Navigation Links
Scripps studies show community-based diabetes programs are key to lowered costs and improved care

LA JOLLA, Calif. New findings from a 15-year series of studies led by care providers at Scripps Whittier Diabetes Institute reveal that culturally tailored community-created programs are effective at reducing health-related costs and delivering higher quality care.

Results from "Community-Created Programs: Can They Be the Basis of Innovative Transformations in Our Health Care Practice?" were published in the fall issue of Clinical Diabetes, and also posted on its website. The journal article discusses the results of a series of studies involving approximately 18,000 patients who were involved in Project Dulce, 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. "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."

Project Dulce Model

Project Dulce was developed in 1997 as part of a collaborative effort in San Diego County to improve the health and access to health care of under-served, ethnically diverse people with diabetes. Program partners include the Scripps Whittier Diabetes Institute, the County of San Diego, Community Health Centers and San Diego State University.

Since its inception, Project Dulce has enrolled and treated more than 18,000 patients 65 percent of whom are of Latino/Hispanic descent in 15 locations in San Diego.

The Project Dulce model uses a patient registry to identify and stratify patients with diabetes by risk. Trained diabetes registered nurses follow evidence-based care management protocols to lead a multidisciplinary care team that provides clinical care and management for patients in federally qualified community health centers throughout San Diego County. The team also includes registered dietitians and medical assistants acting as health coaches.

Trained peer educatorsindividuals with diabetes who have successfully managed their own diseaseprovide education and support to participants. These peer educators, or "promotoras," hail from the patients' ethnic group and are able to help patients overcome cultural, social, and economic barriers.

"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," said Dr. Philis-Tsimikas. "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."

Project Dulce Results

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. Project Dulce achieved these results across a broad range of insurers and government programs, and was especially cost-effective for under- and uninsured groups.

Whereas costs for pharmacy, diabetes-related supplies and disease management increased under Project Dulce, hospital and emergency department care costs declined. This decrease in hospital and acute-care costs was attributable to a reduced likelihood of admission rather than lowered costs once patients were hospitalized, suggesting a clinically and economically meaningful benefit for a high-risk population.

For example, in 2009, as part of a statewide Health Care Coverage Initiative, a comparison of costs demonstrated that annual inpatient costs were $1,260 lower, and outpatient costs were $723 higher among participants in disease management program.

Tools for Chronic Disease Management

In addition to helping patients, Project Dulce staff is training other health care providers how to design and implement a culturally appropriate diabetes management program. To date, the program has been adopted by health care providers in New Jersey, Los Angeles and across the border in Tijuana, Mexico.

"The potential significance of this approach and these outcomes extends far beyond the borders of San Diego County," said Dr. Philis-Tsimikas. "Economical, effective and culturally tailored interventions such as the Project Dulce model may be a crucial link in our health care delivery system to achieve improved outcomes, not just for diabetes, but for many other chronic disease states."


Contact: Lisa Ohmstede
Scripps Health

Related medicine news :

1. Scripps Research scientists show how memory B cells stay in class to fight different infections
2. Scripps Florida scientists awarded nearly $1.5 million to develop new approaches to treat cancer
3. Clinical trials start for stroke drug developed by Scripps Research, USC, and ZZ Biotech
4. Scripps Research scientists devise powerful new method for finding therapeutic antibodies
5. Scripps Research Institute scientists show protein linked to hunger also implicated in alcoholism
6. Scripps Research Institute receives $20 million to shed light on HIV drug resistance
7. First targeted nanomedicine to enter human clinical studies
8. Joint-Replacement Failure Rate Higher for Smokers: Studies
9. IADR/AADR publish studies on severe early childhood caries - proposes new classification
10. ASCO releases studies from upcoming annual meeting
11. University studies and career expectations of medical students
Post Your Comments:
(Date:11/30/2015)... ... November 30, 2015 , ... Holcomb – Kreithen Plastic ... surgery practices in Florida, is proud to announce that Dr. Joshua Kreithen, one ... Ethicon Inc., a Johnson & Johnson Company. , Ethicon is a global medical ...
(Date:11/30/2015)... New York, New York (PRWEB) , ... November 30, 2015 , ... ... at the Greater New York Dental Meeting. Their Ecosystem empowers dentists to make complex ... Dentists who visit the booth will receive a free fee survey with 10 procedures ...
(Date:11/30/2015)... EMIGSVILLE, PA (PRWEB) , ... November 30, 2015 ... ... (CCMS) software provider, has verified that their Vasont Universal Integrator (VUI) extension unites ... handle creating, editing, and managing content as a continuous process with the latest ...
(Date:11/30/2015)... ... 30, 2015 , ... Healthjump, Inc. announced that it has ... consulting, development and support company. The purchase will expand the capability to serve ... extend the services currently provided by Healthjump. , Through this purchase, ...
(Date:11/30/2015)... ... November 30, 2015 , ... SIMmersion’s ability to present dynamic ... schools of the future. To reach an audience of key visionaries and reformers ... in Chicago, organized by the American Medical Association. , AMA President Steven ...
Breaking Medicine News(10 mins):
(Date:11/30/2015)... AUSTIN, Texas , Nov. 30, 2015  Hanger, ... the amendment and restatement of the terms of its ... "Consent Solicitation") relating to its $200,000,000 aggregate principal amount ... among other things, (i) the consent fees payable pursuant ... rate on the Notes and (iii) the expiration date ...
(Date:11/30/2015)... Mexico Healthcare and Life Sciences Report 2015 . --> ... Pharmaboardroom releases its new 98-page Mexico Healthcare and Life Sciences ... country of over 122 million people. --> Latin ... --> It offers companies, investors, policymakers, and stakeholders with an ... largest pharma and healthcare market in Latin America ...
(Date:11/29/2015)... , Nov. 29, 2015   Royal Philips  (NYSE: ... radiology solutions at the 2015 Radiological Society of North ... at McCormick Place in Chicago . ... experience the company,s broad portfolio of integrated Diagnostic Imaging, ... to increase clinical performance, improve workflow and create a ...
Breaking Medicine Technology: