Systems Changes Increase Referrals, Use of Self-Management Program, and Short-Term Health Outcomes to Prevent Diabetes

Estimated annual Medicaid costs for diabetes in Maine are $73 million (in 2007 dollars). Estimated diabetes prevalence increased from 3.5% in 1995 to 8.7% in 2010. The Diabetes Prevention Program study showed that people with prediabetes can prevent or delay diabetes through lifestyle changes resulting in modest weight loss.

The Maine CDC Diabetes Prevention and Control Program partnered with MaineGeneral Health on a systems change intervention to prevent diabetes. A prediabetes protocol for diagnosis, treatment and referral was implemented through training and ongoing technical assistance, site visits, and meaningful use of aggregate electronic health record data. Pilot sites used the protocol to identify patients with prediabetes; develop referral mechanisms; and assist with outreach and follow-up to get patients with prediabetes appropriate self-management support.

Primary care practices: i) changed policies and practice environments to support diabetes prevention (e.g. placed protocol in exam rooms to identify those with prediabetes and refer them to self-management, developed a prediabetes registry, and used monthly data reports on patient status and outcomes to improve quality of care and health outcomes); ii) removed an identified barrier to quality care (e.g. lack of a nearby program for referrals – through startup of a new Living Well program); iii) increased referrals to Living Well, an evidence-based self-management program that can help participants achieve lifestyle change to prevent diabetes; and iv) improved short-term health indicators (e.g., increased identification of people with prediabetes and increased BMI measurement, increased BMI < 25, and increased A1c <7 in people with prediabetes).