New Frontiers in Diabetes Care: Quality Improvement Study of a Population Health Team in Rural Critical Access Hospitals

Tanumihardjo, Jacob P.; Kuther, Shari; Wan, Wen; Gunter, Kathryn E.; McGrath, Kelly; O’Neal, Yolanda; Wilkinson, Cody M; Zhu, Mengqi; Packer, Christine; Petersen, Vicki; Chin, Marshall H.

doi:10.1007/s11606-022-07928-0

Cited by 6 publications

(1 citation statement)

References 18 publications

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“…With a diagnosis, these efforts can be done efficiently. Population health studies in hypertension and diabetes have demonstrated improvements in care, and patient identification is simplified when International Classification of Diseases (ICD) codes can be searched electronically [ 28 , 29 ]. Without a diagnosis, population health initiatives become less efficient if they must start with screening [ 30 , 31 ].…”

Section: A Way Forwardmentioning

confidence: 99%

A Systematic Approach to Treating Early Metabolic Disease and Prediabetes

Carris,

Bunnell,

Mhaskar

et al. 2023

Diabetes Ther

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At least 70% of US adults have metabolic disease. However, less is done to address early disease (e.g., overweight, obesity, prediabetes) versus advanced disease (e.g., type 2 diabetes mellitus, coronary artery disease). Given the burden of advanced metabolic disease and the burgeoning pandemics of obesity and prediabetes a systematic response is required. To accomplish this, we offer several recommendations: (A) Patients with overweight, obesity, and/or prediabetes must be consistently diagnosed with these conditions in medical records to enable population health initiatives. (B) Patients with early metabolic disease should be offered in-person or virtual lifestyle interventions commensurate with the findings of the Diabetes Prevention Program. (C) Patients unable to participate in or otherwise failing lifestyle intervention must be screened to assess if they require pharmacotherapy. (D) Patients not indicated for, refusing, or failing pharmacotherapy must be screened to assess if they need bariatric surgery. (E) Regardless of treatment approach or lack of treatment, patients must be consistently screened for the progression of early metabolic disease to advanced disease to enable early control. Progression of metabolic disease from an overweight yet otherwise healthy person includes the development of prediabetes, obesity ± prediabetes, dyslipidemia, hypertension, type 2 diabetes, chronic kidney disease, coronary artery disease, and heart failure. Systematic approaches in health systems must be deployed with clear protocols and supported by streamlined technologies to manage their population’s metabolic health from early through advanced metabolic disease. Additional research is needed to identify and validate optimal system-level interventions. Future research needs to identify strategies to roll out systematic interventions for the treatment of early metabolic disease and to improve the metabolic health among the progressively younger patients being impacted by obesity and diabetes.

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Section: A Way Forwardmentioning

confidence: 99%

A Systematic Approach to Treating Early Metabolic Disease and Prediabetes

Carris,

Bunnell,

Mhaskar

et al. 2023

Diabetes Ther

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Community-engaged Systems for Population Health Improvement: A Novel Approach to Improve Diabetes Outcomes in Rural Communities

Pullyblank,

Rosen,

Wichman

et al. 2024

J Community Health

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Background Approaches to prevent and manage diabetes at a community population level are hindered because current strategies are not aligned with the structure and function of a community system. We describe a community-driven process based on local data and rapid prototyping as an alternative approach to create diabetes prevention and care management solutions appropriate for each community. We report on the process and provide baseline data for a 3-year case study initiative to improve diabetes outcomes in two rural Nebraska communities. Methods We developed an iterative design process based on the assumption that decentralized decision-making using local data feedback and monitoring will lead to the innovation of local sustainable solutions. Coalitions act as community innovation hubs and meet monthly to work through a facilitated design process. Six core diabetes measures will be tracked over the course of the project using the electronic health record from community clinics as a proxy for the entire community. Results Baseline data indicate two-thirds of the population in both communities are at risk for prediabetes based on age and body mass index. However, only a fraction (35% and 12%) of those at risk have been screened. This information led both coalitions to focus on improving screening rates in their communities. Discussion In order to move a complex system towards an optimal state (e.g., improved diabetes outcomes), stakeholders must have access to continuous feedback of accurate, pertinent information in order to make informed decisions. Conventional approaches of implementing evidence-based interventions do not facilitate this process.

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