Aligning to Improve Outcomes: The Alliance to Reduce Disparities in Diabetes A presentation from a symposium at the Centers for Disease Control and Prevention’s (CDC) Division of Diabetes Translation's (DDT) 34th annual Diabetes Translation Conference on April 11-14, 2011 in Minneapolis, Minnesota.

1. Diabetes Equity Project
Dallas, Texas
CDC 2011 Diabetes Translation Conference
Minneapolis, MN
April, 2011
www.alliancefordiabetes.org

2. Diabetes Equity Project (DEP)
• Primary Goals
– To support physician volunteerism in Dallas
County by providing a standardized approach
to diabetes self-management training &
advocacy for diabetic patients receiving care
in volunteer charity clinics
– To expand the role of Community Health
Workers to a chronic disease management
support/adjunctive function
http://www.youtube.com/watch?v=jYr2IkB0UZc
This project was supported by a grant from The Merck Company Foundation through its Alliance to Reduce Disparities in Diabetes program.

3. Diabetes Equity Project (DEP):
Interventional Strategy
• Intervention Program
– Patient Relationship Expansion
• Community Diabetes Education Program (CoDE™)
• One-on-One format - Up to 7 patient contacts per year
– Culturally competent relationship-based program delivery
• Treatment adherence & disease control troubleshooting
– Knowledge Transfer Expansion
• ADA Standards of Care & AADE’s 7 Self-Care Behavior
Education
– System Expansion
• Disease registry management – Targeted patient recall (VIPs)
• Regular physician reporting – Fax, Scanned, HIE
3

4. DEP Early Results:
Race & Ethnicity Demographics - 2010
0.4% White
9.6%
16.4% White/Hispanic
0.6%
Non-White 68.7% Hispanic
Hispanic
14.2%
Black/Hispanic
53.9% African American
Other
N = 475 (10/1/09 – 9/30/10) 4

5. DEP Early Results:
Preferred Primary Language - 2010
N = 514 (10/1/09 – 9/30/10)
5

6. DEP Early Results:
Educational Level Achieved - 2010
N = 161 (10/1/09 – 9/30/10)
6

7. DEP Early Results:
Diabetes Control – Dec.09 – Mar.11
Diabetes Equity Project
Percent of Patients with A1c<7
Includes Patients with 2 or More Visits Through 3/11/2011
N=710
60%
50% 55.0%
51.4%
% Pts. with A1c<7
46.9%
40%
30%
30.8%
20%
10%
0%
DEP DEP HTPN Minnesota
Initial A1c Most Recent A1c
•DEP Data from DiaWeb and includes patients enrolled through 2/24/11 and patient visits up through 3/11/10.
•Minnesota Community Measurement and Minnesota Department of Health. 55.0% (A1c < 7) 2009 data - Includes patients from 1/1/2008 through 12/31/2009 with two
or more visits coded with a diabetes ICD-9 code, and has been seen within 7/1/2008 through 12/31/2009 once regardless of any diagnosis code . Measured annually.
http://www.health.state.mn.us/diabetes/pdf/FactSheet2010.pdf.
•HealthTexas Provider Network Decision Support EHR Audit Report Dashboard. Percentage of Patients with A1c Control. Includes patients with two or more patient
visits at least 7 days apart. December 2010 Audit

8. DEP Early Results:
Glucose Control - Dec.09 – Nov.10
Mean A1c
9
8.7
8.5
8
7.5 7.4
7.1 7.1 7.1
7
6.5
6
Baseline 3 Months 6 Months 9 Months 12 Months
N=351 N=233 N=131 N=73 N=43
* For patients with at least two A1c measurements. Change from baseline is statistically significant (p-value <.001) at 3,
6, 9, and 12 months.
8

9. DEP Early Results:
Disparity Reduction – Dec.09 – Nov.10
DEP helps avoid disparities in diabetes care:
• No differences in “improvement” of Diabetes Control
between:
– “Minorities and Non-Minorities”
– Males and Females
– Persons of different age groups
– Location where DEP operated
Non-Minority = White & Non-Hispanics; Minority = Non-White & Hispanics
* P-Value < 0.0001

