Fifteen years worth of study has lead Scripps Whittier Diabetes Institute care providers and researchers to a familiar, yet important conclusion -- community counts.
The report "Community-Created Programs: Can They Be the Basis of Innovative Transformations in Our Health Care Practice" analyzes the experiences of some 18,000 patients involved in Project Dulce, which is described as a "culturally appropriate, clinically sound and cost-effective care model for managing diabetes."
"Since its inception 15 years ago, we have found that the Project Dulce model has demonstrated positive effects on physiological, behavioral and cost-effectiveness outcomes," said Athena Philis-Tsimikas, MD, lead author and corporate vice president, Scripps Whittier Diabetes Institute, in a news release. "As the United States continues to seek methods to deliver higher quality medical care at lower costs, the concepts tested with Project Dulce in a real-world environment may prove particularly valuable."
One of the building blocks in a 1997 San Diego County collaborative effort to enhance health and healthcare access for underserved, ethnically diverse pockets of the diabetes populace, the Project Dulce model aims to decipher and stratify a patient’s diabetic risk through a registry. Thereafter, evidence-based care management protocols are pursued by qualified staff, a team that includes registered nurses, physicians, dieticians and medical assistants acting as coaches.
The model also includes peer-educators or “promotoras,” around which the whole system functions.
"We have found that using promotoras versus standard care is a much more successful method of delivering self-management education. Patients show better glucose control and improved outcomes in their diet and exercise," Philis-Tsimikas added. "The value of the promotoras stems from their direct experience with the community and firsthand understanding of the myths, beliefs and cultural remedies that may interfere with adherence to health recommendations. This type of support and empathy is often difficult for professionally trained individuals from outside the community to provide."
The Scripps Whittier Diabetes Institute described the program’s cost-effectiveness as vast and comprehensive on multiple levels of care: “In multiple comparisons of total costs, the Project Dulce diabetes care management program was associated with improved objective and subjective outcomes, including improvements in health status and quality of life, such as a decreased incidence of diabetes-related complications and hospitalizations throughout a patient's lifetime.”
Statistics from a statewide Health Care Coverage Initiative in 2009 affirm that annual inpatient costs were $1,260 lower as a result of the program, while outpatient costs were $723 higher.
As such, Philis-Tsimikas hopes the model will be adapted nationwide.
"The potential significance of this approach and these outcomes extends far beyond the borders of San Diego County," Philis-Tsimikas concluded. "Economical, effective and culturally tailored interventions such as the Project Dulce model may be a crucial link in our healthcare delivery system to achieve improved outcomes, not just for diabetes, but for many other chronic disease states."
The results of the study were published in the autumn edition of Clinical Diabetes.