Diabetes Primary Prevention Initiative

Michigan, along with 5 other states, has been awarded a grant from CDC for Phase II (the implementation phase) of the Diabetes Primary Prevention Initiative (DPPI). This project developed consists of piloting the addition of diabetes screening into the WISEWOMAN (Well Integrated Screening and Evaluation for Women Across the Nation) program in Lenawee County.  It is expected that diabetes screening will be included in all Wisewoman programs in the state next year.  In addition to the screening, WISEWOMAN staff will be involved in linking to lifestyle intervention programs, including diabetes self-management training programs. Diabetes Prevention and Control Program staff recently participated in a “Healthy Weight Partnership” meeting to share information about the DPPI and to explore opportunities to partner with this group.  This partnership is part of the plan to prevent obesity and reduce chronic disease,  and is a subcommittee of the cardiovascular health advisory committee.

The Michigan Quality Improvement Consortium revised the diabetes guidelines.  MQIC  is a group of health plans, physicians, QI organizations and medical societies that use a collaborative approach to develop and implement common evidence-based clinical practice guidelines for the treatment of certain conditions and also (more recently) for primary preventive services.  A significant revision consisted of the deletion of “Diabetes self-management education recommendation” which was replaced with “People with diabetes should receive medical care from a physician-coordinated team” and “to consider referral to diabetes educator if education not provided by physician or practice staff” (see copy of complete guideline).  The Medical Directors’ committee makes the final decision for recommendations.

The importance of family health history continues to be a focus at both the State and National level.  There was a conference last month called “Applications of Family Health History in Primary Care” addressing the collection and utilization of family health information.  Encouraging people to collect family health information in a format that lends itself to identifying trends or clusters of conditions that are hereditary is important.  A Family Health Portrait can be created online (or downloaded and printed for completion) at the website below.

Personal Action Toward Health, is an initiative to implement the Standford Chronic Disease Model statewide.  This is a lay leader led program to help people with chronic disease achieve behavior change in a group setting.  Leader trainings are occurring throughout the state, some of them in partnership with Area Agency on Aging , who have grant money to expand services to promote better chronic disease management.  DPCP staff are participating in this project, which includes several different work groups. 

In December, 2005, Governor Granholm called for a statewide initiative to build the foundations of a statewide health information network to bring Michigan’s health care system into the 21st century.  The goal is to foster an interoperable health information network that will reduce the overall cost of care while increasing the quality of care and patient safety.  Health care professionals who participated in the clinical group identified that accessing a patient’s information from across multiple providers to improve the quality, safety and efficiency of health care was a high priority.  In order to accomplish the vision of integration and portability of patient healthcare records, there are general statewide roles that will be accomplished by 2 groups:  The HIT commission and the MiHIN operations Group.  The Commission has been mandated by the governor and members have been appointed.  It will be responsible for funding appropriations for regional health information entities, identifying standards of security, privacy, and interoperability, and other.  It is expected that this group will establish the operations group, which will be comprised of public and private stakeholders with responsibility for statewide coordination of the implementation of regional Health Information Entities (HIEs) and statewide exchange.

This group of stakeholders, who are working collaboratively to eliminate system barriers that prevent the effective delivery of prevention services and chronic disease management in primary care settings throughout Michigan, is poised to begin the first phase of implementation.  A report, which includes the strategic plan, will be available on the web site soon.  A web accessible database of projects that represent quality examples of “early adopters” towards removing the identified barriers is being developed.  One of the projects that will be included involves the use of a diabetes educator in a primary care setting.  If you know of others, please contact Karen Boyer.

The Diabetes Partners in Action Coalition (DPAC) has gone through slight restructuring in the last year.  DPAC has added two committees—Membership and Governance.  The previous “committees” are now called “workgroups,” and are the same:  Policy/Advocacy; Data/Research; Training Programs; Prevention and Consumer Awareness.  New this year is the direction the workgroups and committees will address the Strategic Plan.  This year, all activities will be directed to accomplishing one Strategic Plan recommendation:  Improve access to diabetes self-management training, supplies and health care (Recommendation #6).  The full member meeting is scheduled for November 15 in Lansing. 

The National Kidney Foundation of Michigan, in partnership with the Department of Community Health and Michigan State University, has convened a group to address quality improvement in diabetes and cardiovascular and kidney diseases this replaces the Diabetes Care Improvement Program (DCIP) that many of the DSMTPs used to participate in.  The group is comprised of representatives from MPRO, GDAHC, NKFM, MDCH, MSU, PCI, MQIC, MSU and MAHP.  The group has come together to discuss the linkages between the three diseases and what tools or assistance are feasible for the health care system to effectively treat these linkages.  The initial planned activity is to work toward developing one simple and straightforward message for providers to treat patients to goal for these three disease states.  The group will meet again in October.

An interactive, self-paced CD program for all levels of health care clinicians is available free.  The program was a project of MDCH, CVD section and takes about 1 hour to complete.  It includes an update and review of the key factors for accurate blood pressure measurement technique, using the most recent national recommendations for blood pressure determination.   Contact Karen Boyer boyerk@michigan.gov or 517-335-9504 if you would like an order form.

The Surgeon General’s initiative to support healthy living, has a web site from which a variety of information and tools can be accessed.  Some of these include a Quarterly newsletter, a tool to create a personal healthy living plan and tools to support the plan (daily journal to use online or print; and a week-end journal calculator); a Health risk Appraisal, an in-depth assessment with recommendations for health improvement; and “Tip of the Day."

A collaborative initiative between MDCH and Michigan Association of Health Plans Foundation since 1999. Materials are still available.  Order forms can be obtained from web site:  www.foundation.mahp.org., or phone:  517-332-3323.

This relatively new program is working closely with Offices of Services for the Aging (OSA) to promote healthy aging.  A Steering Committee comprised of 10 members from OSA and 10 members who represent state and local public health are convening and anticipate that a statewide strategic plan will be written by June, 2007.  Currently, the state program is supporting some local programs that seek to implement evidenced-based practice in communities through coalitions organized within the infrastructure of the Area Agency on Aging (“triple As”).  There are 16 of these regional organizations throughout the state, each including approximately 5 counties.  The specific programs include:  Fall prevention; Stanford Chronic Disease Program (PATH – see above); nutrition and exercise  (Eating Better; Moving More); fitness; and depression management.  The “triple As” oversee the senior congregate meal sites and other community wellness centers/initiatives at the local level and DSMTP’s are encouraged to learn more about these groups in their respective areas to increase awareness of DSMTP’s and to explore possible collaborations. 

Diabetes Educators and all health care providers are reminded to check out NDEP’s “Make Better Diabetes Care” website (www.betterdiabetescare.nih.gov).  This is “a dynamic website and continuing education resource that allows you to ask your own questions about the real challenges that affect your practice while earning CE credit”.  Also available on the NDEP website in September are “Tips for Helping a Person with Diabetes”.  This tool was developed in partnership with American Association of Diabetes Educators (AADE) and offers friends and family members ways to help their loved ones control their diabetes for life, and a list of resources where to find additional support and some great ideas from diabetes educators, nutritionist, and other health care professionals.