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Diabetes patients at one of the Cleveland Clinic’s health centers improved their blood glucose control by 32 percent and cut their no-show appointment rate in half after working with patient navigators for a year.
A pilot study conducted by Accenture and Cleveland Clinic targeted 108 high-risk patients with diabetes that was not well-controlled at the Clinic’s Stephanie Tubbs Jones Health Center. The American Diabetes Association recommends an A1C level of 7 percent or less; two-thirds of these patients had A1C levels that exceeded 9 percent.
Over the course of a year, a handful of patient navigators hired by the clinic worked with these patients, their families, care providers and other service providers to break down personal and socioeconomic barriers that stood in the way of effectively managing their conditions. That could be anything from helping them communicate with insurance companies, identifying financial assistance programs, providing education or helping them schedule appointments.
“To really be effective with patient navigation, you need to hire from the community which you serve,” explained David Balderson, who leads Accenture’s patient navigation initiatives. “The fear, distrust, financial and cultural issues that are out there can be just as crippling (to disease management) as the challenges within the hospital.”
Navigators first looked at medical records of the 20 to 25 patients they were assigned, to understand each case, Balderson said. Then, in consultation with an RN, they put together a plan to drive each patient toward any of five interventions: attending an insulin clinic, revisiting a primary care physician, attending a diabetes education class, attending a refresher course or visiting with an RN. Depending on the case, navigators interacted with the patients they were assigned as often as every day, Balderson said.
Collectively, the 108 patients improved their blood glucose levels by 32 percent. By the end of the year, they were also more than 50 percent more likely to complete self-measured metrics like having their blood pressure and A1C levels checked.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
Accenture also monitored whether patients attended appointments with their physicians, ophthalmologists and podiatrists – an important metric as diabetes increases risk for certain complications like foot ulcers and glaucoma. The patients in the study missed 50 percent fewer appointments, according to Accenture.
The clinic is just one of many facilities employing patient navigators – low-cost, trained community members who liaise between patients, care teams and social services – to assist high-risk patients with diseases like diabetes and cancer. In a previous study Accenture did with Cleveland’s safety net hospital, MetroHealth, it found that no-show and cancellation rates were reduced by three percent with use of navigators, and the revenue they generated paid for salaries of two full-time navigators in less than four months.
Balderson said the Cleveland Clinic is using the study as a basis for expanding its patient navigator program across different areas of the hospital, from managing disease populations to utilization of the emergency department.
“Developing a well-balanced healthcare team is so critical,” Balderson said.
The study was done with additional support from the Patient Navigation Institute.
[Image credit: BigStock Photos]
