1. Company LOGO Barton County Memorial Hospital Providing DSMT in Group Visits in Rural Healthcare Clinics Leisa Blanchard BSN, RN, CDE, CPT Eden Ogden BSN, RN, CDE AADE Annual Meeting 2009 Atlanta, Georgia

2. Session Outline 1. Objectives 2. Patient Diabetes Education Group Visit 3. Plan and Evaluate Patient Education 4. Discuss Patient Education Developments Support for this presentation has been provided through a Better Self- Management of Diabetes grant from the Missouri Foundation for Health

3. Objectives Presenters will: Describe a group visit format in rural healthcare clinics for a non-traditional education program Discuss the effective implementation of a wellness and diabetes education program in rural healthcare clinics Discuss the opportunities available for non- traditional diabetes education and how to organize a program Demonstrate use of outcomes data to support the validity of such programs

4. Our Mission at BCMH To provide personalized, humanistic, consumer-driven healthcare in a healing environment; to empower individuals and families to be actively involved in decisions affecting their care and well-being through information and education; and to provide leadership to improve the health of the community we serve.

5. Our Journey A Need A Program Begins ADA Recognized 2002 PRIMARIS Community Care Connection 2004 Missouri Foundation For Health - Better Self-Management of Diabetes Grant 2006

6. Barton County Diabetes Education

7. BSMOD Grantee Map

8. Program Inpatient Group Visits in Clinics Outpatient

9. Focus DSMT Group Visits OrganizeTreatEducate Evaluate

10. Program Partners Physician CDENurse Practitioner Dietitian Counselor Rural Healthcare Clinics Group Visit

11. Who Is Served Uninsured Under-insured These services are billable as a physician visit How often? Diabetes wellness visits recommended every 3 months How often? Diabetes wellness visits recommended every 3 months

12. Program Design Wellness Visit Acute Care Visit VS

13. Program Design by Clinics Patient Rotates to Program Partners Program Partners Rotate to Patients

14. Program Design Patient selection Invitation to participate in a “group wellness visit” Reminder letter sent two weeks prior to scheduled group visit –Includes request for patient to have labs done prior to group visit Phone reminder the week of the visit

15. Lockwood Clinic

17. Group Visit Content Presentation StationsExam Evaluation Group Education Presentation DVD’s *Folders *Handouts *Samples *Meters Ht. Wt. BMI BP Medication/ Lab Review Meal Plan Foot Exam Depression Screen Diabetes Wellness Visit with Physician or Nurse Practitioner Med changes Referrals Labs Resources Evaluate Pt. Outcomes Pt Evaluates Group Visit Providers Evaluate Group Visit Set/Evaluate Goals

18. Presentation Curriculum Diabetes Overview Goals for Control Meal Planning Label Reading Holiday Eating Benefits of Exercise Monitoring Stress Management Problem Solving Sick Day Management Complication Prevention Caring for Feet Traveling with Diabetes Etc.

19. Plan and Evaluate Patient Education Followed Meal Plan 5 or more servings of fruits and veggies Physical Activity Testing blood sugar Minutes of moderate physical activity Take medications/ insulin injections Hemoglobin A1c Eye/Foot Exams Questions???? Followed Meal Plan 5 or more servings of fruits and veggies Physical Activity Testing blood sugar Minutes of moderate physical activity Take medications/ insulin injections Hemoglobin A1c Eye/Foot Exams Questions???? Hemoglobin A1c Follow Meal Plan Maintain/Lose Weight Check Feet Exercise Stop Smoking Support Network Check Blood Sugar Yearly Eye Exam Hemoglobin A1c Follow Meal Plan Maintain/Lose Weight Check Feet Exercise Stop Smoking Support Network Check Blood Sugar Yearly Eye Exam Blood Glucose Lipids Hemoglobin A1c Microalbumin Eyes Blood Pressure Feet Blood Glucose Lipids Hemoglobin A1c Microalbumin Eyes Blood Pressure Feet Goals for Control Goal Setting Tell Us How You’ve Been Doing Tell Us How You’ve Been Doing

20. Patient Handouts Goals for Control –Blood Glucose Level –A1C –Blood Pressure –Lipids –Microalbumin Goal Setting –Pick at least one to work on Tell Us How You Have Been Doing –On how many of the last seven days did you…. Followed your eating plan? Eat five or more servings of fruits and vegetable? Do physical activity of moderate intensity? How many minutes? Check your blood sugar as recommended? Take your recommended medications?

21. BSMOD Tracking Measures Percentage of patients with: –A1C <7% –LDL <100 mg/dl –BP <130/80 mmHg –Average BMI of Patients –Two A1C’s within the last 12 months –Foot exam in the last 12 months –Dilated eye exam in the last 12 months –Documented self-management support goals –Follow-up rating of “4” in at least one goal

22. Group Appointment Evaluation ExcellentVery GoodGoodFairPoor Info & advice 88%6% Personal attn 88%6% Group leaders 88%6% Involved in care 88%12% Medical needs met 87%13% Questions answered 87%13% Overall group visit 94%6%

23. Provider Satisfaction Survey Not at All Satisfied Somewhat Satisfied Very Satisfied Extremely Satisfied Staff helping patients manage their chronic illness? 63%37% How satisfied do you think your patients are? 75%25% Staff involving patients in their own care? 63%37% Self-management goals assessed in a standardized manner? 13%50%37% Tools & protocols making difference in outcomes? 13%37%50% Format allowed effective care? 13%37%50%

24. Better Self-Management of Diabetes Primary Care Resources and Supports Survey Patient Support Scores Score

25. Better Self-Management of Diabetes Primary Care Resources and Supports Survey Organizational Support Scores Score

26. Better Self-Management of Diabetes Primary Care Resources and Supports Survey Support Score Totals

27. Benefits Patients use ancillary services Referrals increase by word of mouth Patients are healthier and better informed Hospitalizations are decreased Patients build relationships with providers

28. Sustainability A recognized program can bill for DSMT –ADA –AADE Community –Conversation Maps –Health Fairs –Group Visits –Wellness Program –Collaboratives –Community Education Presentations Grant Acquisition –Networking –Increased Credibility/Visibility –Improved Programming/Policy Change

29. Questions ?

30. Contact Information Barton County Memorial Hospital 29 NW 1 st Lane Lamar, MO 64759 417-681-5100 Leisa Blanchard BSN, RN,CDE, CPT Diabetes Education Coordinator 417-681-5259 lblanchard@bcmh.net Eden Ogden BSN, RN, CDE Grant Manager 417-681-5258 eogden@bcmh.net