Impacts of a Two-Part Multidisciplinary Diabetes Education Program on Glycemic Control and Hospital Use

Background: Emergency room and hospital use remain high among those with diabetes. Interventions need to be developed to reduce the utilization of this high-cost care while still improving diabetes management.

Purpose: To analyze changes in outcomes for patient with diabetes who attend a two-part multidisciplinary diabetes education program, which includes a 1-day DSME class and a ½ day “Speed Dating” session in terms of ER and hospital use, A1C, and LDL-cholesterol from January 2016-2018.

Method:Adult patients with diabetes at a family medicine clinic are enrolled and attend an 8-hour DSME class followed by a 3-hour multidisciplinary clinic 2 weeks later during which patients rotate every 30 min through 5 centers hosted by a 1) family medicine physician, 2) clinical pharmacist (CDE), 3) nurse or dietician (CDE), 4) case manager, and 5) clinical psychologist to address and improve care. Data was systematically extracted from the electronic medical record (EMR) 6 months before, 6 and 12 months after attending the class to determine impact of the program. Paired t-tests determined significance between baseline and post-intervention measures.

Results: Over 24 months, 22 adults attended the program. At baseline patients had an average A1C of 10.2% and LDL of 115 mg/dL. Six months before attending the class they presented to the ER 0.68 times, were admitted to the hospital 0.5 times, and when admitted, had an average length of stay (LOS) of 5.3 days. After attending the program patients’ A1C declined to 9.1% at 6 months (p=0.28) and 8.7% at 12 months (p=0.022). Their LDL-C declined to 110 mg/dl (p = 0.71). Although ER use increased to 0.8, their hospital admission rate and LOS decreased to 0.36 and 3.3 days respectively per patient.

Implications: Incorporation of the DSME plus Speed Dating program improved care by lower A1C by 1.5%, hospital admission rate by 0.14, and LOS by 2 days over a 6-month window. Ultimately these improvements additionally lower healthcare costs.