Increasing Healthcare Provider Referrals for Diabetes Prevention

Submission Date: September 2014

Entry Type: Case Study

State/Territory Submitted on the Behalf of: Michigan

States/Territories Involved: Michigan

Funding Source: NACDD

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. 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 support partners in educating at least 50 healthcare providers to increase knowledge of prediabetes and to increase referral to local diabetes prevention evidence-based lifestyle change programs

Program Action:

The Michigan Diabetes Prevention and Control Program (DPCP) funded a small pilot project with six evidence-based lifestyle change program providers to pilot test referral processes. The goal was to increase healthcare provider referrals to the lifestyle change program. These pilot partners worked with healthcare offices, practices, and organizations to institute strategies to support and sustain provider referrals. Three partners also worked with local health department programs through Maternal/Child Health and WIC clinics and WISEWOMAN programs.

The primary intent of the pilot project was to establish local relationships with healthcare organizations and practices and to build sustainable systems to drive referrals to evidence-based lifestyle change programs. First, the pilot partners identified healthcare providers that were likely to be receptive to diabetes prevention programming. The partners contacted practices through phone calls, e-mail, and in-person meetings and presentations. Targeted educational/awareness materials, including the CDC provider brochure, were utilized. Once they had buy-in, the pilot partners worked with practice staff to identify and implement referral processes or tools. Methods varied across practices. Many began to use referral forms/logs and display consumer-focused marketing materials in exam rooms.

Throughout the project, the DPCP helped troubleshoot and assure movement toward institution of referral processes. The DPCP provided technical assistance mainly through phone calls, including a formal review call two months after contract initiation. In addition, the DPCP arranged for a referral system expert, Lynnzy McIntosh, to consult with pilot partners. Ms. McIntosh explained that before healthcare providers will refer, they must have an understanding of the program, trust in its evidence and credibility, trust in the relationships with the program provider, and receive regular updates on their referred patients. This advice greatly influenced the pilot partners’ work. For example, one developed a feedback loop in which healthcare providers referring to the lifestyle change program received four letters about their patients’ progress. A registration letter informing the referring provider of patient enrollment, 8- and 16-week updates, and an overall evaluation at program end were sent.
These efforts increased healthcare provider identification and referral of patients who could benefit from the lifestyle change program.
“Working with healthcare providers on referring their under-activated patients can change the mindset of the practice on the power of self-management support….not to mention transforming the life of the patient.”     -Lynnzy McIntosh, COAW

State Health Department Roles

• Engaged six evidence-based lifestyle change program providers to implement pilot referral project
• Shared CDC and other healthcare focused materials with pilot partners
• Provided technical assistance to pilot partners as they established relationships with healthcare providers and implemented referral processes
• Linked pilot partners to a healthcare provider referral expert for training and follow-up technical support
• Identified and facilitated relationships with state health department programs equipped to institute referral processes
• Clarified definition of referral system and desired outcome of the pilot project

Partners

• Pilot partner organizations
  • District Health Department #10
  • Hurley Medical Center
  • MedNetOne Health Solutions
  • Michigan State University Extension
  • University Pharmacy
  • YMCA of Marquette County
• Healthcare provider offices, practices, and organizations

Impact/Accomplishments:

• 19 Healthcare system partners
  • 88 Healthcare delivery sites
  • 220 Primary care providers at participating sites
• 79,623 Adult patients served by participating healthcare delivery sites
• 126 Adult patients in participating healthcare delivery sites referred to evidence-based lifestyle change program

Challenges/Lessons Learned:

Factors Supporting Success

• Dedicated Funding: $32,500
• Established network of committed partners that included evidenced-based lifestyle change program providers, Michigan Department of Community Health programs, and state and national organizations interested in working on diabetes prevention efforts
• Experience working with healthcare providers to increase referrals to the Stanford Chronic Disease Self-Management Program
• Built or expanded relationships with healthcare provider offices, practices, and organizations
• Four pilot partners worked with their existing healthcare partners
• Utilized messages and materials that were relevant to healthcare providers
• Achieved healthcare provider understanding of and trust in the evidence-based lifestyle change program
• Expert provided practical applications of key concepts and follow-up technical assistance as pilot partners worked with this project
• Created referral processes that were sustainable

Challenges and Solutions

Challenge: Evidence-based lifestyle change program providers needed a clear definition of a referral system and what constitutes a successful outcome
Solution: The DPCP provided additional education and technical assistance to assure lifestyle change program providers understood definitions, outcomes, and processes needed to achieve sustainable relationships with provider practices

Challenge: Project timeline allowed for implementation of provider referral processes but was too short to demonstrate long-term outcomes
Solution: While the data shown here reflects the project time period, the referral processes are in place and will continue

Challenge: Pilot partners were unsure of all the steps in the referral process and what was needed for ongoing capacity and sustainability
Solution: These pilot partners were encouraged to be prepared with actionable next steps and adapt established referral processes to fit the lifestyle change program

Next Steps:

The pilot partners will build upon their efforts and continue to educate healthcare providers on the diabetes prevention lifestyle change program

Program Areas:

Diabetes

State Contact Information:

MI
Jennifer Edsall
Michigan Diabetes Prevention and Control Program
(517) 335-8378
edsallj@michigan.gov

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