Project IMPACT: Diabetes

Launched in 2010, Project IMPACT: Diabetes is the first national diabetes self-management program conducted by the APhA Foundation in partnership with the Bristol-Myers Squibb Foundation’s Together on Diabetes initiative that is specifically designed to improve the health of underserved populations with limited access to quality care in 25 participating communities disproportionately affected by diabetes.
Today, more than 2,000 patients who are uninsured, under-insured, homeless and/or living below the poverty line are receiving care from community-based interdisciplinary teams that include pharmacists, physicians, diabetes educators and other members of the health care team.
Participating organizations include community and university-affiliated pharmacies, self-insured employers, Federally Qualified Health Centers (FQHCs), free clinics and others that have the opportunity to leverage unique stakeholders, existing programs, creative ideas, and additional resources to effectively adapt and implement similar models of care.  The APhA Foundation provides communities with tools, resources, guidance and support to facilitate local success.
Project IMPACT: Diabetes is modeled after several other highly successful APhA Foundation programs that produced positive clinical, humanistic and economic outcomes, including the Diabetes Ten City Challenge (2005-2009); the Patient Self-Management Program for Diabetes (2003-2005); and the APhA Foundation’s cholesterol management program, Project ImPACT: Hyperlipidemia™ (1996-1999). 
Frequently Asked Questions

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Key Objectives

1. Expand proven community-based models of care to patients who need it the most in communities across the U.S.

2. Improve key indicators of diabetes care in selected communities

3. Strengthen local models of care by establishing community peer-to-peer networking and mentoring relationships

4. Establish a sustainable platform for permanent change by embedding the following guiding principles:

• Identification and support of disproportionate share populations

• Implementation of collaborative care programs engaging pharmacists

• Establishment of continuous quality improvement processes

• Utilization of patient self-management credentialing

• Collection and regular reporting of minimum data sets

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Advisory Committee
​An Advisory Committee of industry leaders provided input and guidance to the project. The group includes representatives from:

• American Pharmacists Association 

• Center for Health Value Innovation

• Giant Food Stores

• National Diabetes Education Program

• U.S. Health and Human Resources (HHS) Office of Women’s Health

• U.S. Health Resource Services Administration – Pharmacy Services Support Center

• Walgreens

In partnership with Bristol-Myers Squibb Foundation Together on Diabetes

Project IMPACT: Diabetes took root in 25 diverse communities in 17 states across the United States. 
Participating organizations included community and university-affiliated pharmacies, self-insured employers, Federally Qualified Health Centers (FHQCs), and free clinics.
Participating patients range from the unhoused to farm workers to school teachers and more. Target patient populations were identified based on the following criteria:

• Geographic areas with a high incidence of diabetes

• Patients with sub-optimal hemoglobin A1C and other outcomes

• Patients with limited access to quality diabetes care

• Communities with socioeconomic challenges and other factors that impact patient access to care.

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About the Communities
Each Project IMPACT community consists of unique local partners who come together with the goal of improving the health of people with diabetes. These partners are located in a single geography and care for a defined patient population. 
Read more about the 25 participating organizations below.
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About the Experts
Project IMPACT: Diabetes was implemented by a team of dedicated individuals who believe in the role of the pharmacist in improving diabetes care.

• Two APhA Foundation staff members provided oversight for the design and implementation of the project, created resources for communities, and monitored and analyzed data collected from the communities

• Three pharmacist consultants served as implementation liaisons between the Foundation and the communities. Each of these Community Coordinators helped 8-9 communities successfully implement the Foundation’s care model.

• Over 25 Community Champions were responsible for the local implementation and success of each community. These on-the-ground project leaders interfaced with the APhA Foundation, managed the local stakeholders and data, and served as the spokespeople for the community.

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Community Champions
​Each of the following community champions led the local implementation of Project IMPACT: Diabetes:

• Applachian College of Pharmacy: Elshamly Abdelfattah, RPh

• Balls Food Stores: Nikki Schwartze, RPh and John Witt, RPh

• Central Ohio Diabetes Association: Jeanne Grothaus

• Centro de Salud Familiar La Fe, Inc: Jeri Sias, RPh

• County of Santa Barbara Department of Health: Carol Millage, RPh

• CrossOver Health Care Ministries: Sallie Mayer, RPh

• Eau Claire Cooperative Health Centers: Valencia Gray-Williams, RPh

• Eau Claire Internal Medicine - Cooperative Health Pharmacy: Dean Slade, RPh

• El Rio Health Centers: Sandra Leal, RPh

• El Rio – Pascua Yaqui Reservation: Marisa Rowen, RPh

• Fink’s Pharmacy: Kristen Fink, RPh & Christine Lee-Wilson, RPh

• Jefferson County Department of Health: B. DeeAnn Dugan, RPh

• Kroger, TriHealth, and City of Cincinnati: Jim Kirby, RPh

• Mountain States Health Alliance: Joy Waddell, RPh

• Paramount Farms and Komoto Pharmacy: Roxanne Wolfe

• Price Chopper: Kimberly Houser, RPh & Alicia Roberts, RPh

• The Daily Planet: Kelly Goode, RPh

• The Ohio State University College of Pharmacy: Stuart Beatty RPh

• University of Kentucky School of Pharmacy: Holly Divine, RPh & Trish Freeman, RPh

