Generating Healthcare Provider Referrals for Diabetes Prevention

Submission Date: September 2014

Entry Type: Case Study

State/Territory Submitted on the Behalf of: West Virginia

States/Territories Involved: West Virginia

Other Funding:

NACDD funding

Domain Addressed:

Community-Clinical Linkages, Health Systems Strategies

Public Health Issue:

• In WV, the diabetes prevalence is 13% and the prediabetes prevalence is 8.6%. 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.
• Many healthcare providers are not currently referring to the National Diabetes Prevention Program’s (National DPP) evidence-based lifestyle change program. One strategy to promote referrals to the lifestyle change program is to work with healthcare providers and practices to help providers easily refer their patients to the program.

Project Objectives:

To increase the number of primary care centers which routinely refer high-risk patients to the evidence-based lifestyle change program from 0-4.

Program Action:

The West Virginia Diabetes Prevention and Control Program (DPCP) worked with three health centers to pilot test a diabetes prevention referral system. The aim was to embed referral processes, including prediabetes identification and evidence-based lifestyle change program referral, into the delivery systems currently used by healthcare providers. These processes helped providers engage in conversations with patients about prediabetes risk and inform them about how they might benefit from the evidence-based lifestyle change program.

At project onset, the DPCP met with health center leadership to discuss how to address prediabetes in their patient population. Two factors facilitated health center buy-in: 1) better understanding of prediabetes and its impact on their patients, and 2) recognition that referral processes could help them achieve PCMH status or Meaningful Use goals. In order to accommodate the unique needs of each health center, the DPCP worked with them independently and suggested modifications to their current referral processes. While these varied, the overall system sought to first select start dates for the evidence-based lifestyle change program then refer eligible patients. The DPCP and WVU OHSR also applied an algorithm to mine electronic health record (EHR) data in order to help identify at-risk patients. The referral processes were evaluated throughout the project and revised as needed. A key revision was closing the “feedback loop.” The DPCP helped establish center-specific procedures to provide feedback to referring healthcare providers, including the type of information and frequency of feedback. Part of this process was the creation of a referral form that obtained patient consent to release information about their progress back to their referring provider. This change helped to sustain the referral processes by letting health centers and providers see the successes of the patients and the program.

“Most of the health centers did not have to change their current referral system to incorporate referrals to the lifestyle change program. This effort promises to be very sustainable.” -Jessica Wright, WV DPCP

State Health Department Roles

• Selected three pilot sites to test the referral system
• Provided CDC risk assessment, marketing materials, and talking points to health centers and evidence-based lifestyle change program providers
• Identified metrics of interest for health centers, such as how referrals fulfill the goals of Meaningful Use and Patient Centered Medical Home (PCMH) models
• Encouraged the development of formalized and clear policies, procedures, and partner roles for each referral system
• Convened meeting of trained coaches and other diabetes prevention partners to address barriers and solutions learned in implementing the evidence-based lifestyle change program
• Maintained ongoing communication with health centers to discuss issues and successes of the referral process
• Assessed the utilization of diabetes prevention referral processes within pilot sites

Partners

• West Virginia University Office of Health Services Research
• Community Health Centers and Free Clinics

Impact/Accomplishments:

• 3 Healthcare system partners
  • 8 Healthcare delivery sites
  • 32 Primary care health providers
• 11,332 Adult patients served by these providers
• 2,270 Adult patients identified as at-risk for prediabetes
• 261 Adult patients referred to evidence-based lifestyle change program

Challenges/Lessons Learned:

Factors Supporting Success

• Dedicated Funding: $109,000
• Partnerships with health centers and√Ǭ†evidence-based lifestyle change program providers
• Access to health center electronic health records via the West Virginia University Office of Health Services Research (WVU OHSR)
• Achieved necessary buy-in from pilot partners
• Tailored modifications to the health centers√¢‚Ǩ‚Ñ¢ current referral processes to allow for often minimal changes palatable to their healthcare providers
• Provided individual support to meet each health center√¢‚Ǩ‚Ñ¢s unique needs
• Evaluated and adapted processes continuously to adjust for challenges
• Recognized how provider referrals can meet PCMH standards, achieve Meaningful Use goals, and fit Affordable Care Act provisions
• Developed feedback protocol that aided in closing the √¢‚Ǩ≈ìfeedback loop√¢‚ǨÔøΩ
• Facilitated the addition of the evidence-based lifestyle change program to the list of referrals within EHRs in order to create referrals electronically
• Developed a process whereby EHR data was exported to a patient registry and analyzed to identify patients at risk for prediabetes/diabetes

Challenges and Solutions
Challenge with no solution yet identified: Some health centers voiced difficulty in recruiting patients who would commit to the program

Challenge: Participant progress was not relayed back to their providers
Solution: Worked with the evidence-based lifestyle change program partners to close the feedback loop and supply patient information to the referring healthcare provider

Challenge: Providers wanted to know the location of evidence-based lifestyle change program sites in their area; the DPCP did not have a coordinated way to collect or provide this information
Solution: Evidence-based lifestyle change program providers were given the option to include their information on a Google Map created by a local health department and linked to the DPCP’s website

Next Steps:

The WV Division of Health Promotion & Chronic Disease will be bringing together diabetes prevention stakeholders to assess progress and determine WV’s next steps.

Program Areas:

Diabetes

State Contact Information:

WV
Jessica Wright (Jessica.G.Wright@wv.gov) and Tony Leach (Tony.M.Leach@wv.gov)
West Virginia Diabetes Prevention and Control Program
304-356-4193
Jessica.G.Wright@wv.gov

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