Program Reinforcement Impacts Self Management (PRISM)
Condition: Diabetes Mellitus
Study type: Interventional

Summary: 
      Patients who receive DSME (Diabetes Self Management Education) will be enrolled in a 4 arm,
      randomized study with each group receiving a different method of follow up. The 4 arms will
      be evaluated based on clinical indicators, goal achievement and patient satisfaction.
    

Detailed description: 
      As the diabetes burden worsens, the need for people to become more involved in
      self-management will increase. Research has demonstrated that diabetes self-management
      education (DSME) can improve HbA1C levels by 0.76%. While the rates of diabetes are
      increasing, the numbers of educators available are shrinking. This is a particular hardship
      in underserved and military communities where the supply of health care providers is already
      scarce. Our investigative team has led efforts in supporting DSME in the PA state-wide
      deployment of the Chronic Care Model (CCM) and reported findings nationally on innovative
      ways to increase the pool of education services by integrating educators into primary care,
      establishing nurse clinics in underserved communities and demonstrating that an educator
      position could be sustained by reimbursement. A 0.76% reduction associated to DSME can be
      considered an enormous benefit and is equivalent to the impact of most pharmacologic
      treatments for diabetes. Unfortunately, however the benefits of DSME decrease over time. This
      suggests that sustained improvements require contact and follow-up. SMS is defined as the
      process of ongoing support of patient self-care, to sustain the gains following DSME. There
      is often confusion among the terms self-management education (DSME) and self-management
      support (SMS). DSME is associated with the provision of knowledge and skills training
      delivered by a health care professional, e.g. nurses, dietitians, etc. SMS is defined as the
      process of making and refining changes in health care systems (and the community) to support
      patient self-care and maintain the gains made following DSME. We know that SMS is currently
      provided by diabetes educators, but only one 3-6 month follow up is usual care. It has been
      suggested that SMS can be provided by community workers, peers with diabetes, and office
      staff within community sites, like PCP offices, and wellness centers, etc. The National
      Standards for DSME and American Diabetes Association (ADA) Education Recognition Program
      (ERP) require that SMS approaches be delivered and documented, yet no evidence has been
      provided to define who should deliver it and how often. This uncertainty has led to many
      programs delivering SMS in an unstructured, non-standardized and at times haphazard fashion.
      Practical approaches designed for providing SMS have the potential to sustain improvements.
      The objective of this study is to compare Self-Management Support (SMS) interventions
      following Diabetes Self-Management Education (DSME) and determine which will be more likely
      to maintain improvements in behavioral and clinical outcomes following DSME while achieving
      patient satisfaction.
    

Intervention name(s): Office Staff Support; Peer Support; Usual Care Support; Educator Support
Intervention type(s): Behavioral; Behavioral; Behavioral; Behavioral
Intervention description(s): The intervention includes the Office staff of primary care practices trained to provide diabetes support for behavioral goal setting were tasked to follow up with patients via phone following completion of diabetes self-management education.; Community peers trained to provide diabetes support for behavioral goal setting were tasked to follow up with patients via phone following completion of diabetes self-management education.; Diabetes educators provided patient follow up for behavioral goal setting support according to traditional clinical guidelines following completion of diabetes self-management.; Diabetes educators provided patient follow up for behavioral goal setting support that was problem-focused and patient centered.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: Diabetes Self Management Education (DSME); Diabetes; Self Management Support (SMS)