen Newberry Joy Hospital and Healthcare Center Newberry, Michigan Disclosure to Participants Notice of Requirements For Successful Completion Please refer to learning goals and objectives Learners must attend the full activity and complete the evaluation in order to claim continuing education credit/hours Conflict of Interest (COI) and Financial Relationship Disclosures: Presenter: Lynn M Kihm, RN,CDE - No COI/Financial Relationship to disclose Non-Endorsement of Products: Accredited status does not imply endorsement by AADE, ANCC, ACPE or CDR of any commercial products displayed in conjunction with this educational activity Off-Label Use: Participants will be notified by speakers to any product used for a purpose other than for which it was approved by the Food and Drug Administration. Care Coordination within Diabetes Education Accountable Care Organization: Improve health of participants; decrease spending Team Based Health Service Program for patients with chronic health conditions, developing a personalized plan of care. Target population: 2+ chronic diseases Unnecessary use of higher-cost services (E.D. and hospital readmissions) Adherence challenges to medical plan of care Adherence challenges to primary care follow-up Care Coordinator Role and Activities Transition of Care Partnering with Ambulatory Practice Chronic Care Management Primary Care Provider Specialty Care Test Results Medications & Pharmacy Care Givers Community Resources Education & Support Medical History Family Dedicated Care Coordinator Patient is the Center The Dilemma to Combine CDE position cut to part time and addition of Care Coordination DSMES lost its value with new Administration We as diabetes educators must sell ourselves and our services and areas you impact. 2
12 Months into the Combination Identify your worth to both Hospital Administration and Community: Your Clients/ Patients already value you Services that promote Standards of Care: Lab services, Primary Care Physician visits, Hospital Wellness Center Memberships Community Health Screening Be your best advocate to community: Present to community groups, DM Support Group, live or recorded radio talk show, Walk/Run for Diabetes (Fund Raiser); Motor Cycle and Classic Car Ride (fund raiser) Diabetes Awareness Month Activities: Glucose Meter Clinic @ local pharmacy Talk about both positions when presenting to community groups Cut back duties: Inpatient care( outpatient referrals only) ; Long Term Patient visits; Education and Training for Nursing staff for inpatient PCX( in house glucose meter system) Considered stopping DM Support Group, but did not Kept Foot Care Clinic one day per week and LPN position Changed my work schedule to 5 days /pay period for each position Keep my RN position who makes phone call follow up to review AADE7 1 day /week as needed, ~ 4 hours (will change to Clinic staff) Maximized my volunteer LPN who assisted 4 hours per week Continued with both Walk/Run and Ride for Diabetes fund raisers Always keep Administrator up to date about the good, bad, and successes! Conclusion Update as of last week: AADE program will not continue after recognition end date 12/2107, I have not given up yet. Continue as salaried staff and supervisor position for Foot Care Clinic and DSMEP staff but will move to Rural Health Clinic. Even with designated days I am in both positions daily, two different offices for billing purposes which will change with above changes and only bill for Care Management services. Unsure how billing will be for non Care Management diabetic patients, recommend continuing with AADE Recognition. I may have to discontinue other non outpatient services in the future. Megan Barriger MA, RD, LD, CDE, MLDE Program Coordinator, Diabetes Education Norton Healthcare Louisville, KY Disclosure to Participants Notice of Requirements For Successful Completion Please refer to learning goals and objectives Learners must attend the full activity and complete the evaluation in order to claim continuing education credit/hours Conflict of Interest (COI) and Financial Relationship Disclosures: Presenter: Megan Barriger, MA, RD, LD, CDE, MLDE - No COI/Financial Relationship to disclose Non-Endorsement of Products: Accredited status does not imply endorsement by AADE, ANCC, ACPE or CDR of any commercial products displayed in conjunction with this educational activity Off-Label Use: Participants will be notified by speakers to any product used for a purpose other than for which it was approved by the Food and Drug Administration. Welcome to Louisville! 3
