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  • Thank you for joining us today for the

  • webinar "Strategies to Increase Health

  • System Referrals to Type 2 Diabetes

  • Prevention and Diabetes Management

  • Programs". Our presenter is Krista Proia,

  • who is a Health Scientist with the

  • Centers for Disease Control and

  • Prevention. I am Michelle Knight with ICF

  • Next and I will be your moderator today.

  • the recording and transcripts as well as

  • the PowerPoint slide deck for this

  • webinar will be available on the CDC

  • website. Our learning objectives for this

  • webinar are shown here.

  • Moving forward we will refer to chronic

  • disease prevention programs and chronic

  • disease management programs collectively

  • as chronic disease programs. The content

  • of this webinar is drawn from the CDC

  • brief "Increasing Health System Referrals

  • to Diabetes Prevention and Diabetes

  • Management Programs". Now Krista will

  • begin by describing the need for chronic

  • disease programs. Thank you Michelle. As

  • many of you know chronic diseases are

  • the leading cause of death and

  • disability in the United States and the

  • leading cause of health care costs.

  • Prevention and management of chronic

  • diseases are critical to improving

  • health and reducing cost. One way to

  • improve prevention and management is

  • increased Health System referrals to

  • evidence based chronic disease programs

  • such as the National Diabetes Prevention

  • Program lifestyle change program and

  • diabetes self-management education and

  • support.

  • The types of chronic disease programs

  • we are going to talk about today are

  • chronic disease prevention programs and

  • chronic disease management programs.

  • Chronic disease prevention programs are

  • designed to provide lifestyle change

  • support and education to reduce chronic

  • disease risk.

  • Examples of chronic disease prevention

  • programs include the National Diabetes

  • Prevention Program,

  • also known as National DPP, other

  • lifestyle change programs, and smoking

  • cessation programs. Chronic disease

  • management programs promote self

  • efficacy, self monitoring and adherence

  • to better manage disease and prevent

  • complications in people who already have

  • a chronic disease. Examples of chronic

  • disease management programs include

  • diabetes self-management education and

  • support or DSMES for those diagnosed

  • with diabetes and cardiac rehabilitation

  • programs for people who recently had a

  • heart attack. Referrals from a health care provider

  • can be important in helping make sure

  • individuals participate in effective

  • chronic disease programs. However, often

  • people eligible for these programs are

  • not aware of and do not participate in

  • them. This is particularly true for

  • people with prediabetes who are

  • eligible to participate in a National

  • DPP lifestyle change program. Often

  • people only hear about their risk from a

  • health care provider and thus health

  • care providers are an important champion

  • to raise awareness of the availability

  • of effective chronic disease programs.

  • Health care providers are often viewed

  • as credible sources of health advice and

  • thus are likely to influence behavior

  • change and continued participation in

  • chronic disease programs. Health care

  • provider referral can also predict

  • enrollment for some types of programs and

  • thus program planners will have a better

  • idea of how many participants to expect

  • based on health care provider referral.

  • For the purposes of this webinar we define a

  • Health System referral as a process by

  • which an individual in the clinical

  • setting is recommended to receive a

  • specific service or attend a specific

  • program delivered by another entity. A

  • health system referral can serve as a

  • community-clinical linkage, connecting the clinical

  • sector to the community sector. An

  • example of this is the physician

  • referring one of her patients to a

  • community-based National DPP lifestyle

  • change program. Referrals can also

  • connect one clinical setting such as a

  • physician's office to another clinical

  • setting like a hospital. Referrals to

  • chronic disease programs may be made by

  • a variety of healthcare providers

  • including physicians, nurse practitioners,

  • physician assistants, registered nurses

  • midwives, diabetes educators, pharmacists,

  • dietitians, nutritionists, dentists or

  • community health workers. However in some

  • instances for reimbursement purposes

  • only certain healthcare providers can

  • refer an individual to certain programs

  • or services. For example only physicians

  • and qualified non-physician healthcare

  • providers can make referrals to DSMES.

  • Let's talk more about barriers to

  • referral. We will use referral of

  • patients with prediabetes to National DPP

  • lifestyle change programs as our example.

  • Barriers to referral may occur because health

  • care providers lack specific information

  • about the lifestyle change program, such

  • as where and when the program occurs.

  • Health care providers are not aware of why the

  • program is important or the impact

  • the program has on preventing type 2

  • diabetes. Or, health care providers may

  • not understand the referral process

  • within their network, program eligibility

  • requirements, or cost and coverage/

  • payment options. Barriers occur among

  • potential participants. Too many eligible

  • persons aren't aware of the program and

  • their need for it and don't participate

  • because of this. People may not ask their

  • health care provider for more

  • information about the National DPP or a

  • referral to one.

  • In 2019 scientists in the Division of

  • Diabetes Translation at CDC conducted a

  • systematic review to identify strategies

  • that may help address the barriers

  • mentioned on the previous slide and

  • improve referral rates for chronic

  • disease prevention and management

  • programs. The strategies we present

  • today are those we identified from that

  • systematic review. Because type 2

  • diabetes prevention and diabetes

  • management programs can learn from

  • multiple strategies used for other types

  • of chronic disease programs this review

  • included studies of referrals to other

  • programs such as smoking cessation

  • counseling, cardiac rehabilitation and

  • nutrition and weight loss services. The

  • work also included studies of referrals

  • to preventive services recommended by

  • the US Clinical Preventive Services Task

  • Force such as mammograms and HIV testing.

  • From that systematic review we

  • identified four types of health system

  • referral strategies. Provider education

  • strategies have a primary focus on

  • health care staff education and training.

  • Examples include distribution of

  • referral guidelines or providing

  • feedback from current provider referral

  • practices. System change strategies

  • involve large-scale activities such as

  • the movement of health staff, expanding

  • roles for existing staff, and inclusion of

  • non-traditional staff into the care

  • team to increase referral. System

  • changes may even involve relocation of

  • clinics or changes to financial

  • arrangements to support referral process.

  • Change strategies involve smaller

  • changes that impact the