DESIGNING YOUR PROGRAM *
Designing and implementing an effective diabetes management program is no small task. There are many steps involved with each stage of the process—from making the decision to implement a program to setting goals to developing specific program elements. To make this job easier, it is a good idea to take a methodical approach and to be aware of best practices established by the ADA and other reputable sources. By working slowly and carefully, employers will find the task less daunting and more productive. The steps listed below provide a good framework for developing your program.
- Complete a needs assessment and choose your target audience
Before implementing any program, you should complete a needs assessment to find out employees' health status, habits and interests. This information can help you choose your target audience (people with diabetes, at risk for diabetes or both) and design your program. A needs assessment can include:
- Current health status (i.e., cholesterol levels, body mass index (BMI), blood pressure);
- Lifestyle decisions (i.e., physical activity, diet); and
- Ideas about effective programs that would encourage their participation, including times, locations, barriers, and incentives.
Ways to get this information include Health Risk Appraisals, medical claims data, pharmacy claims data, surveys and focus groups. See Tools for gathering data to help design and evaluate your program for more details.
To identify employees who may be at the highest risk and most appropriate for a targeted care management intervention, it is important to pay particular attention to repeat hospital admissions; specialty referrals, including dialysis; emergency department claims; and insulin use. In using any data, it is imperative that employers be sensitive to employees need for confidentiality. Also, employers should be aware that there could be errors in the data, or that individuals may not yet be ready to deal with their condition. Because of these issues, employers should proceed with caution.
You may use this diabetes risk test to help raise awareness about the seriousness of diabetes and its risk factors. For community screenings it is advised that a paper or electronic risk test be used first prior to blood sugar screening. If a person has a high risk score, they will need to follow-up with their medical provider. If a person has a low risk score, they can begin or continue adopting healthy lifestyles to prevent diabetes. Blood sugar screening in a health fair setting is not recommended.
- Set Goals
The first, crucial step is to determine the goals for the program. Making decisions about goals also means deciding which population or populations you want to serve and which existing data sets, such as those reported through HEDIS (Health Plan Employer Data and Information Set), you want to use to help identify appropriate areas of diabetes management to focus on, such as self-management education.
Another way to set goals is through assessing the population by using national prevalence estimates (link to assessment tool section). This model suggests a simple way to estimate the cost of people with diabetes to and to determine which group to target for change.
Healthy People 2010 goals for diabetes, which have been established by the U.S. Department of Health and Human Services, is another framework on which to base your program. Healthy People 2010 is a prevention agenda for the United States that includes the most significant and preventable threats to health in this country, as well as national goals designed to reduce these threats. The agenda for diabetes includes 30 objectives aimed at reducing risk factors; improving diabetes control processes; identifying and treating people with diabetes, especially those with co-morbidities; reducing complications associated with diabetes; and increasing patient counseling and education.
Sample goals include the following:
- Provide information to increase employee awareness of the risks and treatment for diabetes.
- Raise interest in and awareness of health so that employees become more informed health care consumers.
- Work with the health plan to improve how people with diabetes are identified, diagnosed, educated, and treated using HEDIS measures at the health plan level.
- Establish goals with local area business coalitions on health to increase community awareness of diabetes and to address one or more of the Healthy People 2010 goals.
Once you have developed the program goals, you should develop objectives to help you achieve the goals. In order to be most effective, objectives should be clear and leave no room for interpretation. S-M-A-R-T is a helpful acronym for developing objectives that are specific, measurable, achievable, relevant, and time-bound.
- Implement health interventions and policies
The interventions developed will depend upon the goals that are established and the findings from the assessment steps outlined above. The interventions can take place in a number of different settings, including at the clinic or health care provider's office, at the workplace, at ethnic group meetings and events, or in the community. Purchasers may also focus their intervention in collaboration with a health plan, or they can consider how company policy can help create a "culture of wellness." Interventions may include education, referrals, case or care management, or support groups.
- Modify Goals
Modify goals based on evaluation results, if necessary.
* Source: Taking on Diabetes