• University of Mississippi School of Pharmacy and Diabetes Care Group: Courtney Davis, RPh & Lauren Bloodworth, RPh

• Variety Care: Jamie Farley, RPh

• West Virginia Health Right: Patricia White

• Wichita Public Schools and Dillons Pharmacy: Dean Benton, RPh & Shannon Krysl

• Wingate University School of Pharmacy: Delilah Jackson, RPh

• Zufall Health Center: Teresita Lawson, RPh & Rina Ramirez, MD​

The process of care deployed in Project IMPACT: Diabetes was a refinement of that used in the Patient Self-Management Program for Diabetes and the Diabetes Ten City Challenge. These past projects brought together interdisciplinary care teams, innovative payers, and aligned incentives to create a diabetes care model that improved health outcomes, enhanced the quality of care, and reduced costs. In Project IMPACT: Diabetes, the communities are very diverse and care for patient populations that face significant barriers to managing their diabetes, which required a flexible approach to implementing the care model across the US.
 
Pharmacists' Patient Care Services
The key requirement within Project IMPACT: Diabetes is that all communities include pharmacists on their diabetes care teams. Collectively, more than 80 pharmacists are participating in Project IMPACT: Diabetes. These pharmacists meet one-on-one with patients to provide targeted education based on the Patient Self-Management Credential, medication-related coaching, and goal achievement plans that fits into their lives. Pharmacists talk to patients about what diabetes is, how medicines help address the problem, diet changes, exercise plans, and the many barriers that may keep that patient from being an effective self-manager of their health. Pharmacists hold their patients accountable for good self-management behavior by showing each person how much they care, investing time into frequent visits, and truly listening to the challenges each person is facing.
 
Interdisciplinary Health Care Teams
Pharmacists do not work alone when helping patients become better self-managers – integration into the healthcare team is essential. Each community brings together a unique group of stakeholders based upon what services are needed and provided within that community. Pharmacists collaborate with these stakeholders to design care plans, select and adjust medications, and bring resources to patients. Collaborating healthcare team members within communities include:

• Family practitioners

• Nurses

• Physician assistants

• Certified diabetes educators

• Social workers

• Dietitians

• Patient advocates or promatoras

 
Innovative Payers and Sustainability
Communities were encouraged to integrate the pharmacists’ services in a way that would make them sustainable even after the project ended. Some communities developed partnerships with self-insured employers that provided payment for the pharmacist to provide care. Groups that care for uninsured or underinsured patients often sought buy-in from the administration at their clinic, which allowed for the pharmacist to dedicate time to patients with diabetes. In each of the scenarios, positive outcomes justify the resources invested in pharmacists’ services, often leading to the continuation or expansion of the care model.
 
Aligned Incentives
As described in Our Approach, “aligned incentives” means that all stakeholders are motivated to implement the model because of what they will receive in return. For healthcare providers and clinic administrators, interdisciplinary care teams provide efficiency in the system and result in healthier patients. For pharmacists, the ability to provide direct patient care and receive payment for those services supply strong incentives to implement the model. Payers experience reduced total cost of care when they implement models. The incentives that motivate patients change based on culture, health beliefs, access to quality care, socioeconomic status, and many other factors.
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Within Project IMPACT: Diabetes, communities were not required to provide patient incentives but they were encouraged to consider what tactics would best motivate patients to visit with the pharmacist and stay engaged in self-management behaviors. Many self-insured employer communities waived copayments associated with diabetes medications and supplies, and some provided additional incentives for goal achievement. In FQHCs, free clinics, and other communities serving the un- or under-insured, incentives were provided in the form of bus tickets, free meals during educational sessions, enhanced social services, and grocery store gift cards. Some communities found that many patients saw the access to quality diabetes care as the incentive and were eager to maintain their relationship with the pharmacist who cared for and spent time helping them.

Final Data
Aggregate data from all 25 participating communities showed statistically significant improvement in A1C (blood sugar) control, a key diabetes indicator. Clinical indicators for cardiovascular health including LDL Cholesterol, Total Cholesterol, and Triglycerides also showed statistically significant improvements. HDL Cholesterol, