1. Health Care, Education and Research PRISM Project: Promoting Realistic Individual Self-Management for Diabetes Billings Clinic Center for Clinical Translational Research September 1, 2009 * Supported by funding from NIDDK

2. Health Care, Education and Research

3. What is Translational Research? Translational research examines how people access health care, how much care costs, and what happens to patients as a result of this care. The main goals of translational research are to identify the most effective ways to organize, manage, and deliver high quality care, reduce medical errors, and improve patient quality.

4. Health Care, Education and Research CTR PRISM Team Members Valerie Caton, MN, FNP-C, Nurse Practitioner, Team Leader Diane Kersten, LCSW, Social Worker Stephanie Selzler, LD, RD, Dietitian Karen Gransbery, RN, CDE, Diabetes Educator Barbara Holloway, RN, CDE, Diabetes Educator Jude Russell, MSN, CDE, Diabetes Educator Patricia Coon, MD, Medical Director Chris Sorli, MD, Endocrinologist Consultant

5. Health Care, Education and Research Study Objective Evaluate the effectiveness of an NP-led multi- disciplinary team approach to diabetes self- management on achieving American Diabetes Association (ADA) guidelines for diabetes disease control, patient satisfaction and patient self-management in the urban and rural primary care setting.

6. Health Care, Education and Research Methods: Study Participants Participants: –259 adult patients –Type 2 diabetes mellitus (DM) –At least one uncontrolled risk factor (HbA 1c, BP or LDL-C) 1 –Seen by PCP in past year Study Sites: –One urban primary care clinic: Billings Clinic with 48 PCPs who manage ~5,000 diabetes patients –Five rural community clinics in Eastern Montana 2 to 9 providers per site serving 30 to 300 diabetes patients 1 Standards of medical care in diabetes--2009. Diabetes Care 2009;32 Suppl 1:S13-61.

7. Health Care, Education and Research Study Sites

8. Health Care, Education and Research Patient-Centered Care Traditional Care Content driven education Provider recommends preferred course of action PRISM Patient driven education Motivational Interviewing techniques (Patient decides action)

9. Health Care, Education and Research Patient-Centered Care Traditional Care Patient is either “compliant” or “noncompliant” Passive Patient Expert providers work separately PRISM Readiness for change Active Patient Team working for improved healthcare, including patient

10. Health Care, Education and Research All Team Members Responsibilities Empowerment of patient. Determine barriers to self-management, including psycho-social issues, teach problem solving skills. Help patients to develop and implement realistic self-management goals. Facilitate behavior change. Participate in weekly team meetings.

11. Health Care, Education and Research

12. Perceived Challenges Establishing trust Nonverbal communication Difficulty discussing sensitive issues Managing the technology

13. Health Care, Education and Research Services Provided Individual and Dual Sessions Patient Care Conferences Education and Support Groups Create Your Weight Group

14. Health Care, Education and Research Education Groups

15. Health Care, Education and Research Support Groups

16. Health Care, Education and Research Create Your Weight 10 week Adult Weight Management Program based on guidelines from the ADA* which encompassed nutrition education, physical activity and the role of behavioral therapy in weight management Adapted the class to PRISM participants and the use of telemedicine Provided two series and 18 urban, 21 telemedicine and 15 family members participated. * American Diabetes Association

17. Health Care, Education and Research Results

18. Health Care, Education and Research Ciemins EL, Holloway B, Coon PJ, McCloskey-Armstrong T, Min SJ. Telemedicine and the Mini-Mental State Examination: Assessment from a distance. Telemedicine and e-Health, 2009;15(4): 325-327.

19. Health Care, Education and Research Patient Satisfaction with PRISM Program

20. Health Care, Education and Research Patient Satisfaction with Technology 111 patient surveys –100% were satisfied with their telehealth sessions –100% felt comfortable with learning health information using this technology and said they understood as if it were in person –99% felt picture and sound were clear –99% felt equal comfort with in-person encounters and felt comfortable discussing personal information –96% felt their privacy was protected

21. Health Care, Education and Research Staff Satisfaction with Technology 177 staff surveys –98% felt telehealth equipment worked properly and with clear sound –95% felt they had a clear picture –96% felt they had adequate access to patients’ medical records and tests prior to appointment –99% felt patients’ privacy was protected –98% felt patients were satisfied –96% were satisfied with the consultations –97% felt telehealth was a useful tool for teaching patients about Diabetes management

22. Health Care, Education and Research

24. Pending Projects Expansion of Diabetes Care to Rural Communities via Telehealth Using Telehealth to Enhance Shared Diabetes Medical Appointments in Rural Communities Supporting Rural Caregivers Using Telehealth Technology