DSME program strengthens patient-centered medical home


Lovelyamma Varghese, NP, MS, RN, discusses the importance of diabetes self-management education in the patient-centered medical home model.

Diabetes self-management education (DSME) can play a key role in strengthening the patient-centered medical home healthcare delivery model that emphasizes care coordination and communication to transform primary care into a system that focuses on what patients need and want.

In a breakout session Friday, two speakers from New York-Presbyterian Hospital’s Ambulatory Care Network described their DSME program, which offers patient education, individualized patient care plans, standardized teaching materials, and continuing education for clinicians within a patient-centered medical home model.

Implemented in 2011, the DSME program has served diabetes patients in the communities of Washington Heights and Inwood in New York, resulting in a 7 percent increase in the number of patients who lowered their A1C levels to less than 7.0 between April 2012 and June 2013, said Yesenia Cabral, BSN, RN, lead diabetes educator for the program.

In the same period, the program also resulted in a 16 percent decrease in the number of patients with an A1C greater than 9.0 and a 7 percent decrease in the number of patients with blood pressure greater than 140/80, Cabral said. Overall, 67 percent of the patients had a drop in A1C, and 53 percent had a drop in their low-density lipoprotein levels.

The program focuses on the AADE 7 Self-Care BehaviorsTM and measures outcomes in A1C, blood pressure and lipids, and requires patients to get a foot exam every year.

According to Lovelyamma Varghese, NP, MS, RN, director of nursing practice and quality at New York-Presbyterian, a systematic review of 26 studies evaluating the benefits and costs associated with diabetes education found that more than half of the studies (18) reported that diabetes education and disease self-management lowered the costs of diabetes care and resulted in costs saving and a positive return on investment.

A longitudinal analysis of the effectiveness of DSME given by diabetes educators found a reduction in complications, improvement in quality of life and better compliance with diabetes-related drug regimens. It also found that patients were more likely to receive care in accordance with recommended guidelines, Varghese said.

Implementing the program required gaining accreditation from AADE, adding two diabetes educators and one program coordinator to the staff, training primary care nurses in diabetes education, and creating culturally appropriate educational materials to serve communities comprising mostly immigrant and Hispanic populations.

Varghese and her colleagues initially developed a business plan and established a referral network of registered dietitians, community health workers, social workers, and other specialists, including endocrinologists, ophthalmologists, podiatrists, nephrologists, and dentists.

In addition to one-on-one sessions, the program provides patients with three group classes based on the AADE 7 Self-Care Behaviors. The first class covers the physiologic basics of diabetes, the difference between type 1 and type 2 diabetes, and the role of the liver and pancreas in diabetes. Class 2 gives patients advice on being active, problem solving and healthy coping. Class 3 addresses healthy eating.

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