Increasing Healthcare Provider Referrals for Diabetes Prevention

Submission Date: September 2014

Entry Type: Case Study

State/Territory Submitted on the Behalf of: Washington

States/Territories Involved: Washington

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 work with providers enrolled in the Washington Healthcare Improvement Network to increase referrals to the evidence-based lifestyle change program.

Program Action:

The Washington Diabetes Prevention and Control Program (DPCP) partnered with the WHIN project to promote prediabetes awareness and provider referrals to primary care providers, case managers, and office systems managers. The Washington Healthcare Improvement Network (WHIN) offers training and improvement coaching to support primary care providers and practices in behavioral health/medical home development. Provider referral to evidence-based community programs is a part of the behavioral health/medical home model. WHIN primary care practices were encouraged to embed processes for referral to the evidence-based lifestyle change program into their clinical decision systems.

The DPCP and WHIN staff worked with providers enrolled in the WHIN project to increase referrals to the evidence-based lifestyle change program. The DPCP work was focused on raising provider awareness and developing referral processes. They also helped Washington State University (WSU) Extension align its diabetes prevention efforts with the WHIN project. With the DPCP’s support, WSU Extension trained lifestyle coaches to serve counties with WHIN primary care practices. WHIN practices were encouraged to refer to the evidence-based lifestyle change program sessions provided by these newly trained coaches.

Together with electronic health records (EHR) and other resources, the lifestyle change program can assist physicians in  meeting criteria for Patient Centered Medical Home (PCMH) and Meaningful Use. For example, referring patients to a lifestyle change program satisfies PCMH criteria such as providing educational resources or assisting in self-management and using an EHR to identify patient-specific education resources.

The DPCP also helped providers become more comfortable with referring to the evidence-based lifestyle change program and talking about the program in positive and realistic ways with patients. Washington Information Network 211 (WIN211) was available for patients and providers to use to find a nearby lifestyle change program. In areas without evidence-based lifestyle change program providers the DPCP worked with WSU Extension to train coaches and offer the lifestyle change program. The DPCP connected these newly trained lifestyle coaches to primary care practices enrolled in the WHIN project.

The DPCP used various methods to encourage WHIN primary care practices to focus on prediabetes: attended the WHIN kickoff meeting, displayed materials, made initial contacts, presented a webinar to WHIN practice providers and worked with WHIN staff to create an online learning system to reach providers statewide.

State Health Department Roles

• Collaborated with the WHIN staff to integrate prediabetes awareness and referral into the WHIN project
• Developed a provider brochure to increase prediabetes awareness
• Provided consultation and consumer-focused materials to the WHIN primary care practices
• Encouraged WSU Extension to align their diabetes prevention efforts with the WHIN project
• Facilitated connections between evidence-based lifestyle change program providers, WHIN primary care practices, and other referral sources/community providers
• Offered a webinar for WHIN teams in March, 2014, which provided information on prediabetes and referral information for DPP

Partners

• Washington Healthcare Improvement Network
  • State staff
  • Primary care practices and providers
• Washington State University Extension

Impact/Accomplishments:

• 1 Healthcare system partner
  • 45 Healthcare delivery sites
  • 308 Primary care health providers
• 250,000+ Adult patients served by these providers
• 5 Counties with primary care teams enrolled in the WHIN project
• 38% of Washington counties offer the lifestyle change program

Challenges/Lessons Learned:

Factors Supporting Success

• Dedicated Funding: $20,000
• Extensive experience and a strong reputation for working with healthcare providers to improve quality of care
• Long-standing, statewide network of organizations supporting the DPCP and its work
• Collaborated with the Washington Department of Health WHIN project
• Utilized a stepwise set of strategies to engage WHIN primary care practices
  • Attended the WHIN kickoff meeting and made initial contacts
  • Created/presented a webinar to WHIN teams
  • WHIN partners invested in an online learning system to educate healthcare providers statewide
• Linked WHIN primary care providers to an established mechanism for referrals (WIN211)
• Partnered with WSU Extension to assure the evidence-based lifestyle change program was offered in all WHIN counties

Challenges and Solutions
Challenge: Loss of essential staff increased the workload for remaining staff
Solution: Remained committed to this project and sought alternative resources

Challenge: DPCP was not able to meet with practices prior to their enrollment in the WHIN project
Solution: Met with WHIN colleagues to discuss ways to reach practices and next steps

Challenge: Initially the WHIN project focused on small community health practices, which do not have a large reach
Solution: As the healthcare landscape becomes more stable, WHIN will consider working with larger health systems to serve more people

Next Steps:

• Continue to coordinate with WHIN staff to provide information, materials and support to WHIN teams regarding prediabetes
• Expand information provided to WHIN staff to include DSME and CDSME referrals

Program Areas:

Diabetes

State Contact Information:

WA
Sara Eve Sarliker (SaraEve.Sarliker@doh.wa.gov) and Jeanne Harmon (Jeanne.Harmon@doh.wa.gov)
Washington Heart Disease, Stroke and Diabetes Prevention Program
360-236-3799
SaraEve.Sarliker@doh.wa.gov

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