This article, focusing on data utilization, is part of a larger series surrounding the Centers for Medicare & Medicaid Services’ diabetes self-management program, Everyone with Diabetes Counts (EDC).
With a data-driven approach to quality improvement, Telligen, the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Colorado, Illinois and Iowa, is using observational and survey data from diabetes self-management education (DSME) classes to help recruit physicians into its Everyone with Diabetes Counts (EDC) program in Illinois.
EDC offers a six-week, evidence-based diabetes education program to improve health outcomes among beneficiaries from targeted populations. Gaining physician buy-in to the EDC program can be challenging, according to Merle Shapera, MS RD CDE LDN, a diabetes program specialist with Telligen in Illinois.
“Physicians respond positively to hearing how DSME makes a difference in beneficiaries’ lives. We have evidence demonstrating that the class empowers patients to modify behavior and reach goals they set with their doctor.”
To be eligible, providers need to meet certain criteria related to performance and health disparities within their patient population. QIN-QIOs must obtain permission from providers before sending them information on EDC and then have to await a response. In-person meetings can be difficult to schedule with physicians who understandably have limited availability.
Shapera said, “In the future, Telligen would like to use findings from pre- and post-DSME clinical outcome data to incentivize more providers to participate. Because those findings are not yet available, we are making use of qualitative and quantitative data from class to support physician recruitment.”
Quantitative data is gathered through a Patient Activation Survey (PAS) administered at the beginning and conclusion of the course to gauge how each individual’s diabetes-related knowledge, behavior and coping skills improve over the course of the program.
“I see improvements in class, as well as through the surveys,” Shapera said. “I listen to patients talk about diet and exercise. I know from the goals they set that they’re making progress. We see them making changes and meeting their goals, and that’s our message to the doctors.”
Shapera said classroom interaction offers the truest and most complete reflection of beneficiaries’ progress – and she wishes there were a standardized process for documenting and reporting that qualitative data. She added that right now, the PAS does not reflect the full scope of positive changes that trainers see in class. However, answers to three specific questions consistently show improvement: how often beneficiaries take their medication according to doctors’ orders, how often they check their feet for complications, and how confident they feel that they can make a plan with goals to control their diabetes.
Shapera explained that although the survey currently reflects a fraction of overall improvement, PAS data can help quantify DSME’s impact.
“Physicians respond positively to hearing how DSME makes a difference in beneficiaries’ lives,” Shapera said. “We have evidence demonstrating that the class empowers patients to modify behavior and reach goals they set with their doctor.”
By showing that DSME prompts positive changes in patients’ health, Telligen aims to help doctors understand the potential for improved clinical outcomes. Program leaders hope this will motivate more doctors to provide clinical data to help illuminate those outcomes. They also hope it will inspire providers to refer patients to DSME courses.
“They know that if they send patients to this program, they play a role in forwarding the understanding of the importance of diabetes education,” Shapera said.