Evidence that diabetes self-management education (DSME) can improve health outcomes has repeatedly been shown and is considered to be a critical component of care. Diabetes educators (DEs) are highly skilled at addressing diabetes-related clinical and behavioral needs through DSME, but engagement with DEs is underutilized. It has been suggested that poor referral practices and the way in which DSME service is delivered are the problems. Most patients receive diabetes care in primary care (PC) yet most DSME programs are distinctly separate from PC practice. This limits care coordination and DE access to amenities currently available to PC. Efforts are underway to change the U.S. health care paradigm with a focus on quality in PC that includes practice redesign, population management, and communication through electronic medical records (EMRs). The purpose of this application is to evaluate the deployment of Glucose to Goal, a model relying on a systematic redesign of practice that links DE services with PC. The goal is to improve PCP referrals and, subsequently, DSME participation. Using a non-randomized controlled study design, the intervention model will be implemented with three DEs each assigned to two PC practices in their local communities. This will be compared to the traditional process for DSME delivery, without the direct connection to PC processes, with two DEs and six PC practices, for an eighteen month period. Assessment of the impact of the model on provider referrals to and patient participation in DSME will be examined. We hypothesize that the proportion of PCP referrals and patient utilization of DE services from PC practices participating in Glucose to Goal will be higher compared to those associated with traditional DSME. To inform scalability and sustainability of the model, assessment of the program implementation process will be made. Finally, glycemic control, behavioral and psychosocial outcomes will be examined. We anticipate that this model will appeal to PC providers, demonstrate a feasible approach to offering diabetes education in the current health environment, and set the stage for future testing of the model, namely its impact on meaningful improvements on diabetes outcomes and cost-effectiveness.
Diabetes education is a very important part of diabetes care. Most people with diabetes receive care in primary care practices where diabetes education is not always available. This project tests a model designed to improve access to diabetes education services.
