October 3, 2010 in City

Region part of federal pilot program to track diabetes

By The Spokesman-Review
 
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Find maps, charts and more data on diabetes in Washington, Idaho and the U.S. at the CDC’s website.

The diabetes problem is reaching full roar in the Spokane-Coeur d’Alene region. More than 48,000 people are living with the chronic disease and another 114,000 are on the cusp as they struggle with obesity and sedentary lifestyles.    It’s an epidemic that has grown along with the nation’s girth. Diabetes rates could double within 25 years, threatening to overwhelm hospitals, clinics, businesses, insurers, government and taxpayers, according to studies that analyze government reports.

Educational campaigns and hard-fought regulations are considered a start in combating the problem – food labeling and tobacco restrictions, for example, that have revealed how unhealthy some foods are and chased smokers from public places.

Now the federal government is undertaking a technical strategy to attempt to address the issue.

Eastern Washington and much of North Idaho are included in a $15.7 million pilot program funded by the federal government called Beacon Community of the Inland Northwest. If it’s successful, the program will serve as a national blueprint on how best to share medical records and help diabetics stay healthier and out of hospitals.

The stakes are high. About 23.6 million Americans had diabetes in 2007, according to a report from the U.S. Centers for Disease Control and Prevention. Another 57 million were considered “prediabetic,” meaning that unless they manage their weight and lower their blood sugar levels, they will develop the chronic disease.

Those numbers have likely grown by millions since then, according to the American Diabetes Association.

Plan includes regular calls, texts

The Beacon plan includes having nurses or clinic staff check up on their diabetes patients regularly. Those contacts might be a quick phone call to ask how a patient is feeling, or perhaps a text message regarding a patient’s diet plan. It could also include checking on a prescription to ensure medications are being taken.

For Sue Els, of Davenport, Wash., that means monitoring her blood sugar levels and talking regularly with registered nurse Jennifer Larmer at the Davenport Clinic, who was hired as a patient care coordinator partly with money from the Beacon grant.

Els learned she had Type 2 diabetes after attending a health fair six years ago.

She has since lost 20 pounds by exercising and sticking to a healthy diet, but she needs to take an oral medication that spurs her pancreas to produce enough insulin to help her body process sugars and fats.

Most diabetics have Type 2 – sometimes referred to as adult-onset because they develop the disease later in life. In most cases the disease can be handled with the right mix of medication, diet and exercise. In some cases the onset of the disease can be reversed.

It is different from Type 1, which is usually diagnosed in children and young adults, and for which there is no cure.

“It wasn’t easy,” Els said of changing her lifestyle. “I had to drop the habit of snacking. My favorites were salty foods and cheese.”

She visited a dietitian in Spokane and came up with a modest plan that has worked. It includes counting carbohydrates and plenty of physical activity every day. The plan was a better choice, she said, than risking the possibility of heart disease, kidney failure, stroke or blindness.

“Those are the kind of complications I didn’t want,” she said.

At the Davenport Clinic, Larmer, the nurse who works with Els, has consultations with newly diagnosed diabetics and visits with those who have been living with the disease for many years. Her goal is to help them manage their disease.

“I had one patient tell me ‘You’ll never tell me I can’t have my root beer and candy bar every day,’” Larmer said. “And that’s OK. It’s a place to start and hopefully, maybe someday, that’s something they won’t need every day.”

Program’s backbone is technology

Larmer’s role in the Beacon program is one that patients will notice. But there’s a significant technological aspect to the far-reaching program that should go largely unnoticed. It will incorporate computer programmers in Spokane, physician specialists at large clinics and hospitals, and nurses like Larmer who work one-on-one with patients in small towns.

Spokane-based Inland Northwest Health Services received the Beacon grant, largely based on its successful work in building an electronic medical records network for the region’s hospitals. Now the nonprofit organization will link physicians – especially doctors in rural clinics and hospitals – with specialists in larger cities.

Diabetics often see multiple specialists for the various aspects of their chronic disease. That could include cardiologists, ophthalmologists and nephrologists, who specialize in kidney disease and treatment.

“From a doctor’s perspective, it’s often hard to know where my patient has gone and what was done,” said Aaron McKethan, the Washington, D.C.-based program director for the U.S. Department of Health and Human Services’ Beacon Community Cooperative Agreement Program.

“And from the patient’s perspective, it often feels like we’re on our own. It’s on us to try and remember everything and to tell the right people.”

Such a seemingly simple step of having an online medical record where a patient’s medical file is both secure and accessible by authorized health care staff continues to be a high hurdle.

That’s partly because health care remains a fee-for-service business, so there’s an incentive to repeat expensive tests – especially those generously covered by insurers and reimbursed by the government’s Medicare and Medicaid programs.

Inland Northwest one of 15 places chosen

Spokane was one of 15 communities across the country selected for the Beacon pilot program. McKethan said the region was chosen because there’s already a system of record-sharing and acceptance of the practice among health care providers. It made financial and practical sense to invest in such areas first and then duplicate those successes elsewhere rather than start from scratch, he said.

The program will spend $220 million on the 15 communities.

“It’s ambitious, we know,” said Jennifer Polello, director of the diabetes education center for Inland Northwest Health Services.

Spokane’s two competing hospital systems created INHS in the 1990s as a nonprofit collaboration designed to offer services such as an air ambulance, a rehabilitation hospital and electronic patient files.

Success will be measured with periodic report cards, measuring such factors as the number of emergency room visits by diagnosed diabetes patients, said Jac Davies, director of INHS’ Northwest TeleHealth regional outreach and Health at Work programs. The area included in the study is large, comprising some 950 doctors and 48 hospitals and large clinics.

Goal is long-term cost control

Long-term cost control is a driver behind the Beacon projects.

The Obama administration is ready to invest $27 billion in electronic medical records technology across the country with hopes that the payoff will be coordinated care that lowers costs and improves health.

The projects range from Tulsa, Okla., where obesity and diabetes have led to the highest rates of heart disease deaths in the nation, to the Mayo Clinic in Rochester, Minn., where money will be spent on trying to reduce the number of hospitalizations of diabetes patients and children with asthma.

Emergency room visits and hospital admissions among diabetes patients are a ripe target for improvement because many can be avoided with careful management of the disease.

In Spokane and the rest of Washington state, hospitalization rates related to diabetes have risen significantly. According to the Spokane Regional Health District, the county had an average of 452 hospitalizations each year from 2000-2006. Those numbers have likely climbed along with the diabetes rates.

“For the patient, hopefully what we’re doing will make their lives easier,” said INHS’ Davies. “They should have more confidence that their doctor has all the information they need to make good decisions on their behalf.”

Project could help rural communities

That could be especially true in rural communities, where information gaps and tight funding are commonplace.

Doctors may not know everything they need to know about a patient’s medical history, Davies said.

What’s more, said Tom Martin, chief executive of Lincoln Hospital in Davenport, “Health professionals now realize that with a disease like diabetes, we need to be there with the patients as they cope at home and work.”

Simply giving a patient advice and a plan during an office visit does not mean that the patient will follow it, said Larmer, the nurse at the Davenport Clinic.

“Some patients throw up their arms and say ‘I don’t know what to eat,’ ” she said.

Many Type 2 diabetes patients are older than 50 and have developed bad eating and exercise habits that led to diabetes, said Dr. Fred Reed, who works at Lincoln Hospital.

“Gathering the data on all these folks, I think, will be the easy part around here,” he said. “Using it to do something that helps patients make changes in their lives? That’s going to be the hard part.”


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