Two Referral Systems for Diabetes Prevention

Submission Date: August 2014

Entry Type: Case Study

State/Territory Submitted on the Behalf of: Colorado

States/Territories Involved: Colorado

Other Funding:

NACDD funding

Domain Addressed:

Community-Clinical Linkages, Health Systems Strategies

Public Health Issue:

• 86 million (more than 1 out of 3) American adults have prediabetes, and 9 out of 10 people with prediabetes do not know they have it. In Colorado, 6% of adults identifited with having prediabetes. Without lifestyle changes to improve their health, 15 – 30% of people with prediabetes will develop type 2 diabetes within five years.
• The Diabetes Prevention Program research study showed that making modest behavior changes helped participants lose 5 – 7% of their body weight and reduced the risk of developing type 2 diabetes by 58% in people with prediabetes.
• Statewide, regional, or system-wide referral systems can connect people with prediabetes to the National Diabetes Prevention Program’s (National DPP) evidence-based lifestyle change program. Developing and implementing systems for referral of people at risk to sites offering the lifestyle change program is a sustainable strategy to increase use of this program.

Project Objectives:

To develop a system for referring people with prediabetes to the evidence-based lifestyle change program

Program Action:

To increase referrals to the evidence-based lifestyle change program, the Colorado Department of Public Health and Environment (CDPHE) established two referral systems – self-referral and healthcare provider referral.

Self-referral: CDPHE’s relationship with the ADA Colorado office helped them establish a partnership with the ADA hotline (1-800-DIABETES) to add the evidence-based lifestyle change program to their national hotline database and refer Colorado callers to the program. CDPHE trained hotline staff at ADA’s Center for Information and Community Support (CICS) to refer callers from Colorado seeking information on the lifestyle change program to a program near them. CDPHE contacted the Senior Manager at CICS monthly to share information about new organizations offering the evidence-based lifestyle change program, evaluate the number of callers asking about prediabetes, and troubleshoot the referral process. The American Diabetes Association is pleased to partner with CDPHE to promote and enroll patients in the National Diabetes Prevention Program (DPP) though our 1-800-Diabetes hotline. “The partnership aligns with one of the Association’s strategic priorities to improve outcomes for people with prediabetes.” -Sue Glass, ADA

Healthcare Provider Referral: CDPHE contracted with a quality improvement organization, HealthTeamWorks, to develop and implement Rapid Improvement Activities (RIAs) in health centers to educate the health center staff about prediabetes and the evidence-based lifestyle change program and to establish a provider-initiated referral system. RIAs are similar to academic detailing. The RIAs focused on increasing healthcare provider awareness of the importance of screening for prediabetes and referrals to the evidence-based lifestyle change program. Each RIA included facilitation of a one-hour, onsite training provided by a quality improvement coach from HealthTeamWorks. The coach provided monthly follow-up to assess progress on implementation and offer ongoing technical assistance. In addition, CDPHE hosted an evaluation workshop and webinar for evidence-based lifestyle change program providers. At these events, program providers were encouraged to continue communication with health centers and establish a “feedback loop” for referring healthcare providers to receive information on their patients’ progress in the lifestyle change program. Establishment of a “feedback loop” allows providers to see their patients’ success in the program and can help sustain the referral system.

 

State Health Department Roles

• Coordinated efforts to add the evidence-based lifestyle change program to the ADA consumer hotline
• Adapted marketing materials to include the ADA hotline
• Supported ADA hotline staff through training and providing up-to-date information on Colorado organizations offering the evidence-based lifestyle change program
• Acted as a liaison between HealthTeamWorks, health centers participating in RIAs, and evidence-based lifestyle change program providers
• Established tracking mechanisms to evaluate use of the referral systems
• Hosted an evaluation workshop and provided technical assistance on tracking referrals to the evidence-based lifestyle change program providers

Partners

• American Diabetes Association, Colorado
• HealthTeamWorks
• Evidence-based lifestyle change program providers
• Health centers participating in RIAs

Impact/Accomplishments:

• 2 Referral system partners
• 1.3 million Adults with prediabetes living in the geographic area covered by the referral systems
• 100% Of the evidence-based lifestyle change programs with “pending recognition” status were listed on the ADA hotline
• 11 Health centers completed RIA

Challenges/Lessons Learned:

Factors Supporting Success

• Dedicated Funding: $35,000
• Partnerships with ADA and evidence-based lifestyle change program providers
• Existing contract with HealthTeamWorks to execute RIAs
• Used relationship with Colorado ADA office to initiate partnership with the national ADA hotline
• Maintained regular communication between CDPHE and ADA hotline
• Advertised the ADA hotline throughout the media campaign
• Trained evidence-based lifestyle change program providers on establishing a “feedback loop” with referring healthcare providers

Challenges and Solutions

Challenge: Scheduling RIAs with clinics was difficult because the quality improvement organization wanted the evidence-based lifestyle change program provider to make the first introduction to the clinic
Solution: Despite state communication to evidence-based lifestyle change program providers about the value of the RIAs, program providers did not schedule RIAs until one provider that completed an RIA confirmed its value to others

Challenge: Needed a formal mechanism to evaluate the impact of the healthcare provider referral system
Solution: Held an evaluation workshop to help evidence-based lifestyle change program providers track and report referrals

Challenge: Media campaign for ADA hotline did not start until late into the project
Solution: Planned to continue and expand the media campaign using new federal funds

Next Steps:

• Continue to promote the 1-800-DIABETES hotline as a way to find out about evidence-based lifestyle change program sites in Colorado
• Continue regular phone meetings with the 1-800-DIABETES hotline staff to update them about the programs in Colorado
• Promote the importance of establishing referral networks with local health systems to Colorado’s CDC-recognized lifestyle change program coordinators during bi-monthly meetings

Program Areas:

Diabetes

State Contact Information:

CO
Kelly McCracken
Colorado Department of Public Health and Environment
303-692-2512
kelly.mccracken@state.co.us

<< Back to All Success Stories