Texas Diabetes Education &
Care Management Project
Funded by
Bristol-Myers Squibb
Foundation
Bureau of Primary Health,
HRSA
CDC Diabetes Prevention
(in-kind support)
TDECMP Steering Committee
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Bristol-Myers Squibb Foundation
HRSA/Bureau of Primary Health
CDC/Division of Diabetes Translation
UIC Midwest Latino Health Research, Training and
Policy Center
Texas Department of Health Diabetes Council
Migrant Health Promotion
Texas Association of Community Health Centers
Overview
Project Goals & Objectives
Diabetes Education & Empowerment Program (DEEP) Training Sessions
Initial Training
Follow-up Trainings
Preliminary Patient Outcome Evaluation Results
Texas Diabetes Education & Care
Management Project (TDECMP)
Goals
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Conduct one initial train-the-trainer 3 day intensive
training.
Train 160 community health workers in self care
management using the DEEP curriculum.
Conduct five regional follow-up trainings in Lower
Rio Grande Valley, Laredo, El Paso, San Antonio,
and Houston.
Impact 16,000 diabetic patients or people at risk of
diabetes by providing diabetes education using
DEEP curriculum.
Framework for Implementing
Diabetes Self Care Management Program
Three Step Process
Patient Benefits:
Program Approach:
Patient Empowerment:
•Train team of Promotoras •Provide Deep classes
and Clinical staff on DEEP. on weekly basis.
•Recruit patients for
classes.
•Provide coordinated
services to patients.
•Improved standards
of care for patient.
•Off set complications.
•Reduced HbA1c.
•Overall better health.
•Reduced Health Care
costs including ER.
24 health workers attended the initial
training representing the five targeted
regions.
Experiential Learning focuses on both
Process and Content
Process –
teaches
participants
how to
disseminate
information
using an
interactive
style of
facilitation.
Participants learn how to read food
labels
Typical food
plates are
converted
into fats,
sugars and
sodium.
Texas Department of Health & BristolMyers Squibb staff participate in
training
TDECMP has helped
community health
centers and state
health agencies
change how they
work with people
who have diabetes.
Some content such as medication
management is covered using
traditional methods
DEEP Curriculum in Action
Diabetes Self Care Management Program
Delivery Process
Patients
Promotora
Clinical
Medical Providers
Recruitment
Led Classes
Support Staff
Involvement
Community Health Center
Top Five Medical Diagnosis Profile
3000
2733 (43.3%)
2500
1699
(26.9%)
2000
1305
(20.7%)
1500
Diagnosis
1000
386
(6.1%)
500
0
181
(2.8%)
Diabetes
Hypertension
Otitis Media
Mental
Disorder
Asthma
N=6304
*Gateway Community Health Center
Source 2002 UDS
Typical Payment Source Category
N=14144
1210(9% )
210 (1% )
860 (6% )
3251(23% )
8613 (61% )
Uninsured
Medicaid
Medicare
Pvt.Insurance
Other
Source 2002 UDS
Typical Profile of a Patient with Diabetes
Female
Age 43
Hispanic
Obese
4 to 5 Children
Uninsured
Low Social Economic Status
Multiple Family Dwelling
Sixth Grade Education
Hemoglobin A1C Higher than 7%
Has a difficult time managing her diabetes
Preliminary Patient Outcomes
Base Line
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HbA1c before DEEP self-management class 9.1%
After Intervention

HbA1c after self-management course 7.4%

87% Class attendance rate
*Gateway Health Center Data from random chart audit
(N=99 patients)
Process Evaluation Results

The goal of 160 was surpassed with a total of 177 health care staff
completing the DEEP curriculum training.

A total of 7 trainings were completed exceeding the goal of 6 All five
targeted regions participated in the trainings including Lower Rio
Grande Valley, Laredo, El Paso, San Antonio, and Houston.
Participants from Lubbock, Dallas, and Austin also attended.
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Trainee satisfaction has been very positive with an evaluations
mean score of 4.8 out of a 5.0 satisfaction scale.
Process Evaluation Results
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While several trained health centers have not yet implemented the
program completely after being trained, the majority have committed
to implement a full DEEP self care management program once
project implementation funding is secured.
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Trainee limit of 16-20 per session adjusted upwards to 28 per
session to meet demand.
Care Management Economic Impact
In collaboration with a third party evaluator, a budget impact model
using data from the enrolled diabetic patients will demonstrate the
near-term fiscal value attached to the reductions in HbA1c.
Example of cost differentials for 1% changes in HbA1c over a 3-year period*^
Patient profile
Change in HbA1c level (%)
10 to 9
9 to 8
8 to 7
Diabetes only
$1,205
$869
$601
Diabetes with HTN
$1,703
$1,260
$897
Diabetes with CVD
$2,796
$2,088
$1,503
Diabetes with HTN and CVD
$4,116
$3,090
$2,237
Given the number and likely comorbidities of the patient population
in the program it is predicted that the savings generated for a
State may be significant.
* Reference available upon request
^ Numbers are summative when one combines a  HbA1c
Texas Care Management Chart Audit
100 random records: 8 CHC’s
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Assumes same risk stratification as Fla
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High Risk:
30% with HbA1c 10 reduced to 7
Yearly savings = 30 pts x $3,150
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Moderate Risk: 20% with HbA1c 9 reduced to 7
Yearly savings = 20 pts x $ 950
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= $94,500
Low Risk:
= $19,000
50% with HbA1c 8 reduced to 7
Yearly savings = 50 pts x $ 200
= $10,000
$123,500
Yearly Savings for 2,400 patients = $2,964,000
Yearly Savings for 10,000 patients = $12,350,000
Conclusions
It has become evident that teaching self care management education
such as DEEP to people with diabetes is perhaps our only chance
we have in helping reduce the onset of diabetes type 2 and
preventing this chronic disease within affected families.
The DEEP curriculum has been well received by community health
centers, Texas Department of Health and CDC. Requests for
additional training continues throughout the State of Texas and
across the United States.
Preliminary evaluation results clearly indicate a great benefit to
patients with diabetes type 2.