everyone with diabetes counts: emerging strategies in ... · everyone with diabetes counts:...

EveryonewithDiabetesCounts:EmergingStrategiesinRuralOregon

RuralPopulationHealthLearningCollaborativeApril25,2016

Objectives

• TellthestoryofhowtheQIN-QIOishelpingtobuildcapacityfordiabetesself-managementprogramsinOregon’sruralcommunities

• Sharepromisingpracticesforimprovingdiabetesself-managementsupportinruralcommunities

• HelpyouidentifyhowyourQIN-QIOcansupportyourgoalsforreducingtheburdenofdiabetesinyourcommunity.

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Questionstorunon

• Whatwouldhealthandhealthcarelooklikeinyourcommunityifpeoplehadthesupporttheyneededtostayashealthyaspossibleforaslongaspossible?

• Howdoescommunity-basedself-managementeducationlookinthisfuture-statesystem?

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Self-managementeducationinOregon

• Community-basedself-managementeducation– Infrastructuredecentralizedandlocallysupported– Stateresourcesarefocusedonimprovingsystems;limiteddirect$$availableforprograms.

– Fundingstreamsdiverse;mostlygrantbased– Notwelllinkedtoclinicalentitiesorvalue

• AADE/ADA-recognizedDSMEPrograms– Underutilized– Geographicandlanguagebarriers

• Opportunitiestoimproveaccess

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Oregon’sQIN-QIOapproach

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OregonEveryonewithDiabetesCounts(EDC)Communities

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Frameworkforregionalhealthsystemdesign

7©ReThinkHealth,FieldGuideforMulti-StakeholderMobilizationandCoalitionBuilding,2014.Usedbypermission.

SixLeadershipPractices

• MotivatingVision:Creatingasharedstorythatmotivatespeopletoturnvaluesintoaction

• Buildingrelationships:Deliberateidentificationbytwo(ormore)partiesofsharedvaluesandcommoninterestsspecifyingmutualcommitmentstoexchangeresources

• EngagingNetworks:Intentionalmappingofactorsandassets tounderstandtheenvironmentyouroperatingin.

• Structuringteams:Designingandlaunchingself-governingteams,connectedasdistributedleadershipstructuresacrossmultiplelevelsofcoordination

• Strategizingcollectively:Collectivedecisionmakingaboutgoalsandinterdependentstrategydevelopment

• LearninginAction:Producingspecific,observable,andmeasurableresultstoevaluateprogress,exercisemutualaccountability,andadaptstrategybasedonexperience

8©ReThinkHealth,FieldGuideforMulti-StakeholderMobilizationandCoalitionBuilding,2014.Usedbypermission.

Integrated Diabetes Self-Management Education

MeasurableAim:IntegratedDSMEprogramsareactiveinthestateserving50%ofolderadultswhohavediabetes.

PEAK2:Corereferralsystemsinplace;enrollmentimproved

KICKOFF:InitialstatementofintentinplaceamongLeadershipteam;Leaderstrained

PEAK1:Firstprogramsareimplemented;collectiveexcitementishigh

FOUNDATION:Coalitionformed;collectiveaimidentified

PEAK3:Fullyintegratedwithsustainablefinancialsupport

Lowparticipantregistrations

Financialchallengesthreatenabilitytoofferregularprograms

9©ReThinkHealth,FieldGuideforMulti-StakeholderMobilizationandCoalitionBuilding,2014.Usedbypermission.

Usingdatatodrivechange

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Measurementandreporting• Standardizeddatacollection

• Translatingdatatovalueandaction

DSMPCommunityDataReports

• Quarterlycumulativesummaryforeachcommunity

• AnnualanalysisofDSMPdata• Pre&PostPatientActivationSurvey– Howwelldoparticipantscopewiththeirdiabetes?–Whatknowledgehaveparticipantsgained?– Inthelastweek,howmanydays…

• ParticipantDemographicData• Future:ClinicalData

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Patientconfidence insettingself-management goals

122015DataReportonOregon“EveryonewithDiabetesCounts”DSMPCommunities

Pre N=52 P-value: Yes: 0.001*Maybe:0.003*Post N=41 *statisticallysignificant

Managingstressrelatedtodiabetes

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PreN=52 P-valuePostN=41 Yes:0.000*

Maybe:0.008*

2015DataReportonOregon“EveryonewithDiabetesCounts”DSMPCommunities*statisticallysignificantP-Value

Communicationwithprovider

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PreN=52 P-valuePostN=41 Yes:0.036*

2015DataReportonOregon“EveryonewithDiabetesCounts”DSMPCommunities*statisticallysignificantP-Value

Clinical–communitypartnerships

• Clinical–communitylinkages– Aligningvaluewithqualityreporting

– Brokeringmeaningfulrelationshipsbetweenclinicalandcommunitypartners

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Creatingclinical–community linkages

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Communityexample:pre-partnership

• Historicalbarrierstobringingself-managementprogramstothecounty

• Acoupleofchampionsandsomecollectivewillalreadyexisted,buttheyneededhelporganizing

• Clinicalandnon-clinicalpartnerswerenottalking,buttheywereidentifyingsimilarneeds!

• Limitedresourcesforsustainability

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Readiness forchange

• Collectivewillanddesireforself-managementeducation

• Localchampions• Agreementonneedfordiabetesself-managementeducation

• Linkingclinicalandcommunitypartners• Engagedpayer

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Organizing forsuccess

What’sworking:• Partneringwithlocalleadership• Bringingdiverseclinicalandnon-clinicalpartnerstogetherinperson

• Engagingleadershipearlyandoften• Identifyingandbeingresponsivetodiversedriversforinvolvement

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Organizing forsuccess

What’sworking:• Broadstakeholderinvolvement• CreatingawrittenstatementofintentwithclearcommitmentfromEVERYorganizationatthetable

• Leadershipcommitmenttoprovidingstafftime• Identifyingsustainabilitypartners• QIN-QIOresourcesfocusedonstart-upandcapacitybuilding

• JointPDSAactivities20

Organizing forsuccess

Whatarewestilllearning:• BeststrategiesforfillingclassesandreachingMedicarebeneficiaries

• Operationalizingclosed-loopreferralacrossclinicalandcommunityDSMEservices

• Aligningwithqualitymetricsandreferralpathwaysforsustainability

• Managingdiverseinterestsanddrivers• Financialmodelforlong-termsustainability

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Contactme!

TracyCarver,MPAtcarver@acumentra.org

(503)382-3931

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ThismaterialwaspreparedbyHealthInsight,theMedicareQualityInnovationNetwork-QualityImprovementOrganizationforNevada,NewMexico,OregonandUtah,undercontractwiththeCentersforMedicare&MedicaidServices(CMS),anagencyoftheU.S.DepartmentofHealthandHumanServices.ThecontentspresenteddonotnecessarilyreflectCMSpolicy.11SOW-B2-16-18-OR4/25/16