Members of The Root Cause have over 17 years of experience in improving the management of diabetes in populations. Although the model we use was developed in the United States, we believe it has direct applications to the needs of populations around the world.
In 1997 a population health management program for diabetes was started in Asheville, North Carolina, USA. This program was a collaborative effort of the University of North Carolina, Mission Hospital Diabetes Center (Asheville, NC), North Carolina Pharmacists Association, and the City of Asheville. This program has come to be known as the “Asheville Project.” For further background on the program a Google search can be done. As a result of the program five peer review research articles have been published, and this model is currently in place in over 30 U.S. states and has been replicated in several other countries.
This simple model uses local health care professionals, primarily nurses and pharmacists, to meet face-to-face on a regular basis with individuals in the community who have diabetes to “coach” them to better health.
During the coaching session the individuals are provided basic diabetes education, blood pressure and blood sugar levels are checked, and medications are reviewed for results and compliance. The “health coach” is able to spend the necessary time to focus on individual needs and help establish achievable mediation therapy, nutrition, and activity and biometric goals. In addition, patient compliance with medication therapy and appropriate testing (eye exams, blood pressure, blood sugars, etc.) are assessed and tracked. These sessions also act as an early warning system to catch small problems before they become big problems. These health coach encounters are face-to-face, take place in the person’s community every one to three months (depending on the patient’s needs) between regular physician visits. And in communities where physician availability is limited, the “local” health coach provides a vital triage function that serves to maximize the use of limited resources.
Studies using this simple model have consistently found that not only are blood sugar, blood pressure, and cholesterol values improved, but there is also a reduction in emergency room visits and hospitalizations due to the complications that arise from diabetes.
Complications of Type 2 diabetes result in a great deal of human suffering. Diabetes is the number one cause of adult blindness, the second most likely reason to lose a limb (second only to accidents) and the number one reason for kidney failure and dialysis. In the original Asheville Project, and in other follow-up studies, health care costs consistently decreased by nearly $2,000 per person per year, but the value in terms of avoided human suffering is immeasurable.
The Root Cause realizes that in many parts of the world it will not be possible to directly measure the impact of the program on health care costs. However, having demonstrated that this approach consistently improves diabetes control and results in fewer complications and lower health care costs, we feel compelled to apply this simple approach world-wide. Especially in countries where access to a health care provider is limited. Our experience proves that individuals with an interest in health care can easily be trained to make a difference in the lives of individuals with diabetes.
Please refer to the links to the published data on this model for your review. These include some of the actual publications as well as a summary of the program that was published in the U.S. government’s Agency for Healthcare Research and Quality (AHRQ) “Innovations Profile”, a video clip of a NBC Nightly New segment that highlighted the program, and several national newspaper articles (New York Times, Washington Post, Los Angeles Times).
We believe the principles that resulted in improvements in care and management of Type 2 diabetes in the U.S. are applicable elsewhere. These principles include using available local health care resources, focusing on diabetes (an extremely high risk condition), frequent face-to-face contact with individuals at the community level, frequent monitoring of blood sugar levels , the use of safe/effective/relatively inexpensive medications to reduce the risk of complications of diabetes, and an emphasis on realistic lifestyle changes. In addition, frequent follow-up meetings assure that education is being comprehended and applied, that medications (when indicated) are being taken, and that diabetes control is improving.
Your interest in helping us achieve our goal of dramatically improving the control of diabetes world-wide is greatly appreciated.