Affecting over 26 million adults and another 7 million who are yet undiagnosed, diabetes is at epidemic proportions and continues to be an enormous burden to Americans of every race, gender and ethnicity. Similarly, over 35% of our adult population and roughly 17% of our youth are obese, adding to the complexity of the problem.
Unfortunately, populations such as those in the Southern part of the U.S. are at even higher risk for developing diabetes and obesity due to a host of considerations such race, ethnicity, socioeconomic, genetic and environmental factors that cannot be detached from one another. Compounding these issues are the unique challenges faced in some communities to obtain good preventive education and access to individualized care, proven to be the most effective.
This year Pri-Med/Amazing Charts reinforced its commitment to develop and deliver its highly successful Southern Diabetes Initiative: Overcoming an Epidemic. These regionally focused, multichannel, integrated continuing medical educational (CME) programs emphasized culturally competent clinical strategies designed to specifically close identified practice gaps in the prevention, diagnosis and treatment of diabetes and cardiovascular risk. Based on the previous successes of Pri-Med initiatives and new insights into deep patient-level data, this comprehensive program was designed to specifically meet the needs of primary care clinicians and the multidisciplinary health care team at the front lines of managing the disproportionate challenges of diabetes, obesity and cardiometabolic risk in the Southern region of the United States.
Evolving approaches to continuing medical education (CME) strive to facilitate the acquisition of in-depth clinical knowledge and practical skills which are easily translated into practice, and result in improved quality of care and health outcomes. These innovative models employ more active participation than traditional didactic formats, but more importantly promote self-directed learning on topics relevant to a participant’s gaps in clinical practice. New methodologies seek to change performance at the level of the practitioner, as well as within the greater healthcare system, so as to improve both patient and population health.
Thoughtful integration of CME focused on quality improvement (QI) and coordination of care are validated strategies designed to improve both quality and patient health outcomes by equipping providers with evidence-based tools and resources that can foster and sustain change in practice. Successful adult learning principles combine varying educational formats that engage the learner to both acquire and sustain knowledge and competence that can be translated into improvements in clinical performance and thus result in improved patient health. Quality improvement initiatives which are aligned to address documented clinical care gaps have been demonstrated to have the greatest impact, yet clinicians are often unaware of how to identify these quality gaps in their own
Clinical tools, such as electronic health records (EHRs) can facilitate the continuous assessment of patient level data and provide valuable insight into barriers and gaps in care, so as to align education and clinical resources demonstrated to have the greatest impact. The ability to assess individual patients, as well as population cohorts, provides one the ability to refine clinical strategy to better address gaps in clinical care. Guidelines, recommendations and performance improvement measures are important components to helping establish suboptimal performance and strategies to address discovered problems.
As part of the 2014 Southern Diabetes Initiative: Overcoming an Epidemic, Pri-Med and Amazing Charts deployed a unique and novel approach to education which integrated a multi-faceted CME initiative and quality improvement, whereby Pri-Med’s broad-based and proven educational platform was utilized to create and deliver medical education designed to close gaps in clinical care identified from research on patient data derived from the Amazing Charts EHR platform. This in-depth assessment of quality care gaps combined with the prescriptive delivery of aligned clinical education and resources facilitated a process of assessing the impact of education on quality improvement and health.
Based on identified gaps in care, education (in part) focused on how to implement culturally competent preventive, diagnostic and treatment strategies for minority patients at risk for poor outcomes associated with type 2 diabetes and obesity. Participants were afforded information on how to establish HbA1c goals that best meet an individual patient’s clinical presentation, so as to effectively initiate and advance treatment strategies to better achieve and maintain glycemic goals, while limiting risk and adverse events.
Participating clinicians of the Southern Diabetes Initiative (SDI) were enrolled to longitudinally assess for changes in clinical measures representative of patient health status. De-identified patient data was acquired through either submittal of a chart audit questionnaire or through electronic queries conducted within the Amazing Charts EHR system.
Patient inclusion criteria consisted of: (1) Type 2 diabetes patients ≥18 years of age (2) Baseline HbA1c is ≥ 7.0% (3) NOT currently on insulin or GLP-1 RA therapy (4) HbA1C target goal ≤ 7.0%. Patient data was collected retrospectively with the same patients being used for the control and treatment groups so as to ensure matching of study criteria. Baseline data was established from patient records within 3 months prior to date of educational activity. Post-activity assessments were conducted at least 6 months after baseline visit and the first educational activity.
Participating clinicians contributed 2,202 patients who met previously discussed inclusion criteria. Average age of patient was 63.4 yrs; with 52% male and a duration of type 2 diabetes of 6.5 yrs. Average HbA1c at baseline was 8.4% with percentage of patients meeting a HbA1c goal of <7% only 1.5%. On average, patients were taking 1.7 oral anti-hyperglycemic agents. Average BMI at baseline was 35.1 kg/m2. Changes from baseline, subsequent to education, exhibited a preponderance of positive impact on clinical measures representative of improvements in health. Average HbA1c post-activity decreased to 7.9%, representing a 6% relative reduction in glycemic burden. Similarly, 64.9% of patients exhibited a decrease in HbA1C >0.3% and an additional 36.4% of patients achieved a HbA1c <7%. Average BMI post-activity also decreased significantly to 33.4 kg/m2 or a 4.8% relative reduction in BMI. Insights into these significant changes in clinical measures revealed formidable changes in therapeutic approaches to care. In general, anti-hyperglycemic therapy was initiated, switched or intensified in at least 66% of the patients. Of those, 18% were initiated on insulin and another 7% were initiated on a GLP-1RA. Patients who exhibited the greatest change in both HbA1C and weight were placed on either insulin and/or a GLP1-RA agent, validating the underutilization of important therapeutic agents designed to help bring patients to target goals. These novel approaches have proven to be highly effective in enhancing prevention, diagnosis and management of culturally diverse patients afflicted with diabetes and comorbid conditions. Pri-Med / Amazing Charts remains fully committed to innovative strategies which facilitate the integration of health analytics, CME other methodologies designed to improve both quality of care and patient health outcomes which shift the diabetes and obesity paradigm.