Assessing the Value of Diabetes Education

Solucia Consulting, Hartford, CT 06106, USA.
The Diabetes Educator (Impact Factor: 1.79). 09/2009; 35(5):752-60. DOI: 10.1177/0145721709343609
Source: PubMed


The purpose of this study was to evaluate the impact of diabetes self-management education/training (DSME/T) on financial outcomes (cost of patient care).
Commercial and Medicare claims payer-derived datasets were used to assess whether patients who participate in diabetes education are more likely to follow recommendations for care than similar patients who do not participate in diabetes education, and if claims of patients who participate in diabetes education are lower than those of similar patients who do not.
Patients using diabetes education have lower average costs than patients who do not use diabetes education. Physicians exhibit high variation in their referral rates to diabetes education.
The collaboration between diabetes educators and physicians yields positive clinical quality and cost savings. The analysis indicates that quality can be improved, and cost reduced, by increasing referral rates to diabetes education among low-referring physicians, specifically among men and people in disadvantaged areas. More needs to be done to inform physicians about ways to increase access to diabetes education for underserved populations.

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    • "Surveys of health care providers in the United States and Canada have suggested that barriers to utilization include patient unwillingness, programs’ location, languages of service, operating hours, and (in the United States) insurance coverage [30-32]. The disparities in utilization found in this study may also partially explain the observation that patients utilizing education services had lower average costs than non-attendees [17], since older, poorer and sicker patients who would be predicted to have higher health care costs were also less likely to use such services in the first place. Nonetheless, the presence of these disparities in diabetes self-management education program utilization is noteworthy in a publicly-funded health care system where patients are meant to have equitable access to these services. "
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    ABSTRACT: Background Patients newly-diagnosed with diabetes require self-management education to help them understand and manage the disease. The goals of the study were to determine the frequency of diabetes self-management education program utilization by newly-diagnosed patients, and to evaluate whether there were any demographic or clinical disparities in utilization. Methods Using population-level health care data, all 46,553 adults who were diagnosed with any type of non-gestational diabetes in Ontario, Canada between January and June 2006 were identified. They were linked with a diabetes self-management education program registry to identify those who attended within 6 months of diagnosis. The demographic and clinical characteristics of attendees and non-attendees were compared. Results A total of 9,568 (20.6%) patients attended a diabetes self-management education program within 6 months of diagnosis. Younger age, increasing socioeconomic status, and the absence of mental health conditions or other medical comorbidity were associated with attendance. Patients living in rural areas, where access to physicians may be limited, were markedly more likely to attend. Recent immigrants were 40% less likely to attend self-management education programs than longer-term immigrants or nonimmigrants. Conclusion Only one in five newly-diagnosed diabetes patients attended a diabetes self-management education program. Demographic and clinical disparities in utilization persisted despite a publicly-funded health care system where patients could access these services without direct charges. Primary care providers and education programs must ensure that more newly-diagnosed diabetes patients receive self-management education, particularly those who are older, poorer, sicker, or recent immigrants.
    Full-text · Article · Jan 2013 · BMC Public Health
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    • "Randomized controlled trials (RCTs) of self-management or lifestyle interventions for diabetes that examine cost benefit have variously shown reductions in diabetes incidence,68,69 improvements in co- morbid depression,70 and clinical benefits,71–73 although others have shown no clinical benefits.74,75 Although studies from administrative databases49 and studies other than RCTs have indicated reduced costs for those enrolled in self-management programs, RCT evidence in diabetes management or prevention has not consistently supported this finding.76 Of note is that administrative data suggest that participation in diabetes education is not spread evenly across socioeconomic groups, with one study showing that participants were younger, more were female, located in more affluent areas, at lower clinical risk, and at higher adherence to diabetes standards of care.49 "
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    ABSTRACT: A central plank of health care reform is an expanded role for educated consumers interacting with responsive health care teams. However, for individuals to realize the benefits of health education also requires a high level of engagement. Population studies have documented a gap between expectations and the actual performance of behaviours related to participation in health care and prevention. Interventions to improve self-care have shown improvements in self-efficacy, patient satisfaction, coping skills, and perceptions of social support. Significant clinical benefits have been seen from trials of self-management or lifestyle interventions across conditions such as diabetes, coronary heart disease, heart failure and rheumatoid arthritis. However, the focus of many studies has been on short-term outcomes rather that long term effects. There is also some evidence that participation in patient education programs is not spread evenly across socio economic groups. This review considers three other issues that may be important in increasing the public health impact of patient education. The first is health literacy, which is the capacity to seek, understand and act on health information. Although health literacy involves an individual's competencies, the health system has a primary responsibility in setting the parameters of the health interaction and the style, content and mode of information. Secondly, much patient education work has focused on factors such as attitudes and beliefs. That small changes in physical environments can have large effects on behavior and can be utilized in self-management and chronic disease research. Choice architecture involves reconfiguring the context or physical environment in a way that makes it more likely that people will choose certain behaviours. Thirdly, better means of evaluating the impact of programs on public health is needed. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework has been promoted as one such potential approach.
    Preview · Article · Oct 2010 · Risk Management and Healthcare Policy
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