Kentucky Diabetes Centers of Excellence

Submission Date: December 2013

State/Territory Submitted on the Behalf of: Kentucky

States/Territories Involved: Kentucky

Domain Addressed:

Community-Clinical Linkages, Health Systems Strategies

Public Health Issue:

• Care coordination, diabetes self-management education and promoting changes in the health care system are effective strategies for improving the delivery of preventive services and clinical care, helping to improve health outcomes for people with diabetes.

Program Action:

• A portion of an increase in state diabetes funds was designated for establishment of regional Diabetes Centers of Excellence (DCOEs) in Kentucky, building on an existing state-funded local health department component. The Kentucky Diabetes Prevention and Control Program (KDPCP) took the lead in designing specifics for the program selecting six local health department centers using a request for proposal process.
• The DCOEs targeted Medicaid recipients with the goal of improving self-management skills, preventive care measures, and health systems changes related to diabetes, as well as controlling costs for Medicaid. They provided no clinical services focusing instead on education and care coordination services.
• The implementation of Medicaid Managed Care in Kentucky as well as decreases and changes in Department of Public Health funding, led to discontinuation of the DCOE project.  Despite this, local health department sites continue to utilize variations of the model and lessons learned in their diabetes prevention and control efforts.

Impact/Accomplishments:

Improved diabetes care outcomes resulting from establishment of the Centers of Excellence include:

• 40% of non-compliant^a patients had improvement in medication compliance^b
• 50% of patients with poor glycemic control had increased SMBG monitoring frequency
• Foot exams increased from 36% to 71%
• Eye exams increased from 24% to 54%
• Flu vaccination increased from 37% to 66%
• Pneumococcal vaccination increased from 33% to 49%
• 74% with 2 or more A1Cs recorded in the system

Improved health outcomes resulting from establishment of the Centers of Excellence include:

• 54% of patients with diabetes had 1 point or more decrease in A1C
• Average A1C decreased from 10.2% to 8.8%^{a-Non-Compliance = Missing/skipping their diabetes medication 2-3 times a week or more}b-Compliance = Never missing diabetes medication or missing less than once a week.

  ^{c-Poor glycemic control = A1C baseline above 9%}

Program Areas:

Diabetes

State Contact Information:

KY
Becki Thompson, RN, CDE
Kentucky Department for Public Health
502-564-7996, ext. 4444
becki.thompson@ky.gov

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