Yesterday, AMA Wire® brought you the story of a health care team in suburban Detroit that, seeking ways to provide more timely care to patients with prediabetes, launched its own diabetes prevention program (DPP). Members of the team share their advice for setting up your own DPP, including how to budget for, and staff, this new activity, as well as what to look for in your first group of participants.
Western Wayne Physicians is an independent family medicine practice with three sites in suburban Detroit. Its patient population is largely drawn from the region’s blue-collar workforce, including many autoworkers and their families. Many of these patients have prediabetes.
Robert Jackson, MD, a family physician at Western Wayne, had looked for DPPs in his area but was unable to locate one, so he sought out a lifestyle training program approved by the Centers for Disease Control and Prevention (CDC) as part of its National DPP. After selecting three staff members for training, the practice launched its DPP nine weeks ago, and the 13 participants are already losing significant weight.
Dr. Jackson and Kayla Jones, office receptionist and lifestyle coach for the group, have the following advice for other primary care practices looking turn the tide of type 2 diabetes by implementing their own prevention programs.
Find room in your budget. While Medicare coverage of CDC-recognized DPPs will begin Jan. 1, 2018, many of the nation’s 86 million people with prediabetes are under 65, and coverage of the benefit outside of Medicare is spotty. “You have to be able to pay your staff—Kayla isn’t doing this for free, and we had to backfill her position,” Dr. Jackson said. “You’ll need to make a commitment to doing something that may not make you money for a while.”
Identify key staff members. “Pick people who like people. They have to be able to stand in front of a group and talk,” Dr. Jackson said. “You’ll also need people who are studious enough to review the curriculum and understand it.”
Get trained. Sign up with a CDC-approved training program. “It’s definitely something that’s doable, regardless of what kind of staff you have. They give you the resources you need,” Jones said. “Once we went through the training, it didn’t take us very long to get it started. Within a matter of weeks, we were able to contact patients and get the first class going.”
Download and organize the literature. This will be available from the CDC-approved program after you have done the training. “We put it all in three-ring binders with tabs,” Jones said. “You’re giving patients 26 weeks’ worth of information, and you want them to stay organized so it’s easier for them to remain interested in what’s going on.”
Locate a meeting space. Western Wayne uses one of its conference rooms. “Theoretically, somebody could do this in their waiting room after patient hours,” Dr. Jackson said.
Recruit patients. Dr. Jackson’s staff pulled a list of patients with prediabetes from the practice’s electronic health records system (EHR). “Then I looked for patients who I thought would work well in groups and seemed motivated,” Dr. Jackson said. “Going forward, we’re going to have to pick some people who might fail, but I wanted my staff to have more motivated people at first so they could gain experience. And as they gain that experience, they’ll be able to deal with more difficult patients.”
Screen, test, act today
The CDC and the AMA have been working together since 2014 to address diabetes prevention on a national level. This has included a national co-branded initiative, Prevent Diabetes STAT™, which aims to increase engagement with physicians, care teams and patients to reach some of the millions of adults with prediabetes and stop their progression to type 2 diabetes.
A module from the AMA’s STEPS Forward™ collection of practice improvement strategies includes more complete instructions for incorporating prediabetes screening into your practice. The module may also be completed for continuing medical education credit.