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Impact of livingwell CARES On-‐Site Care Coordina8on Program on Diabetes Health Outcomes Kathryn D. Cannon, MBS; Eileen Blake, MPH; E. Anne Peterson, MD, MPH; Vivian Green, PhD Public Health Program, PONCE HEALTH SCIENCES UNIVERSITY, PONCE RESEARCH INSTITUTE, Ponce, Puerto Rico
INTRODUCTION
PURPOSE
METHODS
Diabetes is a leading contributor to premature mortality in the United States • 382 million with disease and has resulted in 1.4 million deaths
o 90% with Type 2 Diabetes ~ 3.3% of total population • Diabetes self-management support has been shown to improve
health outcomes • Yale New Haven Health System livingwell CARES (LWC)
program began enrolling employees with chronic diseases in a health intervention program in 2012
• Care coordination programs may be effective in improving health outcomes among individuals with chronic diseases, such as diabetes.
1. Assess the impact of a chronic disease management program on a population of diabetic patients. • Impact of blood pressure (BP), body mass index
(BMI), low density lipoprotein (LDL), and hemoglobin A1c (HbA1c) levels and overall cost related to care of these patients
2. Explore other relevant program outcomes • Assess overall patient satisfaction and determine
opportunities to expand to other chronic diseases
Study Subjects: • Participants were chronic disease patients treated by Yale
New Haven Health System • Participation restricted to
o Yale New Haven Health System employees and spouses o Individuals with diabetes o Enrolled in the program between April 2012 and April
2013 • Intervention group: diabetic individuals who were offered and
accepted enrollment in the livingwell CARES (LWC) Program • Control group: diabetic individuals from the YNHH
diabetes registry Data collection: • Duration: April 2012 – April 2014 • HbA1c, LDL, BMI, BP, and health care cost records obtained
from Epic (YNHH EMR) and Advisory Board (utilization aggregate) data using medical record number (MRN) as unique patient identifier
• Crystal Reports generated from Epic and exported as Microsoft Excel documents for statistical analysis
• A total of 1,263 patient records were collected • Patients signed informed consent upon enrollment
in livingwell CARES program
RESULTS
CONCLUSIONS • Preliminary analysis of pilot livingwell CARE program
reveal positive health outcomes in diabetic patients in comparison to usual care patients
• Systolic and diastolic blood pressure (BP): decrease over time à positive health outcomes for diabetic patients in LWC
• Body Mass Index (BMI): slight decrease over time àpositive health outcome for diabetic patients in LWC
• Low Density Lipoprotein (LDL): decrease over time à positive health outcome for diabetic patients in LWC
• HbA1c: slight decrease over time à positive health outcome for diabetic patients in LWC
• Significant statistical difference between LWC and control groups present in diastolic blood pressure (p-value= 0.0434)
• Patients expressed an overall “agreed or strongly agreed” rate of 95% in relation to the effectiveness and positive impact of the program
FUTURE DIRECTIONS • These findings can be used to encourage further use of care
coordination programs targeted at individuals with chronic disease.
• Increased use and expansion of health intervention programs would elucidate the benefits and positive effects of the livingwell CARES program to may improve or stabilize overall health status of the population.
CONCLUSIONS • Positive health outcomes of LWC diabetic patients provide
support for expanding program to treat include other chronic diseases
• Limitations: o Retrospective review resulted in limitations on available data
(control group LDL and HbA1c values) o Early on in program, analysis serves as baseline, long
term analysis may show more significant outcomes
REFERENCES • Bennett, H.D., Coleman, E.A., Parry, C., Bodenheimer, T., Chen, E.H.
(2010). Health coaching for patients with chronic illness. Family Practice Management, 17(5), 24-29.
• Ghorob, A., Vivas, M.M., De Vore, D., Ngo, V., Bodenheimer, T., Chen, E., & Thom, D.H. (2011). The effectiveness of peer health coaching in improving glycemic control among low-income patients with diabetes: protocol for randomized controlled trial. BMC Public Health, 11(208).
• Schneider, J.I., Hashizume, J., Sreang, H., Maetani, L., Ozaki, R.R., Watanabe,
• D.L. (2011). Identifying challenges, goals, and strategies for success for people with diabetes through life coaching. Journal of Vocational Rehabilitation, 34, 129– 139.
Data Analysis: • 637 patient records were included in data analysis.
o Reasons for non-inclusion: § Deceased § Lack of lab value or less than 3 lab values for variable
o Variable categories: Blood Pressure (BP), Body Mass Index (BMI), Low Density Lipoprotein (LDL), and HbA1c levels
• Change over time was calculated for all categorical variables • Linear regression performed to account for lack
of randomization • T-test and Parsimonious Model were performed for
improvement score • Microsoft Excel and SAS were used for data management and
analysis
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1 2 3 4
BMI kg/m2
Years
LWC Control
Figure 3: Change of Body Mass Index (BMI) Over Time
Figure 4: Change of Low Density Lipoproteins (LDL) Over Time *
80 81 82 83 84 85 86 87 88 89 90
1 2 3 4
LDL mg/dL
Years
LWC
0 1 2 3 4 5 6 7 8 9
1 2 3 4
HbA1
c (%
)
Years
LWC
Figure 5: Change of HbA1c Over Time*
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YNHH Employees LWC YNHH Employees Overall
Figure 6: Per-Member-Per-Month (PMPM) Employee Utilization Costs
125.5 126
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1 2 3 4
Bloo
d Pressure (m
m Hg)
Years
LWC Control
Figure 1. Change in Systolic Blood Pressure Over Time
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1 2 3 4
Bloo
d Pressure (m
m Hg)
Years
LWC Control
Figure 2. Change in Diastolic Blood Pressure Over Time
