In the U.S., 18.8 million people have been diagnosed with diabetes, but more concerning is the estimated seven million people who remain undiagnosed, according to the 2011 National Diabetes Fact Sheet. Educating people about how to manage their diabetes allows them to better control the disease and understand the potential complications such as amputations, blindness and kidney failure.
The Centers for Medicare & Medicaid Services (CMS) selected the city of Meridian, Miss. for a special innovation project focusing on the high prevalence of diabetes and its associated complications, particularly within the African-American community.
Information & Quality Healthcare (IQH), the Quality Improvement Organization (QIO) for Mississippi, is coordinating this effort with the goal of reducing amputation rates and improving care through diabetes self-management education (DSME) classes provided at no cost to African-American Medicare beneficiaries.
IQH began its work on Oct. 1, 2012 by recruiting Meridian-based providers to participate in the project. Participants refer their eligible Medicare patients to DSME classes using tools provided by IQH, including sample standing orders for referrals to DSME classes, chart sticker reminders, monofilaments (for detecting neuropathy), and personal health records that encourage foot and eye exams for people with diabetes.
The IQH Project Leaders, Lisa Camel, R.N., B.S.N., and Willie Ann Thomas, R.N., B.S.N., made a point to get involved in the community and reach out to anyone that comes in contact with beneficiaries. IQH recruited 54 providers to participate.
Diabetes Empowerment Education Program
The DSME classes, held at a variety of meeting sites throughout the city, are taught by nurses trained in a curriculum based on the Diabetes Empowerment Education Program (DEEP), a participatory model that presents complex medical concepts in layman’s terms. The DEEP model uses props, pictures and interactive learning to engage beneficiaries, and makes a point of incorporating culturally-sensitive materials.
The program covers topics such as medications, nutrition, and monitoring foot and eye care. The interactive learning sessions include fun demonstrations such as a fast food meal illustrating the amounts of unhealthy ingredients using sugar, lard and salt as a visual aid.
Camel and Thomas have taught DSME classes in a variety of non-traditional settings such as senior housing apartments, activity centers, churches, Housing and Urban Development (HUD) sites and parks. “Because of their age and barriers to transportation, beneficiaries can’t always come to the classes, so we take the classes to them,” Camel said. “That’s one of the unique things about the DEEP model – you can take the props anywhere.”
A graduation is held for each completed DSME class. Every participant receives a certificate and is shown in a photograph featured in a local newspaper that reaches over 20,000 homes in the Meridian area. This has increased interest in meetings.
To track participants’ progress and the impact of DSME classes, IQH staff conducts follow-up calls at two-month intervals after graduation. As of June 30, 2013, foot exams have increased by 21 percent, and eye exams have increased by 15 percent. These percentages are likely to increase as follow-up is completed.
“It’s truly rewarding to see that the beneficiaries understand the information from our class and are applying it to their everyday lives,” Thomas said. “This project has helped improve the health of Meridian residents and may serve as a model program to improve diabetes self-management nationwide.”
IQH has been active in obtaining a signed proclamation from the mayor of Meridian in support of the diabetes project. The program graduated 178 African-American Medicare beneficiaries with diabetes. The program graduated 178 African-American beneficiaries with diabetes before the project concluded on Sept. 26, 2013.