Collaborative Learning at the 2013 Together on Diabetes Grantee Summit
Patrick Yao Tang, MPH
Together on Diabetes (ToD) is a 5-year, $100 million national initiative that was launched in November 2010 by the Bristol-Myers Squibb Foundation to improve health outcomes of people living with Type 2 diabetes in the United States, China, and India by strengthening patient self-management education, community-based supportive services and broad-based community mobilization. This initiative targets adult populations disproportionately affected by Type 2 diabetes.
On February 25-27, 2013, the Bristol-Myers Squibb Foundation convened grantees, implementing partners, national leaders, expert faculty, and staff in Atlanta, Georgia for the second Together on Diabetes Grantee Summit. Please visit their website to view recordings of the keynote speakers and presentations from all of the grantee panels and skill-building workshops. The Grantee Summit Report, prepared by the National Network of Public Health Institutes, provides an excellent summary of the events.
Grantee panels were organized under five themes: 1) Partnership Development, 2) Evaluation, 3) Population Health Project, 4) Patient Engagement & Practice Change, and 5) Community Health Worker and Community Health Systems Strengthening.
Peers for Progress and our affiliates sent a diverse team to the summit, including:
- Dr. Edwin Fisher (Global Director, Peers for Progress)
- Diana Urlaub (Program Manager, Peers for Progress)
- Phyllis Naragon (Director of Programs and Administration, Academy of American Family Physicians Foundation)
- Manuela McDonough (Program Manager, NCLR)
- Juana Ballesteros (Program Manager, Alivio Medical Center)
- Lizette Martinez (Community Health Worker, Alivio Medical Center)
Dr. Edwin Fisher presented on the Patient Engagement & Practice Change panel. His presentation, titled Diabetes Management through Peer Support and Community Outreach from the Patient-Centered Medical Home (PCMH), may be found on Page 34 of this document. When it comes to patient engagement, Dr. Fisher noted that the reality of working among underserved groups shows that trust must be earned rather than assumed because they are reluctant to accept new services without careful scrutiny. When it comes to practice change, he observed that there is a greater need for organizational rather than technical innovation. Introducing peer support in the context of a PCMH is especially difficult in “silo” healthcare settings with professional bureaucracies.
Lizette Martinez presented on Community Health Worker and Community Health Systems Strengthening panel. Her presentation, titled ¡Mi Salud es Primero! Programa de Diabetes, may be found on Page 9 of this document. In her presentation, Lizette shared a story from the field about a community health worker (CHW) that provided support to a 67 year old male that was diagnosed with Type 2 diabetes 17 years ago. In addition to diabetes, the man had high blood pressure, high cholesterol, experienced a heart attack in 2010, and suffered from neuropathy and foot pain. As a result, he was unemployed and disabled. Unfortunately, his wife and his family lived back in Mexico, which meant that he lacked their much needed support.
When the CHW first contacted the man in August 2012, he seemed indifferent to the CHW at first but responded positively when the conversation addressed his foot pain. The CHW provided some recommendations about his foot pain and made sure that he would receive more information about foot care and leg exercises during his next clinic visit. After the fifth contact in September 2012, the man showed improved glucose levels, his clothes fit more loosely, and his foot pain had decreased. He indicated greater motivation and capability to check glucose levels, control his diet, and start exercising. Encouraged by his improved health, he felt accomplished and engaged in his diabetes self-management. After the eighth contact in November 2012, the man felt comfortable enough to initiate contact with the CHW to ask for help.
Three skill-building workshops were held at the summit, two of which addressed issues pertinent to our current projects at Peers for Progress.
The Policy & Advocacy Workshop entitled The Affordable Care Act: Opportunities for States in 2013, was delivered by Robert Greenwald, Emily Broad Leib, and Maggie Morgan of the Harvard Law School Center for Health Law and Policy Innovation. The primary themes of the workshop included: an overview of health reform, upcoming policy changes, the impact of health reform on diabetes coverage, changes to Medicaid and different models of care (PCMH), existing ACA opportunities, and state and federal policies that may be informed by ToD projects. In March, Maggie Morgan and her colleague, Amy Katzen, were invited to present on this topic for the National Peer Support Collaborative Learning Network’s March webinar.
The Rapid-Cycle Quality Improvement Workshop was led by Dr. George Rust. This quality improvement method identifies, implements and measures changes made to improve a process or system. Rapid cycle improvement implies that changes are made and tested over a short time period rather than the standard eight to twelve months. Workshop participants learned the Plan-Do-Study-Act (PDSA) cycle strategy and were encouraged to consider incorporating this quality improvement methodology into their current ToD projects. Maggy Coufal, senior program manager at Peers for Progress, has been training our collaborators in China to use this methodology as they develop and implement peer support programs for diabetes.
Cross-Cutting Themes from the Summit
The Grantee Summit Report identifies the following themes from the summit:
- The importance of engaging the community, not just the individual – “It Takes a Village”
- The need to better equip the healthcare workforce with an understanding of the social, economic, and environmental determinants of health and complexities in managing diabetes/chronic diseases.
- The importance of an inclusive, participatory, patient-centered approaches to care: CHWs, PCMH, insurance, food partners, etc.
- Shoring up community/clinic linkages to ensure warm hand-offs and strong integration between the two.
- The importance and joy of learning from one another and hearing about each other’s programs.