544-P: Early Evidence from a Pragmatic Trial to Increase Uptake of Diabetes Self-Management Education and Support Services in Rural Health Care Systems in Kentucky

Introduction & Objective: Diabetes self-management education and support (DSMES) is recommended for persons with diabetes (PWD) and is associated with a range of improved outcomes, but it is underutilized (<10% of patients complete). In this study we present interim findings from a pragmatic trial that integrates health information technology and a quality improvement learning collaborative framework based on the Institute for Healthcare Improvement model to increase DSMES referrals among PWD.

Methods: Two healthcare systems from rural Kentucky participated in the study; within each system, two clinics were assigned to be intervention clinics and one clinic served as the control clinic. At the midpoint of the intervention (4.5 of 9 total months), we assessed preliminary effectiveness of the intervention on the primary outcome - percent change in DSMES referrals from baseline.

Results: Across the two healthcare systems, a total of 956 PWD were served by intervention clinics and 489 by control clinics. At the intervention midpoint, all intervention clinics had participated in ~16 hours of education plus monthly coaching calls with a quality improvement advisor and had completed four Plan-Do-Study-Act cycles to optimize their DSMES referral process. At baseline, 0% of PWD at both intervention and control clinics had been referred to DSMES in the prior 12 months. At study midpoint, 0% of PWD from control (0/489) and 19.4% (185/956) of PWD from intervention clinics were referred to DSMES.

Conclusion: Preliminary evidence suggests the effectiveness of our multipronged intervention to increase DSMES referrals among clinics in rural Kentucky. Rates of DSMES attendance among PWD that were referred and implementation outcomes, including feasibility, acceptability, scalability and sustainability, will be assessed.