AMGA and Pfizer Inc. present the Models of Excellence Collaborative on Patient Adherence and Health Literacy

The Foundation for JPS Health Network, Fort Worth, TX
Diabetes Compliance

EXECUTIVE SUMMARY: Department of Health and Human Services Secretary Tommy G. Thompson recently announced that the number of Americans with diabetes rose to an all-time high with an estimated 18.2 million people in 2003. The annual cost of diabetes in direct medical costs and lost productivity was estimated at $132 billion in 2002, according to a study earlier this year by the American Diabetes Association. Direct medical expenditures alone were $91.9 billion--nearly 44 percent of those costs arising from inpatient hospital stays. In 2002, the applicant organization had 276 inpatient stays, 564 emergency room visits and 32,715 outpatient visits due to diabetes and diabetes complications.

In order to reach our goal of reducing the number of emergency room, inpatient and outpatient visits due to diabetes and complications of the disease, the applicant organization would like to embark on a study to randomly assign diabetes patients to three disease management compliance initiatives at one of its predominately African American populated clinics. The most effective initiative will be determined by tracking patient compliance of four baseline factors.

Finding an effective approach to optimize patient compliance may be one of the methods to improve diabetic control. By discovering a creative way to encourage patients to follow their diabetic plans of care, outcomes may be improved including measures of glycemic control, weight loss, compliance with appointments and assuring foot exams by the doctor.

By determining the best disease management program, we hope to achieve increased clinical quality and increased patient satisfaction while at the same time cutting costs associated with emergency room visits and inpatient stays.

PROJECT PLAN: By finding a creative way to encourage patients to follow their diabetic plans of care, outcomes may be improved. Indicators, leading to proof of compliance, include measures of glycemic control, weight loss, compliance with appointments and assuring foot exams by the doctor. The program will utilize the following research design to compare three different interventions for increasing compliance. The three protocols are:

1. Diabingo, a bingo game that patients play, which assists them in meeting diabetes standards, i.e. weight loss, lowered cholesterol, etc. The case manager will explain the diabingo card to the patient. Each time they meet one of the standards they mark their card. For example, when the patient has a foot exam, the medical professional indicates this on the patient’s bingo card with their initials. This process will be repeated until the patient gets a bingo. Each time the subject gets a bingo, they will receive a JPS Gift Shop certificate. Patients are not limited to the number of cards they can go through during the study.

DIABINGO

2. Case Management and Phone Registry where patients are assigned to a case manager who will follow up with patients to make sure they are following their treatment plan. The subjects will receive calls once a month from their case manager regarding different diabetes care quality standards. Discussion will include self-care such as monitoring and exercise, appointment and lab attendance encouragement and also stress importance of medication and dietary compliance.
3. Standard/Usual Care which consists of the physician setting up a treatment plan for the individual on an outpatient basis at their regularly scheduled appointment.

During the study an attending physician and two residents will see a total of 90 patients divided evenly between them, thus N=90. Patients will be randomly assigned to receive one of the three strategies, with 10 patients receiving each strategy per physician, i.e. physician will have 10 patients in diabingo, 10 patients with the case manager and 10 receiving usual office visit care. Therefore, with N=90, there will be 30 patients receiving each of the above-mentioned strategies to increase compliance. The attending physician and the two residents will be responsible for the random assignment of patients to one of the particular strategies. The strategy of Standard Care will be the responsibility of the physician and residents. A case manager will be hired to coordinate and oversee the diabingo and case management/phone registry strategies.

Research subjects will present to their clinic for their usual appointments. Upon meeting inclusion criteria to participate in the study, patients will be given tests to determine baseline data by their physician that includes body mass index (BMI), hemoglobin A_1c serum levels, blood pressure (BP), did not keep appointment rates (DNKA), documented foot exam.

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