By Donna Rice – Baylor Health Care System
Diabetes: it’s the seventh leading cause of death, a major cause of heart disease and stroke, and the leading cause of adult blindness, kidney failure, and nontraumatic lower-extremity amputations, responsible for $116 billion in direct medical costs in the United States and $58 billion more in indirect costs, such as disability. Diabetes is an epi- demic, with 23.6 million people affected—5.7 million of whom are undiagnosed—and rates that continue to grow. Moreover, diabetes is not a disease that affects all equally: African Americans, Hispanics, American Indians, and Alaska Natives are twice as likely as white adults to have diabetes. Further, diabetes is more common among those with less education, with disease rates of 15.8% among those without a high school diploma compared with 6.9% among those who attended college. A quarter of all adults aged 60 and older have the disease, and a third of all US children born in 2000 could develop it during their lifetime.
Statistics for the state of Texas are even worse than the national average:
• The prevalence of diabetes in Texans aged 18 and older rose to 10.3% in 2007.
• More than 1.8 million adults in Texas are diabetic, and 460,000 are believed to be undiagnosed.
• Diabetes rates were 12.9% among African Americans, 12.2% among Hispanics, 11.8% among other minorities, and 8.5% among whites. These latest statistics from the Centers for Disease Control and Prevention (CDC) reinforce the need to prevent diabetes and manage it to avoid the worst outcomes for patients.
In regular office visits for diabetes care, health care professionals tend to focus on several treatment targets and ensure that examinations are completed to assess for potential complications. Despite the array of medications available, however, most patients do not reach the goals for the targets. Thus, patients’ daily decisions have the greatest impact on their health, and they are responsible for the actions and the consequences. While health care professionals have an important role in helping patients make informed self-management decisions, they cannot control patients’ self-care decisions. Instead, they focus on asking questions, beginning the office visit with the patient’s agenda, and developing an individualized treatment plan or contract with the patient. A step-by-step approach is helpful, focusing on behaviors and problem-solving skills rather than outcomes. It is also important to involve family members and other supports, maintain contact between visits, and nourish patients’ coping skills. Finally, health care professionals need to obtain assistance from colleagues and refer patients to specialists as needed.
The “LIFE” approach is useful.
L, learn about diabetes, the health care team, and personal life circumstances;
I, identity the three guiding principles of role, flexibility, and targets;
F, formulate a personal self-management plan; and
E, experiment with and evaluate the plan. Thus, while education is involved, it is personalized, ongoing, and touches on more than the disease process and medications.
When BHCS’s Office of Health Equity was organized in 2006 with the vision of improving health care quality through the elimination of variation in health care access, delivery, and outcomes, it identified the Frazier community of South Dallas as having the greatest potential for health equity improvement:
• The hospitalization rates for diabetes in South Dallas averaged 412.9 per 100,000 in the years 2000, 2002, and 2003, compared with 175.3 per 100,000 for Dallas County as a whole in the same period.
• The diabetes death rate was 57.4 per 100,000 persons in 2003 in ZIP code 75210 in South Dallas, compared with 21.7 per 100,000 persons for Dallas County as a whole. The office planned a center of excellence in diabetes care for this area.
BHCS has set the goal of providing a best-in-class center for comprehensive diabetes care, research, education, and prevention. Its efforts to coordinate care throughout the system highlight a team approach—involving not only multidisciplinary health care providers but first and foremost the patient. Just as the patient must attend to many details and address diabetes management in the context of daily routines, BHCS is focusing on its “daily routines”: its systems, its processes of care, its staff’s education, its own monitoring through outcomes—to continuously improve and provide safe, timely, effective, efficient, equitable, and patient-centered care for this growing group of patients.
A variety of services are offered to encourage individual and family lifestyle changes through screening, health education/training, behavior intervention, and treatment. For more information on the newly opened Diabetes Health & Wellness Institute, please visit www.dhwidallas.com.
Donna Rice is currently the President of the Southern Sector Health Initiative (SSHI), an affiliate of Baylor Health Care System. The SSHI is a new initiative for the Baylor Health Care System, with a vision of improving the care and saving the lives of people with diabetes, by creating a new care model focused on health care, prevention, education, and research in the Frazier Community of South Dallas.
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