Mississippi Clinics Take Diabetes Care from Bad to Best
- From: William Wagner <PainInAss__williamwag@xxxxxxxxx>
- Date: Wed, 26 Oct 2005 09:35:00 -0400
http://www.newswise.com/articles/view/515618/?sc=dwhn
Next to last sentence reads.
³If you¹ve done diabetes well, you have essentially already done high
blood pressure, dyslipidemia and cardiovascular mortality.²
Released: Tue 25-Oct-2005, 16:20 ET
Mississippi Clinics Take Diabetes Care from Bad to Best
Mississippi has the worst diabetes numbers in the country, Yet,a group
of clinics here has had startling results with patients once considered
intractable.
Newswise ? Mississippi has traditionally been the worst state in the
nation for patients with diabetes. The incidence of diabetes is higher
here, the complications more numerous, and until now, the quality of
care was at rock bottom. The complications from diabetes kidney failure,
amputation, blindness and heart disease --are both life-threatening and
severely debilitating.
A new system of diabetes care, however, is changing all that. In several
clinics around the state (two in the Mississippi Delta where diabetes
numbers soar) patients have reduced their risk for complications by 70
percent in just six visits.
The scourge of the state has met its enemy Dr. Marshall Bouldin,
associate professor of medicine at the University of Mississippi Medical
Center where he started the first clinic in 1999. The growth of the
system wasn¹t unplanned. Dr. Dan Jones, vice chancellor for health
affairs at the Medical Center, urged Bouldin to create a system that
could be replicated in other parts of the state to bring diabetes care
up to the national standard and help prevent some of the tragic
complications of the disease.
Now, with six years of data and experience in several locations, Bouldin
has shown that patients in the clinics, even those who were formerly
considered ³difficult,² average a two-point drop in their long-term
levels of blood sugar, and for every point that level decreases, the
patient reduces his risk for complications by 35 percent. Even more
encouraging, there is no disparity of outcomes between African Americans
and Caucasians.
Bouldin said that the prevalence of diabetes among adults in Mississippi
increased from 7.3 percent to 11 percent from 1999 to 2001. In some
subsets of the Mississippi population, the prevalence is even higher.
Among African-American women between 55 and 64, for example, 34.7
percent have diabetes. And diabetes definitely hits hardest among the
poor. Mississippi is the poorest state in the nation, and counties that
make up the Mississippi Delta are the poorest of the poor. Still, in
this population, Bouldin¹s system has produced outcomes equal to or
better than those in affluent white communities in the Northeast.
³Diabetes control ultimately hinges on the patient¹s ability to manage
his or her own diabetes, and everyone responds to interventions that
allow them to do that,² Bouldin said.
Pete Johnson, the federal co-chairman for the Delta Regional Authority,
said his group was looking for models of health care delivery when it
became obvious that health was a key driver of the economy. ³You cannot
turn an economy around if you don¹t have a competitive work force, and
you can¹t have a competitive work force if they¹re not healthy.² The
authority, created by congressional act in 2000 under the administration
of President Bill Clinton, works to improve conditions in 240 counties
and parishes in eight states.
³We¹re right at the beginning of taking this region-wide,² Johnson said.
³We were looking for an efficient model of health care delivery, and it
was right under our noses.²
Johnson, it turns out, is friends with Bouldin¹s father, the famous
portrait artist from Clarksdale. ³He sits two rows in front of me in
church, and one Sunday, when Marshall was home for the weekend, he told
me about his project and how he thought it could work in the Delta. We
looked at his data and analyzed his results and decided it was a program
we should embrace and replicate.²
Funding for the Delta clinics comes from the Delta Health Alliance,
under the direction of Dr. Cass Pennington. One thing that appeals to
both agencies is the cost effectiveness of the clinics. ³It costs about
$250,000 to start up a clinic, but re-imbursement from Medicaid and
Medicare make it self-sustaining,² Johnson said.
Pennington said his agency is impressed with the strong patient
education component of the diabetes project, and the impact it has had
on the health of the Delta. ³Employers in the Delta cite frequent
employee absences because of sickness as a major problem. And they
identify diabetes as the major cause of those absences. This program is
a Godsend, and it will have a tremendous impact on the Delta counties.²
Pennington also credited Bouldin for his perseverance in seeing the
clinics implemented. ³I think his car could find its way to the Delta
without a driver.²
But Bouldin knows that he can¹t be in all locations all the times he¹s
needed, so he¹s developed another collaboration with the University of
Tennessee to use its telemedicine capabilities. ³This way, I can meet
with the staff of the clinics in the Delta once a week and go over
patient records with them or discuss any problems they may have
encountered.²
Bouldin also trains local physicians to use the system he¹s devised for
diabetes care, so it can be done in his absence. But the system uses
physicians very sparingly, and that¹s one of the reasons it can be
replicated in regions where physicians are scarce.
³We don¹t do anything that¹s revolutionary. We use all the tried and
true methods of diabetes management.²
What is perhaps revolutionary is the absence of the traditional
hierarchy of care starting with the physician at the top and the patient
educators and dieticians at the bottom. ³In this model, every
professional role is critical,² Bouldin said. Nurse practitioners, RNs,
diabetic educators, pharmacists and dietitians all work as a team to
teach and care for patients. Nurse practitioners and pharmacists manage
diabetes care much as a physician specialist would. Bouldin, the
physician, manages medical problems beyond the scope of the other
professionals and supervises quality assurance. ³As far as we know, this
is the first time pharmacists have ever been used in this specific role
of diabetes management,² he said, ³and our studies have shown that
they¹re particularly effective in reducing blood sugar levels.²
The risk for complications, Bouldin explained, correlates with the
concentration of sugar in the blood. The insulin in individuals who
don¹t have diabetes allows glucose (sugar) to enter cells and be
converted to energy, to synthesize proteins and store fat. In patients
with diabetes, sugar and fat stay in the bloodstream and damage vessels
and nerves that can eventually lead to kidney disease, blindness and
amputation and heart disease.
No system in Mississippi (and few in the country) has reported outcomes
as good as Bouldin¹s, and especially not in the high-risk populations
the clinics serve.
³Our outcomes have been consistent over six years, and we were surprised
that results could be seen so quickly. Our patients average a two-point
drop in their blood sugar levels in just six months,² he said.
The clinical outcomes of Bouldin¹s system have not escaped notice on a
national level. In the last three years, Bouldin has succeeded in
obtaining $3.2 million in external funding with more funding
anticipated. In May 2005 Bouldin presented results from the various
clinics to the Bipartisan Committee on Health Information Technology on
Capital Hill and made a special presentation to Medicare staff in
Baltimore at the request of the Medicare director.
³I think the general feeling is that if we can do this in Mississippi,
it can work anywhere,² Bouldin said.
To Bouldin, one of the key components of success is the degree of
collaboration between agencies, institutions, the local community and
the federal government. In addition to the Delta Regional Authority and
the Delta Health Alliance, and the University of Tennessee, other active
partners are the Joslin Diabetes Center, Mississippi Valley State
University, Delta State University, Mississippi State University and the
Centers for Disease Control (CDC).
The CDC will put a field station in the Delta to work with the Delta
Health Alliance and the diabetes project. ³We had always planned that
the diabetes program we first established at the Medical Center in 1999
would really be a test case for the management of chronic disease. If
you¹ve done diabetes well, you have essentially already done high blood
pressure, dyslipidemia and cardiovascular mortality. The partnership
with CDC will enable the coalition to develop regional programs along
these lines.²
2005 Newswise. All Rights Reserved.
--
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