Company

LOGO Barton County Memorial Hospital

Providing DSMT in Group Visits in Rural Healthcare Clinics

Leisa Blanchard BSN, RN, CDE, CPT

Eden Ogden BSN, RN, CDE

AADE Annual Meeting 2009Atlanta, Georgia

Session Outline

1. Objectives 1. Objectives

2. Patient Diabetes Education Group Visit2. Patient Diabetes Education Group Visit

3. Plan and Evaluate Patient Education 3. Plan and Evaluate Patient Education

4. Discuss Patient Education Developments4. Discuss Patient Education Developments

Support for this presentation has been provided through a Better Self-Management of Diabetes grant from the Missouri Foundation for Health

Objectives

Presenters will:• Describe a group visit format in rural healthcare

clinics for a non-traditional education program• Discuss the effective implementation of a

wellness and diabetes education program in rural healthcare clinics

• Discuss the opportunities available for non-traditional diabetes education and how to organize a program

• Demonstrate use of outcomes data to support the validity of such programs

Our Mission at BCMH

To provide personalized, humanistic, consumer-

driven healthcare in a healing environment; to empower individuals and families to be actively involved in decisions affecting their care and well-being through information and education; and to provide leadership to improve the health of the community we serve.

Our Journey

A Need

A Program BeginsADA Recognized

2002

PRIMARISCommunity

Care Connection

2004

Missouri FoundationFor Health - Better Self-Management of Diabetes Grant

2006

Barton County Diabetes Education

BSMOD Grantee Map

Program

Inpatient

Group Visits inClinics

Outpatient

Focus

DSMT Group Visits

Organize TreatEducate Evaluate

Program Partners

Physician

CDE Nurse Practitioner

Dietitian

Counselor

Rural Healthcare Clinics

Group Visit

Who Is Served

UninsuredUninsured

Under-insured Under-insured

These services are billable as a physician visit These services are billable as a physician visit

How often? Diabetes wellness visits recommended every 3 months

How often? Diabetes wellness visits recommended every 3 months

Program Design

Acute Care Visit

Wellness Visit

VS

Program Design by Clinics

Patient Rotates to Program Partners Patient Rotates to Program Partners

Program Partners Rotate to Patients Program Partners Rotate to Patients

Program Design

• Patient selection

• Invitation to participate in a “group wellness visit”

• Reminder letter sent two weeks prior to scheduled group visit– Includes request for patient to have labs done

prior to group visit

• Phone reminder the week of the visit

Lockwood Clinic

Lockwood Clinic

Group Visit Content

Presentation Stations Exam Evaluation

•Group Education Presentation

•DVD’s

*Folders*Handouts*Samples*Meters

•Ht. Wt. BMI BP

•Medication/Lab Review•Meal Plan•Foot Exam•Depression

Screen

Diabetes Wellness Visit with Physician or Nurse Practitioner•Med changes•Referrals•Labs•Resources

•Evaluate Pt. Outcomes•Pt Evaluates Group Visit•Providers Evaluate Group Visit•Set/Evaluate Goals

Presentation Curriculum

• Diabetes Overview• Goals for Control• Meal Planning• Label Reading• Holiday Eating• Benefits of Exercise• Monitoring• Stress Management

• Problem Solving• Sick Day

Management• Complication

Prevention• Caring for Feet• Traveling with

Diabetes• Etc.

Plan and Evaluate Patient Education

Followed Meal Plan5 or more servings of

fruits and veggiesPhysical Activity

Testing blood sugar Minutes of moderate

physical activityTake medications/insulin injectionsHemoglobin A1cEye/Foot ExamsQuestions????

Followed Meal Plan5 or more servings of

fruits and veggiesPhysical Activity

Testing blood sugar Minutes of moderate

physical activityTake medications/insulin injectionsHemoglobin A1cEye/Foot ExamsQuestions????

