How to Apply an Evidence-Based Approach to Diabetes Communication

March 1, 2016


How do you address an epidemic of pre-diabetes and severe diabetes in your population? Yakima Valley Memorial Hospital applied evidence to both ends.

  • Identify Your Population: One-third of Yakima County’s multicultural population is pre-diabetic, while 1 in 11 adults has Type 2 diabetes. Yakima has also been recognized as the fourth-fattest city in the United States, with a third of its population classified as obese. Given the $14,000 in annual medical costs to treat each diabetic patient, the hospital realized it had to implement effective diabetes prevention and management programs.
  • Gather Your Resources: A state grant enabled Yakima Valley to expand its diabetes programs and make them evidence-based. It increased coordination between community providers and diabetes program services, and provided services in both English and Spanish to meet the needs of its predominantly Hispanic population. In addition, it offered services not only to the highest-risk pre-diabetic patients, but those at risk for pre-diabetes based on non-modifiable risk factors like family history and age.
  • Launch an Evidence-Based Program: Yakima Valley chose to adopt a proven program. The CDC’s National Diabetes Prevention Program is an evidence-based lifestyle transformation curriculum that incorporates dietary changes, daily exercise, and coaching. Program leaders ask participants to lose 7% of their body weight and incorporate 150 minutes of exercise into each week. Participants attend 16 free weekly group coaching sessions, followed by 7 monthly sessions, while keeping an individual food and exercise diary. In the first year of the program, the hospital tracked participants’ hemoglobin A1c (an indicator of long-term blood sugar control), weight, and activity.
  • Track Results: After 11 months, 87% of participants had met the physical activity goals, beating the national program average of 74%. This metric was particularly impressive given that Yakima is a rural area where residents prefer to drive rather than walk. Nearly half (47%) met the weight reduction goal, losing an average of 13.5 pounds. An impressive 82% of participants lowered their A1c. The majority (62%) of patients became totally confident in their diabetes prevention knowledge. In addition, many patients experienced improvements in their blood pressure and cholesterol levels, allowing some to discontinue their medications. The results spoke for themselves. These documented outcomes demonstrated the long-term benefits of lifestyle modification coaching, driving both physician referrals and patient word-of-mouth marketing. Some particularly successful patients, who lost 50-100 pounds, became lifestyle coaches themselves.
  • Enhance Program Effectiveness: For the program’s second year, Yakima Valley is improving the cost-effectiveness of its programs in several ways.
    • Implement Targeted Communications: To reach the highest-risk patients, the hospital partnered with Healthgrades, which sampled 12 months of data and identified approximately 6,000 patients with A1c test results. Based on those findings, Yakima Valley is sending out 1,000 educational mailers per month over 6 months to patients with A1c test results within the last 30 days. Half are delivered to those at highest risk of diabetes, and half are sent to those with the most severe diabetes. This strategy allows the hospital to promote both its diabetes prevention and its diabetes management programs.

      How to Apply an Evidence-Based Approach

    • Reduce Costs:  To ensure a sustainable prevention program, the hospital now measures waist circumference instead of A1c as a more cost-effective health tracking option.
    • Improve Attrition Rates: While the diabetes prevention program experienced only a 25% attrition rate over 16 weeks, after one year 50% of participants had dropped out. Patients indicated they wanted to be held more accountable, so the hospital is in discussions to increase the monthly coaching sessions to biweekly sessions.

To change how your organization deals with diabetes, follow the evidence. Targeted, cost-effective prevention and management engage patients and their doctors alike.

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