Goals Of The University Of Pittsburgh Diabetes Institute Initiative
Improve Access To Quality Diabetes Care To Individuals Disadvantaged By Distance Or Geography
Rural residents are known to have poor perception of overall health, lower income and a higher proportion of elderly and children compared to those residing in urban settings. The rural population experiences increased rates of chronic disease including diabetes (31.6/1000 vs. 26.7/1000, rural vs. urban respectively). Rural residents also do not receive the same number and types of chronic care services as their urban counterparts. There are half as many physicians in rural areas compared to urban areas, and rural residents also experience limited access to specialty care. This is problematic for patients with diabetes. As studies have demonstrated, lower use of preventive services and poorer glycemic control is seen in patients who receive their diabetes care from primary care providers as compared to specialists.
Primary Prevention Of Diabetes In Those At Risk
The Diabetes Prevention Project (DPP), a clinical trial that studied more than 3,200 adults who were at increased risk of developing Type 2 diabetes, demonstrated that lifestyle changes, including healthy eating and modest physical activity can prevent or delay the disease. The DPP lifestyle intervention was designed at the University of Pittsburgh Graduate School of Public Health and was implemented in Pittsburgh. Publicizing the DPP findings into the community and military populations could potentially have a significant impact on the future incidence of diabetes.
Develop Mechanisms To Facilitate Retinal Imaging And Storing
Diabetic retinopathy is the most frequent cause of new cases of blindness among adults. Evidence has shown that an annual comprehensive retinal exam significantly reduces the incidence of diabetic retinopathy, yet rates for annual examinations are poor. Retinal imaging is now available with high-speed cameras that are easily transportable. The UPMC department of ophthalmology and the Veteran’s Administration (VA) can use portable retinal photography at remote rural and VA sites.
Improve Quality Of Care In Primary Care Practices In Order To Enhance Patient Outcomes
Diabetes is a complex disease that requires time and expertise from a variety of health care professionals, nurse educators, dietitians, podiatrists and pharmacists. Since more than 90 percent of patients with diabetes are cared for by primary care physicians, it becomes critical to develop methods for primary care physicians to have access to state-of-the-art diabetes expertise and opportunities to promote and support diabetes education. Technological interventions that have been developed at UPMC, including programs to enhance education resources to providers and their patients and tracking and monitoring resources will be expanded.
Provide Multi-Disciplinary Team-Based Care in the UPMC Community Health Services Division, Thereby Increasing Access to Quality Diabetes Care for Lower Socio-Economic, Underserved Areas and High-Risk Minority Communities
Reducing the incidence of diabetes complications requires that patients develop competencies in self-management, lifestyle change and decision-making. This is best accomplished with a team-based, multi-disciplinary approach. The Community Health Services Division of UPMC coordinates health centers in some of the most underserved and high-risk communities. Building on the team-based educational programs to date, the Institute will expand these efforts into UPMC Community Health Centers. This community outreach program will be supported through technological approaches (video-conferencing, transmission of images, computer-based education programs, etc.).
Expand and Disseminate Team-Based and Telemedicine Approaches from the VA Pittsburgh Site to Outlying VA Sites, Thereby Increasing Access to Quality Services for Veterans
The VA Pittsburgh Healthcare System currently offers a Diabetic Referral Clinic one half-day per week. Based on the Diabetes Institute’s model, this clinic is staffed by an endocrinologist, nurse, diabetes nurse educator, dietitian and a pharmacist. This clinic is designed to assist VA primary care providers in the management of Type 1 and Type 2 diabetics not meeting the HbA1C target despite multiple (more than 2) insulin injections per day, desiring insulin pump therapy or experiencing recurrent hypoglycemia on insulin. This multidisciplinary clinic has been highly successful in improving glycemic control.
This clinic model would be expanded to facilitate more services at the main site and to support care to outlying VA facilities. Currently, the VA Pittsburgh site is using a teleconsultation system for dermatology. This model will be replicated for diabetes care and will allow general clinicians and medical personnel access to remote expert advice, diagnosis and mentoring and contribute to providing a high-quality standard of care independent of location.
Provide Quality Inpatient Care To All Patients With Diabetes
According to the Pennsylvania Health Care Cost Containment Council (PHC4), diabetes was the principal or secondary diagnosis in 16.5 percent of hospitalizations for Pennsylvania residents in 2001. Diabetes hospitalization rates for Allegheny County were 14.3 percent above the statewide rate. At UPMC Presbyterian, approximately 25 percent of admissions are diabetes-related. Physicians, nurses and other health care providers need to have standardized protocols for diabetes care that will ensure patient safety and optimal patient outcomes.
The Diabetes Patient Oversight Committee has been actively developing and testing protocols to improve treatment for those hospitalized with diabetes at UPMC. A Hypoglycemia Protocol has been successfully implemented in an effort to improve the assessment and treatment of low blood glucose. Protocols for diabetic ketoacidosis, critical care and insulin pump therapy are currently being developed and will soon be implemented. The intention is to disseminate these tested protocols, developed by diabetes experts, to all UPMC facilities and potentially to Air Force facilities.