PROGRAMS / INITIATIVES
Interventions for a Focused Diabetes and Chronic Kidney Disease (CKD) Disparities Project Introduction
The Tennessee Diabetes Self-Management Education (DSME) Project (September 2008 through September 2010) was co-sponsored by the Centers for Medicare & Medicaid Services (CMS) and the National Institutes of Health.
Tennessee has among the highest incidence and prevalence rates of type 2 diabetes in the United States; western Tennessee has the highest rates in the state and the gap between African Americans and Caucasians in Tennessee is substantial (greater than 120 percent throughout the last 20 years). Healthcare Management Solutions (HMS) worked with 40 physician practices to provide DSME to 1,500 Medicare beneficiaries. This project was slightly different from the other Every Diabetic Counts program in that it was designed to decrease the incidence of morbid diabetes outcomes, as well as the incidence of progression to chronic kidney disease. In addition to extensive partnerships, the project used health provider facilitators (called "Community Champions") to facilitate access to primary care practices. Community facilitators assisted in defining the community resources that were available and provided insight into how clinical practice could be effectively linked to public health interventions for the benefit of the patients.
Methods: HMS identified all primary care providers in Madison County and invited 43 primary care practices to participate in the project. From these practices, HMS recruited over 400 Medicare beneficiaries. These beneficiaries were then placed into education groups of at least 15 beneficiaries. Over the course of six weeks, HMS conducted two-hour classes each week. These classes covered nutrition, exercise, disease monitoring, medication management, using the CMS-approved DSME program.
Results: HMS recruited a total of 415 Medicare beneficiaries. During the course of the project, Medicare beneficiaries had a significant improvement in HbA1c (29 percent improvement), an increase in the number of diabetes retinopathy screening (16 percent), and improvement in lipid profile (significant improvement in 25 percent), and 30 percent had improved blood pressure measurements. Additionally, there was a significant improvement in measured diabetes self-management and improved attitudes towards having diabetes.
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LiPAK is a special study funded through a grant from the Centers for Medicare & Medicaid Services to eQHealth Solutions (formerly Louisiana Heath Care Review) – the Medicare Quality Improvement Organization for the State of Louisiana. The project is designed to reduce the high rate of amputation after catastrophic events. The target audience is African-American Medicare beneficiaries with diabetes. This two-year LiPAK special study (October 2009 – October 2011) is the only project of its kind in the country. Through LiPAK, free diabetes education that focuses on limb preservation is provided to Medicare beneficiaries living in Orleans and Jefferson parishes.
LiPAK enhances the current "Every Diabetic Counts" (EDC) program, which provides free nutritional and health education to African-American Medicare beneficiaries with diabetes in five parishes in Louisiana, including Orleans.
The study consists of developing and utilizing interventions that includes patient education aimed at preserving limbs and improving self care, especially when catastrophic conditions exist. The LiPAK Intervention Model uses a 2-pronged approach: patient education and physician behavior change. The components of the project are as follows:
- 500 African-American Medicare beneficiaries with diabetes
- Targeted Counties: Orleans and Jefferson parishes
- Uses the Diabetes Empowerment Education Program (DEEP) curriculum
- Includes Cognitive Behavior Theory (CBT) activities
- Additional foot care education is provided
- Includes a Diabetes Care Questionnaire
- Quarterly follow-up with Medicare beneficiaries is conducted
The project will be measured through:
- Feedback from African-American Medicare beneficiaries
- At least 85 percent of the targeted beneficiaries are to complete the DEEP curriculum
- A 20 percent increase in Medicare beneficiaries receiving foot exams from the primary care providers
- Identification of limb amputations/identification of a control group and preparation of a comparative analysis
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