The Everyone with Diabetes Counts (EDC) Program is targeting Medicare beneficiaries within racial/ethnic minority populations and geographically underserved rural communities. The current program led by Quality Innovation Network (QIN)-Quality Improvement Organizations (QIO) began in August 2014 and will continue through July 2019. The EDC program is measuring changes in the participants' clinical measures and perceived ability to self-manage diabetes as a result of receiving community-based Diabetes Self-Management Education (DSME).
Physical and geographic accessibility for trainers:
- Distance learning to train educators and interactive audio-visual equipment for train-the-trainer classes will allow more CHWs and diabetes educators to take part in and complete their respective programs.
Project Aggregate (August 2014) to date (October 2017)
|Number of beneficiaries who have completed DSME||42,511|
|Number of physician/provider practices, clinics, FQHCs, and MA plans recruited to participate in EDC Program||2,804|
|Educators trained on the approved DSME curricula||4,908|
|Through Technical Assistance provided by the QIN-QIOs increased number of AADE-accredited or ADA-recognized diabetes education programs||185|
Self-Reported Demographic Profile/Patient Activation Survey (PAS) Results
NOTE: Data to become available at a later date.
The participants' self-efficacy, knowledge, and attitude towards self-management of diabetes is measured through completion of a 14-question patient activation survey (PAS) administered both pre- and post- DSME class. The survey is written for a third-grade reading level, in both Spanish and English.
NOTE: Clinical data collected by QIN-QIOs will become available at a later date.
ADA Standards of Medical Care in Diabetes
The American Diabetes Association's (ADA) Standards of Medical Care in Diabetes is updated and published annually in a supplement to the January issue of Diabetes Care, formerly called Clinical Practice Recommendations for diagnosing and treating adults and children with all forms of diabetes. Measures used for the EDC analysis will be assessed using the ADA clinical guidelines.
The hallmark of comprehensive diabetes care is preventing diabetes complications. Unmanaged diabetes can affect many body systems and lead to serious complications such as heart disease, stroke, hypertension, blindness, kidney disease, nervous system disease, and amputations. A comprehensive approach like EDC's can reduce or slow the progression of complications by improving the levels of blood glucose (HbAlc), blood pressure and blood lipids. It can also as encourage people with diabetes to seek appropriate clinical testing in a timely manner. Additionally, modest improvements have been shown to significantly impact individual and population health by reducing morbidity, mortality, and overall health care costs. For example:
National Committee for Quality Assurance (NCQA). 2013. Improving Quality and Patient Experience: The state of health care quality 2013.
Centers for Disease Control and Prevention (CDC). 2011 Diabetes Public Health Resource. 2011 National Diabetes Fact Sheet.
Led by QIN-QIOs throughout the country, the EDC program is driven by multi-faceted approaches to outreach, partnership building, sustainability, and addressing cultural competency. Highlights include:
- In general, every percentage point drop in Hba1C blood test results (e.g., from 8.0 percent to 7.0 percent) can reduce the risk of microvascular complications (eye, and nerve disease) by 40 percent.
- Controlling blood pressure to 140 (systolic or top number) lowers heart disease risk by 33 to 50 percent, and lowers eye, kidney and nerve disease risk by about 33 percent.
For every 10-point reduction of systolic blood pressure, risk of any diabetes complication is lowered by about 12 percent. Based on all evidence to date, blood pressures lower than 140 are not related to significant reductions in complication risk. However, for some individuals , lower targets may be beneficial.
- Reducing diastolic blood pressure from 90 mmHg to 80 mmHg in people with diabetes reduces the risk of major cardiovascular events by 50 percent.
- Detecting and treating early diabetic kidney disease by lowering blood pressure can reduce the decline in kidney function by 30 to 70 percent.
- Improved control of LDL cholesterol can reduce cardiovascular complications by 20 to 50 percent (CDC, 2011).
- Through an affiliation plan with a local community college offering community health workers (CHW) certification, students have the opportunity to participates in DSME lay leader training. Once they complete the training, students are offered internships in the EDC program. Internships allow students to obtain marketable employment skills while the EDC program simultaneously builds a sustainable infrastructure.
- A QIN-QIO implementation an aggressive marketing campaign using Spanish-language radio and social media to recruit among the Hispanic population, as a large portion of this population relies on Spanish-language media outlets for health information.
- Health fairs used to enroll large numbers of beneficiaries in DSME classes.
- Lack of trust by the target populations in certain regions has made it difficult to recruit participants. Educators who reside in those hard-to-reach communities are recruited to teach DSME classes in their neighborhoods and at faith-based organizations. This grassroots approach has shown success in improving the communities' trust, increasing participation in DSME classes.
- Local physicians, pharmacist, clinics, and endocrinologists are instrumental in endorsing the EDC program by utilizing "prescription pads" from the QIN-QIO to "prescribe" diabetes self-management education to patients.
- Certified diabetes educators (CDEs) in several states have increased in number due to the QIN-QIO facilitation of CDE exam study groups. One QIN-QIO has been able to increase the numbers of CDEs in their state by 15 percent.
- A QIN-QIO has facilitated the increase in the numbers of AADE-accredited and ADA-recognized diabetes education prorams by assisting 10 organizations with this process.