Norton Healthcare 5 hospital campuses 3 class types- partner with 4 hospital RN Educators General group class- 48% show rate Gestational Diabetes- 88% show rate Pre-pump class- 84% show rate Norton Medical Group- over 300 providers 29 primary care offices 18 RN Navigators 3 RD/CDEs NMG Diabetes Task Force Senior leadership, primary care providers, Nurse Navigator, LPN, Diabetes Education Coordinator Revitalize diabetes care at NMG Quality diabetes education, Patient Navigation Standards of Care, EHR Optimization, Care Models Together2Goal Campaign T2G Patient Level Report Transition to Primary Care 1.5 FTEs increased to 3 RD/CDEs provide individual 60 minute appointments in primary care offices Linked to provider routine diabetes follow up Provider billing at Level 4 or 5 majority of visits Close care gaps- HEDIS Multidisciplinary team PCMH Recognition Moving Toward Quality and Quantity Greater access to patients Decreased delay in treatment changes from recommendations Increased show rate Multi-disciplinary care team Close HEDIS gaps- reimbursement Increase adherence to Standards of Care Outcomes and Future Directions Educations Show Rate 2016 (Annual) DSME Hospital 351 47% 2016 (July December) Primary Care 430 81% 2017 (January June) DSME Hospital 112 48% 2017 (January June) Primary Care 565 78% 2016 Fourth Quarter Review Primary Care 253 patient educations 0.54% reduction HgA1c 39 patients overdue for HgA1c 4
Julie Pierantoni MSN, RN, CDE Diabetes Education Program Coordinator Sentara RMH Medical Center Harrisonburg, VA Disclosure to Participants Notice of Requirements For Successful Completion Please refer to learning goals and objectives Learners must attend the full activity and complete the evaluation in order to claim continuing education credit/hours Conflict of Interest (COI) and Financial Relationship Disclosures: Julie Pierantoni, MSN, RN, CDE- No COI/Financial Relationship to disclose Non-Endorsement of Products: Accredited status does not imply endorsement by AADE, ANCC, ACPE or CDR of any commercial products displayed in conjunction with this educational activity Off-Label Use: Participants will be notified by speakers to any product used for a purpose other than for which it was approved by the Food and Drug Administration. Sentara RMH Medical Center 27 Four Sites Recognized (AADE) SRMH main campus Medical Homes East Rockingham Health Center (ERHC) South Main Health Center (SMHC) Timber Way Health Center (TWHC) (Mt Jackson Medical Center will open in September) 5
700 600 500 400 300 200 100 0 SRMH Referrals 220 186 225 198 2009 2010 2011 2012 Patient Centered Medical Home (PCMH) a team-based health care delivery model led by a health care provider that is intended to provide comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes the necessary care at the right place, at the right time, and in the manner that best suits a patient s needs https://www.pcmh.ahrq.gov PCP Model of Care Dietitian Lab Patient Nurses LPN/MA CDE Care Manager CDE set up as provider Initial visits 60 minutes Follow ups 30 minutes Individualized follow up according to needs Some patients have been followed for 3 years Leave hospital with PCP visit in 7-10 days and CDE visit 2-3 weeks. Use of license to max Office staff support of CDE 6
Curriculum SRMH Referrals 700 600 4 th QTR 500 430 400 300 200 220 186 225 198 277 100 0 2009 2010 2011 2012 2013 2014 700 SRMH Referrals 620 610 300 2016 Consults by Site 600 500 430 250 200 214 224 236 212 400 300 200 220 186 225 198 277 150 100 50 86 78 88 42 2015 2016 100 0 2009 2010 2011 2012 2013 2014 2015 2016 0 TWHC* ERHC SMHC RMH 2 3 days/mo 1 day/wk 2 days/wk 5 days/wk *began 4 th QTR 2015 Consults/Visits by Site How To Make It Happen 435 385 335 285 235 185 135 85 35 214 187 118 110 86 78 88 42 45 462 414 346 224 236 212 TWHC* ERHC SMHC RMH 2 3 days/mo 1 day/wk 2 days/wk 5 days/wk 2015 Consults 2015 Visits 2016 Consults 2016 Visits *began 4 th QTR 2015 Medical group/office champion Work out logistics Marketing Budget Establish Priority Redesign workload and roles less inpatient presence, more outpatient presence Keeping patients out of ED and hospital 7
