MedStar Pathway to Diabetes Control Demonstration Project: Type 2 Diabetes Boot Camp
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Type 2 Diabetes Mellitus
- Sponsor
- Medstar Health Research Institute
- Enrollment
- 419
- Locations
- 1
- Primary Endpoint
- Percentage Change in Hemoglobin A1C From Baseline to 3 Months
- Status
- Completed
- Last Updated
- 5 years ago
Overview
Brief Summary
A Diabetes Institute (MDI), in partnership with key stakeholders-including Primary Care Providers- in a northeastern US regional, mixed-payer healthcare system), seeks to implement an evidence-based, technology-enabled, innovative, and integrated diabetes care management pathway (Boot Camp) for adult patients with uncontrolled type 2 diabetes (A1C>/=9%) which will demonstrate improvement in diabetes clinical and health resources utilization outcomes.
Detailed Description
* The program is designed to integrate type 2 diabetes specialty services into Primary Care practices to support PCPs and their patients in improving a spectrum of diabetes-related outcomes. * High-risk patients from Primary Care practices who have uncontrolled type 2 diabetes and meet the target population inclusion and exclusion criteria will be invited to participate in an intensive and concise "BOOT CAMP" medication management and education intervention of \~4-8 weeks duration. * The intervention will consist of three key components: (1) intensive, algorithm-based medication management (Appendix A), based on continuous review and management of blood sugars; (2) survival skills diabetes self-management education based on knowledge deficits identified on the KNOW Diabetes knowledge survey; (3) enhanced patient-provider communication, all provided by Endocrinologist supervised allied health professionals (in this instance CDEs). * Survival skills DSME will focus on nutrition and meal plan basics, blood glucose targets, taking medications as prescribed, hyper- and hypoglycemia recognition and treatment, and when to seek medical help. * The intervention is initiated with one to two face-to-face meetings with the CDE, at which the patient's readiness to change is assessed. * These are followed by virtual meetings though a variety of media based on patient preference and health literacy (largely telephone and text messaging). * Various technology tools are used to facilitate patient engagement, access and attainment of glycemic targets, including smart meters, virtual meeting platforms, web-based education content and surveys administration via tablets, etc. * Near real-time transmission of blood glucose data using a cellular-enabled blood glucose monitoring system sends all glucose results to a web-based dashboard accessed daily by the Boot Camp educators. * Concurrent matched charts of patients receiving standard care at the three MedStar locations will serve as a basis of comparison in assessing the impact of MDI on clinical and education outcomes and process of care. * Based on patient progress towards improved glycemic control, the patient will 'graduate' from the program and the CDE will refer the patient back to their PCP in 8-12 weeks with a full report of medication changes, blood glucose readings and further diabetes management recommendations eg referrals; further DSME, etc.
Investigators
Michelle Magee
Director, MedStar Diabetes Institute
Medstar Health Research Institute
Eligibility Criteria
Inclusion Criteria
- •Diagnosis of type 2 diabetes for \>=1 year
- •Active practice patient
- •A1C \> 9.0% at their last visit to Medical Home, ED or hospital admission plus one more high risk factor (ED visit or hospitalization in past 12 mos)
- •Primary Care Provider willing to have patient enter the program
- •Patient is able and willing to participate in the program and exhibits readiness to change DM self-management
- •Proficient in English
Exclusion Criteria
- •Known history of DKA
- •No MedStar PCP visit within past 12 months
- •Endocrine or Diabetes Education consult referral order in the past 6 months which resulted in Endo visit(s) or DSME visit(s) documented in chart or self-reported by patient during initial screen
- •Active additional medical issues which in the opinion of the care team would preclude concentrating on BG control and/or would predispose to ED visits and/or hospital admits independent of glycemic control, e.g.: severe CHF, severe COPD; severe mental illness.
- •Resident of skilled nursing facility, nursing home or receiving home health care services.
- •Active cancer in the preceding 3 years excluding nonmalignant basal cell cancer
- •Supraphysiologic doses of glucocorticoids (hydrocortisone \> 30mg/day; prednisone \> 5-6mg daily; dexamethasone \> 2mg daily).
- •Pregnant or anticipates attempting conception in the following year
- •Patient and/or custodial caregiver unwilling and/or unable to participate in program-related activities
Outcomes
Primary Outcomes
Percentage Change in Hemoglobin A1C From Baseline to 3 Months
Time Frame: 3 months
Comparison of the percentage change in A1C from baseline to 3 months between the intervention and the control group
Secondary Outcomes
- Risk of Experiencing a Composite Endpoint of All Cause ED Visits and Hospitalizations at 6 Months Post Intervention vs 6 Months Pre-intervention for Cases and Controls.(6 months)
- Adherence to Prescribed Diabetes Medications(90 days)
- Frequency of Eye Exams(90 days)