Type 2 Diabetes in the 21st Century

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Sources: Centers for Disease Control; *Huang et al., 2009; Diabetes Care, June 2014*

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Only 48% of US adults get enough aerobic physical activity (150 minutes) as exercise, transportation, or fun to improve their health

Source: Centers for Disease Control (2014)

Type 2 diabetes:

• Obese• Physically inactive• Age• Genetic vulnerability

• Fat cells release pro-inflammatory cytokines and hormones

• Low grade, chronic inflammation

• Hyperglycemia• Hypertension• Dyslipidemia

Dramatic shifts in US Population Trends: The Baby Boomers are Retiring

Dramatic Increases in the Prevalence of T2D for Elders and Minority groups

$245B annually

Specialist runCPT Code system Fee for Service

Group healthinsurance

Lack of financial impact of health decisions

The dark side of the US HealthCare System

Researchers working in chronic disease prevention and management

DM Eye Telemedicine works to save eye disease and prevent blindness but payment reform is blocked

Transmit Images

Eye images captured with

low light camera

Patient scheduled for eye screening at Primary Care Clinic

Review images in MegavisionReading Center

Generates report

Breathtaking changes underway

Alignment !

The HITECH Act (2010): Mandating meaningful Use of the EMR

The goal is to accelerate the adoption and implementation of EHR to improve healthcare delivery and outcomes, and to reduce costs.

Patient Protection and Affordable Care Act (2012): Patient Centered Medical Home (PCMH) and the Accountable Care

Organization (ACO)

NCQA Certification for PCMH

• Focus on all of the patient’s care needs

• Practice as a team to coordinate care across the system

• ‘Triple aim’: better quality, experience and cost

• Long-term partnerships, not hurried, sporadic visits

• Treat based on patient’s preferences

• Help patients become engaged in their own health

• Reassign staff responsibilities and expand roles

• Focusing on prevention and wellness to avoid costly and preventable complications and emergencies

Institute Of Medicine Recommendations for Meaningful Use of the EMR:

– Stress– Depression– Physical activity– Financial resources

strain– Neighborhood median

household income

– Dietary patterns– Physical activity– Social connections and

social isolation– Exposure to violence

Diabetes dashboard for enhanced team care in primary care

Capturing the patient’s story: barriers and feedback

1. No digital readouts or buttons 2. Organizes medications using familiar weekly pillbox

design3. Flashing light, sound, phone call, text, email reminders,

and summary reports, patient portal– Each cup can hold 11-12 M&M sized pills

• Seven-day supply for four dosing periods• Refill trays pre-filled by pharmacy and home delivered

Medminder™ Electronic Pill box

Blood Glucose

All Blood Glucose Readings-Red bar at 180 mg/dL-BG < 60 highlighted

vs.

Expected Fasting Readings- Red bar at 130 mg/dL- BG < 60 highlighted

Blood Pressure- Highlighted target range for SBP and DBP - Heart rate data

Diabetes Telehealth: Clinical Decision Support Blood Glucose and Blood Pressure Graphing with Summary Statistics

Clinical Decision Support: Medication Adherence Percentages and Calendar view

RN Chronic Care Nurses

Community Health Workers

Social Workers

Chronic Care Team

Pharmacists

Clinical Resources: Diabetes

Dashboard Telehealth reports

MD Supervisor and Certified Diabetes Educator

Virtual Calls

Outreach and Patient

Engagement

Coordinate Social Services and Resources

Patient

Remote Home Monitoring Caregiver Support

Home

Community:• Hotlines• Healthy food and

Physical activity network

Community classes and programs

Hospital/ER Specialists

Remote Home Monitoring

Data Uploads

Patient Alerts/

Reminders

Virtual: Telemedicine Telehealth Patient Portal

COMMUNITY

HEALTH CARE

Alerts, reports, communication

Accountable Care Organization

Providers(MD/ PA/ NP)

Clinical Support

Primary Care Team

Medical Home

Assisted Living Home Care/ VNA Nursing Home Hospice

Loss of Independence

Primary Care Centers

Diabetes Chronic

Care Team

Admin Support

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