10. DEP Early Results:
Patient Attrition Rate - Sept.09 – Nov.10
• Attrition Rate = 18.5% (123 patients)
– No Show – 40.7%
– Ineligible – 24.4%
– Patient Relocated – 17.9%
– Scheduling Conflicts – 5.7%
– Patients opted out – 4.1%
– Lack of Transportation – 2.4%
– Mortality – 2.4%
– Other – 2.4%
*Note: For patients that left the program, the average of the most recent A1c measure was
8.5. Specifically, for those patients who had 2 or more visits, the average of the most recent
10
A1c measure was 8.1.

11. DEP Early Results:
Blood Pressure Control - 2010
Diabetes Equity Project
Percent of Patients with BP<130/80
Includes Patients with 2 or More Visits Through 12/31/2010
N=578
60%
50% 56.0%
50.7%
% Pts. With
BP<130/80
40%
41.7%
30%
20%
10%
0%
DEP HTPN Minnesota
•DEP Data from DiaWeb and includes patients enrolled and patient visits through 12/31/2010.
•Minnesota Community Measurement and Minnesota Department of Health. Includes patients from 1/1/2008 through 12/31/2009 with two or more visits coded with a
diabetes ICD-9 code, and has been seen within 7/1/2008 through 12/31/2009 once regardless of any diagnosis code . Measured annually.
http://www.health.state.mn.us/diabetes/pdf/FactSheet2010.pdf.
•HealthTexas Provider Network Decision Support EHR Audit Report Dashboard. Includes patients with two or more patient visits at least 7 days apart. December 2010
Audit

12. DEP Early Results:
Improving Service Quality – Top Box Scores
Total
100%
98%
Top Box %
96%
94%
92%
90%
Oct-09 Dec-09 Feb-10 Apr-10 Jun-10 Aug-10 Oct-10
N 121 82 133 108 62 65 221 151 165 154 194 216 224 165
4 question survey administered to all patients after each visit.
1. Were you treated with respect today?
2. During today’s visit, did you increase your understanding of diabetes care for yourself?
3. Do you feel that you could call the DHP to ask questions about the care of your diabetes?
4. How likely would you be to recommend this program to one of your friends or family who has
diabetes?
•Comments for staff improvement?
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13. Diabetes Equity Project (DEP):
Next Steps - #1
• Reduce % of DEP enrollees with A1c > 9%
– Utilize diabetes registry to identify patients with
Hgb-A1c > 9%
– Leverage patient relationship to identify “new
levers” influencing adherence & compliance
– Link patients with clinic-based Advanced Nurse
Practitioners increasing RX management
efficiency
• “Case management” approach utilizing Diabetes
Health Promoters (pilot 2 sites in 2011)
13

14. DEP Early Results:
Reduced Patients in “Poor Control”
Diabetes Equity Project
Percent of Patients with A1c>=9
Includes Patients with 2 or More Visits Through 3/11/2011
N=710
50%
% Pts. with A1c>=9
40%
38.3%
30%
20%
21.3%
10%
0%
Initial A1c Most Recent A1c
.
•DEP Data from DiaWeb and includes patients enrolled through 2/24/11 and patient visits up through 3/11/10.

15. Diabetes Equity Project (DEP):
Next Steps - #2
• Results suggest promise for applying
DEP to privately insured patient
population
– Introduced to Baylor’s private physician practices
(HealthTexas – 450+ physicians)
– HTPN Disease Management Committee
approved interventional pilot project
• Pilot with Hispanic ethnicity
• Work-flow changes referring Hispanic patients to
Diabetes Health Promoters (~246 patients)
• Track changes in disease control between Hispanic &
Non-Hispanic patients (A1c<7%)
15

16. Diabetes Equity Project (DEP):
For additional details, please contact
Jim Walton, DO, MBA
Vice President & Chief Health Equity Officer
Baylor Health Care System
jameswa@baylorhealth.edu
or
Chris Snead, RN, BSN
Health Equity Manager
Office of Health Equity
972-860-8614
christine.snead@baylorhealth.edu