Surprises Missing an underserved population with many complex, intense barriers to optimal glycemic control Its not, patients are not compliant, the barriers are too much to overcome, the systems are not friendly Successes Patients are receiving diabetes education that otherwise would not have driven to the hospital setting for education. No show rate is less than 10% at the clinic where as it was ~30% at the hospital. Ready access to the providers for discussion of complex diabetes care. Medical practice changed over the past two years Challenges CDE is a provider not office nurse Value as a resource, team member Inpatient vs outpatient how to articulate value Everyone wants us now! 2016-17 Quality Improvement Project Identify: Lack of evidenced based resources for people with prediabetes or high risk of developing diabetes + Community Needs Assessment FBS 100-125 A1c 5.7% - 6.4% Getting Started $10,000 grant from SRMH Foundation for pilot DPP $1400 grant from VDH for training for DPP 8
45 40 35 30 25 20 15 10 5 0 SRMH DPP 41 41 41 36 34 24 22 register commit continue register commit continue register* September (3 sites) January (3 sites) Summer (2) $20,000 grant from Anthem/VDH to implement automatic screening and referral form integration into EMR japieran@sentara.com Becki Thompson RN, BSN, CDE, MLDE DSME Coordinator Healthy Living with Diabetes, Kentucky Diabetes Prevention & Control Program, Department for Public Health Frankfort, Kentucky Kim Coy DeCoste RN, MSN, CDE,DE MLDE, FAA DSME Accreditation Coordinator Healthy Living with Diabetes Kentucky Diabetes Prevention &Control Program, Department for Public Health Frankfort, Kentucky 9
Disclosure to Participants Notice of Requirements For Successful Completion Please refer to learning goals and objectives Learners must attend the full activity and complete the evaluation in order to claim continuing education credit/hours Conflict of Interest (COI) and Financial Relationship Disclosures: Becki Thompson, RN, BSN, CDE, MLDE- No COI/Financial Relationship to disclose Kim Coy DeCoste, RN, MSN, CDE, DE, MLDE, FAA- No COI/Financial Relationship to disclose Non-Endorsement of Products: Accredited status does not imply endorsement by AADE, ANCC, ACPE or CDR of any commercial products displayed in conjunction with this educational activity Off-Label Use: Participants will be notified by speakers to any product used for a purpose other than for which it was approved by the Food and Drug Administration. Healthy Living with Diabetes KY Department for Public Health Why we went this route? Goals to increase availability and utilization of evidence based DSME Infrastructure was in place Local Health Departments (LHD) providing DSME since 1982 DSME Curriculum in place since 2000 Received AADE Award in 2001 System for training LHD to teach DSME Survey of LHD leadership and DSME providers Kentucky Counties Covered by DSME Programs Accredited by the American Association of Diabetes Educators or Recognized by the American Diabetes Association 2012 2017 13 LHD Branches Covering 54 Counties are part of the DPH Accredited Program as of July 2017 Process Completion of a Readiness Assessment Initial face to face training on HLWD program process and data system Additional data entry post initial DSME series to individual sites Site visits Monthly phone calls and yearly face to face meeting 10
Notebook and Forms Curriculum Comprehensive Curriculum Curriculum Pending Accreditation Branding Accredited Programs Branding Marketing Flyers 11
HLWD Struggles and Benefits Reimbursement Struggles Reimbursement Time to spend at branches Competing priorities at the branches Drs. & other providers referring Benefits Accreditation makes good DSME even better Measure outcomes more effectively State takes care of most of the administrative work Collaboration on CQI projects Major headache, challenge for us all. Working to help make our DSME sustainable Working with our State Employee Health Plan Kim Coy DeCoste, RN, MSN, CDE, MLDE, FAADE DSME Accreditation Program Coordinator kim.decoste@ky.gov Becki Thompson RN, BSN, CDE, MLDE DSME Coordinator becki.thompson@ky.gov Thank you to our Program Presenters! Questions? 12