“We have 1.8 million people with diabetes in New York State, of whom 1.1 million are aware of their diagnosis and another 760,000 don’t know they have the disease,” says Wanda Montalvo, R.N., M.S.N., A.N.P., and an alumna of the Robert Wood Johnson Foundation’s (RWJF’s) Executive Nurse Fellows program (2004 – 2007). “That’s enough to fill Madison Square Garden 90 times over, and Yankee Stadium more than 35 times over.”
In her role as clinical director of the New York State Health Foundation’s Diabetes Campaign, Montalvo is using skills honed as an RWJF Executive Nurse Fellow to help lead a multi-pronged effort to tackle the problem. She is working to improve clinical care and patient outcomes; mobilize and support communities to implement localized strategies to identify the undiagnosed and support people in managing the disease; and promote policy solutions that will deliver more comprehensive, coordinated care.
The five-year, $35 million campaign launched in 2008 in response not just to the startling number of current diabetes sufferers, but to the disease’s trend line. The prevalence of diabetes has doubled in the last 16 years, and its toll is both human and economic. The disease is the third leading cause of death among Blacks and fifth leading cause among Hispanics. The total cost of the disease in New York in 2006 was estimated at $12.9 billion, including $8.7 billion in excess medical costs and $4.2 billion in lost productivity.
Primary Aim at Primary Care
Primary care providers are a particular focus of the campaign. “Patients just don’t receive the care they need,” Montalvo says. The problem is not just about access to care, she explains. “Even when you look at people who have insurance coverage, you find that the care they’re getting is well short of meeting guidelines for monitoring and controlling the ABCs of diabetes: hemoglobin A1c, blood pressure, and cholesterol, and so on.” The problem is reflected in the campaign’s slogan, “Diabetes patients get half the care they need. We can do better.”
With that in mind, the New York State Diabetes Campaign is working to support statewide adoption of clinical best practices at community health centers, hospital outpatient departments and private practices. In particular, Montalvo and her colleagues are working to build a critical mass of physicians, nurse practitioners and physician assistants who have achieved public recognition as providers of excellence in caring for diabetes, as measured by the National Committee for Quality Assurance’s Diabetes Recognition Program or the Bridges to Excellence Diabetes Care Link.
The campaign offers financial assistance to providers seeking recognition. “We’re hoping to get 25 percent of all primary care providers in the state to achieve that recognition,” Montalvo says. “That’s 3,000 providers, and we see that as the tipping point, the point at which there’d be enough momentum that providers would engage their colleagues in the process.” The campaign has made significant progress toward that goal, increasing the number of recognized “providers of excellence” from 126 to about 600, Montalvo says, touching the lives of some 200,000 people with diabetes.
In addition, the campaign is partnering with professional associations in the state to provide technical assistance to primary care providers, in the form of telephone technical assistance, webinars, peer mentorship and training seminars.
Reaching out to the Community
The campaign also works to engage community- and faith-based organizations in the state by encouraging their members and parishioners to get screened for diabetes and to develop healthier habits that will help ward off the disease. Montalvo cites the campaign’s efforts in Harlem as an example. Working with faith-based organizations and the YMCA, she says, the campaign is, “mobilizing groups and local communities to get them to own the process, so it lives on after we finish our campaign.”
To help in that effort, the campaign provides tools to help diabetes patients manage their disease, for distribution by providers and community groups, and also available for download on its website. The materials include English and Spanish editions, as well as picture-intensive guides, and guides geared toward teens.
Montalvo recently appeared in a webcast produced by the School of Public Health at the State University of New York at Albany to discuss the campaign’s outreach efforts. She stressed the importance of getting patients to view managing their diabetes as a partnership with their primary care providers. “We need the patient to partner with us in primary care,” she said. “I can do a lot in an office visit, but primary care for diabetes really happens at home. So I need them to understand their disease so that they’ll be able to do interventions in their own lives to get the type of results we need for better outcomes.”
Montalvo sees her work with the campaign as a perfect fit with her Executive Nurse Fellow (ENF) experience. “This is just the kind of thing that the Executive Nurse Fellows program was designed to help do,” she says. “The program prepares us to lead these kinds of initiatives, and I’m using the skill sets that ENF helped develop. I think that in my case, at least, this campaign is ENF’s return on investment!”
The three-year Executive Nurse Fellows program is focused on expanding the role of nurses to lead change in the U.S. health care system. It provides extensive leadership development for nurses in executive roles from a variety of fields, such as public or community health, science and research, corporate health, academia, government, or military health service. A key part of program participation is the development of an innovative initiative to improve health care delivery in the fellow’s organization or community.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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