Raising Awareness of Prediabetes among Healthcare Providers

Submission Date: December 2014

Entry Type: Case Study

State/Territory Submitted on the Behalf of: New York

States/Territories Involved: New York

Funding Source: NACDD

CDC Funding:

Yes

Other Funding:

NACDD funding

Domain Addressed:

Community-Clinical Linkages

Public Health Issue:

In New York State, 25-30% of the adult population, or 4.5 million people, are estimated to have prediabetes. Without lifestyle changes to improve their health, 15 to 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.

Healthcare providers do not always recognize and/or know how to best treat prediabetes. Raising awareness of prediabetes and the National Diabetes Prevention Program’s evidence-based lifestyle change program among healthcare providers can promote increased identification of individuals with prediabetes and facilitate provider referral to the lifestyle change program.

Project Objectives:

To begin dissemination of a modifiable toolkit through academic detailing to 8 small to medium practices (~50 providers) and 3 major health systems (~700 providers)  to promote DPP and increase awareness of prediabetes.

Create and advertise a web-based CME session for 100 providers on how to recognize and treat prediabetes, benefits and highlights of the DPP, and how to utilize to referral/enrollment process.

Program Action:

The New York Diabetes Prevention and Control Program (DPCP) partnered with P2 Collaborative of Western NY to create a
New York State Diabetes Prevention Program provider toolkit and a continuing medical education (CME) as part of their
healthcare provider awareness campaign. Toolkit materials were reviewed by stakeholders, including 24 physician
leaders from health systems and practice groups in Western New York. Once approved, materials were widely disseminated
to Western New York health providers through an academic detailing model.

The State Health Department roles:

• Convened key statewide stakeholders via webinar to promote the campaign
• Selected practices and providers to target for academic detailing
• Developed and utilized new relationships with health system partners to build a foundation for diabetes prevention
  referrals
• Connected with Quality & Technical Assistance Center (QTAC) (www.ceacw.org/qtac) to create an online portal to promote local evidence-based lifestyle
  change programs and to translate participant data into CDC-approved data files
• Trained evidence-based lifestyle change program coaches to serve Safety Net practices
• Provided technical assistance to evidence-based lifestyle change program coaches and coordinators
• Worked with P2 to facilitate referrals to the evidence-based lifestyle change program through 211, NY Connects,
  and the QTAC Portal

Partners:

• P2 Collaborative of Western New York
• New York State Department of Health
• New York State Quality & Technical Assistance Center
• County Office of the Aging Departments

The toolkit included information about the 211 referral system, evidence-based lifestyle change program benefits, and
how referral activity could assist providers in meeting the criteria for Patient Centered Medical Home 2011 and CMS
Stage 2 Meaningful Use. A clinical algorithm for prediabetes and type 2 diabetes and FAQs were also in the toolkit.
The materials were created by the DPCP and P2 Collaborative or adapted from other sources, such as the New York State
Department of Health. Key staff attended the National Resource for Academic Detailing training prior to the toolkit
dissemination in order to enhance provider presentation skills. Using the academic detailing, staff were able to reach
over 45 providers. Additionally, they used the toolkit and the academic detailing model to increase awareness among 15
churches, 4 employers, and 4 large community based organizations. These presentations led to strategic partnerships
which facilitated diabetes prevention referrals for at-risk patient populations.

“Robust relationships with diverse local and regional partners remain the most critical success factor in
realizing improvement in prediabetes awareness, diagnosis, referral, and participation in evidence-based diabetes
prevention programs.” -Sue Millstein

Data/Other Information Collected:

Number of sites/providers reached

Number of presentations

Impact/Accomplishments:

Partnered with 3 healthcare systems

• 7 Healthcare delivery sites
• 500 Primary care health providers
• 143,000 Adult patients served by these providers

Gave 48 presentations of the toolkit through academic detailing at 25 practice sites

Challenges/Lessons Learned:

Factors Supporting Success:

• Dedicated Funding: $50,000
• Leveraging existing relationships with healthcare providers
• Selecting a partner, P2 Collaborative, with experience and the know how to take an awareness campaign from development to dissemination
• Adopting existing materials with a proven track record of success
• Building trust with key stakeholders by incorporating them in the process through formative evaluation
• Identifying and highlighting advantages of stakeholder buy-in (e.g. PCMH)

Challenges & Solutions

• Challenge: Subcontract with P2 Collaborative took longer than anticipated, which put work with external vendors on hold
  • Solution: Continued to work internally and build partnerships that would be key in the execution of the campaign
• Challenge: Lack of agreement regarding physician reimbursement method deterred referrals
  • Solution: Met with health plans in the area which resulted in new health plans signing on and agreeing to a common payment structure
• Challenge: Two regional health plans would not agree to reimbursement of the evidence-based lifestyle change program
  • Solution: Assisted the health plans in enrolling their Medicaid population into locally run diabetes prevention programs

Next Steps:

Continue to utilize the academic detailing model in collaboration with statewide partners for additional healthcare provider prediabetes efforts.

Program Areas:

Diabetes

State Contact Information:

New York
Sue Millstein
New York Diabetes Prevention and Control Program
(518) 408-5142
susan.millstein@health.ny.gov

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