Hemoglobin A1cFollow Meal Plan

Maintain/Lose WeightCheck Feet

ExerciseStop Smoking

Support NetworkCheck Blood SugarYearly Eye Exam

Hemoglobin A1cFollow Meal Plan

Maintain/Lose WeightCheck Feet

ExerciseStop Smoking

Support NetworkCheck Blood SugarYearly Eye Exam

Blood GlucoseLipids

Hemoglobin A1cMicroalbumin

EyesBlood Pressure

Feet

Blood GlucoseLipids

Hemoglobin A1cMicroalbumin

EyesBlood Pressure

Feet

Goals for Control Goals for Control Goal SettingGoal Setting Tell Us How You’veBeen Doing

Tell Us How You’veBeen Doing

Patient Handouts

• Goals for Control– Blood Glucose Level– A1C– Blood Pressure– Lipids– Microalbumin

• Goal Setting – Pick at least one to work on

• Tell Us How You Have Been Doing– On how many of the last seven days did you….

• Followed your eating plan?• Eat five or more servings of fruits and vegetable?• Do physical activity of moderate intensity? How many minutes?• Check your blood sugar as recommended?• Take your recommended medications?

BSMOD Tracking Measures

• Percentage of patients with:– A1C <7%– LDL <100 mg/dl– BP <130/80 mmHg– Average BMI of Patients– Two A1C’s within the last 12 months– Foot exam in the last 12 months– Dilated eye exam in the last 12 months– Documented self-management support goals– Follow-up rating of “4” in at least one goal

Group Appointment Evaluation

Excellent Very Good Good Fair Poor

Info & advice88% 6% 6%

Personal attn88% 6% 6%

Group leaders88% 6% 6%

Involved in care 88% 12%

Medical needs met 87% 13%

Questions answered 87% 13%

Overall group visit 94% 6%

Provider Satisfaction SurveyNot at All

Satisfied

Somewhat Satisfied

Very Satisfied

Extremely Satisfied

Staff helping patients manage their chronic illness?

63% 37%

How satisfied do you think your patients are? 75% 25%Staff involving patients in their own care? 63% 37%Self-management goals assessed in a standardized manner?

13% 50% 37%

Tools & protocols making difference in outcomes? 13% 37% 50%

Format allowed effective care? 13% 37% 50%

Better Self-Management of DiabetesPrimary Care Resources and Supports SurveyPatient Support Scores

1 2 3 4 5 6 7 8 9 10

Individualized Assessment

SMS Education

Goal Setting

Problem-Solving Skills

Emotional Health

Patient Involvement

Patient Social Support

Link to Community Resources

Jul-07 Jul-08 Jul-09

Score

1 2 3 4 5 6 7 8 9 10

Continuity of Care

Coordination of Referrals

Ongoing QI

Systems for Documenting SMS

Patient Input

Integration of SMS into Primary Care

Patient Care Team

Education and Training

Jul-07 Jul-08 Jul-09

Better Self-Management of DiabetesPrimary Care Resources and Supports SurveyOrganizational Support Scores

Score

Better Self-Management of DiabetesPrimary Care Resources and Supports SurveySupport Score Totals

8 16 24 32 40 48 56 64 72 80

Patient Support Score

Organizational SupportScore

Jul-07 Jul-08 Jul-09

Benefits

• Patients use ancillary services

• Referrals increase by word of mouth

• Patients are healthier and better informed

• Hospitalizations are decreased

• Patients build relationships with providers

Sustainability

• A recognized program can bill for DSMT– ADA– AADE

• Community– Conversation Maps– Health Fairs– Group Visits– Wellness Program– Collaboratives– Community Education Presentations

• Grant Acquisition– Networking– Increased Credibility/Visibility– Improved Programming/Policy Change

Questions

?

??

Contact Information

Barton County Memorial Hospital29 NW 1st LaneLamar, MO 64759417-681-5100

• Leisa Blanchard BSN, RN,CDE, CPTDiabetes Education Coordinator417-681-5259lblanchard@bcmh.net

• Eden Ogden BSN, RN, CDEGrant Manager417-681-5258eogden@bcmh.net