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DOI: 10.1177/0145721706294787
Diabetes Self-management Education Program for Medicaid RecipientsA Continuous Quality Improvement ProcessFrom the Arkansas Department of Health and Human Services, Little Rock (Dr Balamurugan); Department of Epidemiology, University of Arkansas for Medical Sciences (UAMS) Fay W. Boozman College of Public Health, Little Rock (Dr Balamurugan); the Department of Health Policy and Management, Texas A & M Health Sciences Center, College Station (Dr Ohsfeldt); Eli Lilly and Company, Indianapolis, Indiana (Dr Hughes); and the Department of Psychiatry & Epidemiology, UAMS College of Medicine & College of Public Health, Little Rock (Dr Phillips). Correspondence to Appathurai Balamurugan, MD, MPH, Epidemiology Branch, Division of Health, Arkansas Department of Health and Human Services, PO Box 1437, Slot H-32, Little Rock, AR 72203-1437 (appathurai.balamurugan{at}arkansas.gov). Purpose Diabetes self-management education (DSME) is the cornerstone in effective management of diabetes. The continuous quality improvement process was used to identify the problem, collect and analyze data, and develop and implement a DSME program for Medicaid recipients, and subsequently, the program was evaluated to assess its effectiveness. Methods A DSME program consisting of a 1-hour initial assessment of individual needs followed by 12 hours of group education on nutrition and self-management was provided to 212 Arkansas Medicaid recipients over 1 year. Key clinical measures were assessed at the end of the period. Results Over 1 year, mean HbA1c declined by 0.45% among the DSME participants who completed the full program. Multivariate analyses found that after controlling for age, gender, race, preperiod diabetes drug use, and preperiod costs, DSME participants were found to have fewer hospital admissions, emergency department visits, and outpatient visits. Changes from baseline clinical values for DSME participants were used to project changes in diabetes-related costs using the Gilmer model. An estimated savings in diabetes-related cost over 3 years was $415 per program completer. Over 10 years, completers were estimated to experience 12% fewer coronary heart disease events and 15% fewer microvascular disease events using the United Kingdom Prospective Diabetes Study risk models. Conclusions A DSME program for Medicaid recipients can reduce health care use among Medicaid recipients with diabetes within 1 year and over longer periods of time is likely to reduce costs associated with reduced use of health care. Plans are in place to explore the possibility of sustaining the program.
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