One-Stop Shopping Leads to Better Health
GREENVILLE, N.C., March 22, 2012 /PRNewswire-USNewswire/ — More than 8 percent of U.S. adults have diabetes. In North Carolina, the rate is even higher, at 9.6 percent. Among the state’s African American adults, the rate is a staggering 15.6 percent. In rural eastern North Carolina, the toll is even greater: the adjusted mortality rate from diabetes is 42 times higher than in other areas.
Ten years ago, a small group of clinicians, diabetes educators and practice managers from University Health Systems of East Carolina and East Carolina University’s Department of Family Medicine began meeting to find ways to stem this devastating tide of chronic disease. They focused on redesigning the way they delivered care to low-income, African American patients with type 2 diabetes.
In 2008 the team began a study, E-Care-Diabetes, funded by Finding Answers: Disparities Research for Change, a national program of the Robert Wood Johnson Foundation that evaluates the impact of interventions aimed at closing racial and ethnic gaps in care, with a particular focus on cardiovascular disease, depression and diabetes. The randomized trial found that African American patients with diabetes at clinics using on-site educator/coaches had significant sustained improvements in A1c and lipid levels versus those in control clinics.
The results were clear — patients did better when they had face-to-face interaction with diabetes educators, a resource difficult to provide consistently in scattered rural clinics where patients have poor access to transportation. Patients also did better when they could benefit from one-stop-shopping – being seen by diabetes educators at the same time they were seen by their doctors.
At Vidant Health in eastern North Carolina (the former University Health System), where the initial study was conducted, the data was compelling enough to move the study from page to practice right away. Vidant has decided to incorporate same-day diabetes education and health coaching into clinics throughout their system. Over the next couple of years, clinics will have an educator-coach rotating into the practice to counsel patients with diabetes as part of the office visit. By sharing these coaches, the practices also share the cost of a skilled diabetes clinician–making this strategy uniquely well-suited to medically underserved communities, where clinics often can’t afford a full-time diabetes educator.
Paul Bray, MA, LMFT, quality program manager for community-based care with Vidant Medical Group and the project’s coordinator in partnership with East Carolina University, says that paying for rotating educator-coaches is still “a work in progress,” but the Affordable Care Act’s emphasis on rewarding outcomes and penalizing inappropriate hospital readmissions is encouraging.
“Even if we can’t always bill directly for it right now, we can keep patients healthier and save money that would have been spent treating complications,” Bray says. “In a reformed payment environment, we think this is going to be a sustainable approach.”
The benefits to patients can be seen at every visit, where personal interaction and the ability to spend a little more time with patients can have life-altering results. Certified Diabetes Educator Lori Goodwin gives a good example, “There was one patient recently who told the physician he was using insulin every day, but his A1c was persistently elevated. So I dug a little deeper and asked about timing and dosage. It turns out he was cutting the insulin dose in half because he couldn’t afford it. So, I helped him enroll in a Patient Assistance Program and now he has it delivered to his home. His A1c is down and he is doing great. But that’s something that could have been missed.”
Finding Answers is a national program of the Robert Wood Johnson Foundation at the University of Chicago, which awards and manages research grants totaling $8 million to health care organizations implementing interventions aimed at reducing disparities. The funds are used to evaluate the interventions and their potential for real-world implementation. This initiative encourages health plans, hospitals and community clinics to focus on racial and ethnic disparities as a priority in their quality improvement agendas. To learn more about Finding Answers, visit www.solvingdisparities.org
The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. For more than 35 years, the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. For more information, visit www.rwjf.org.
SOURCE Finding Answers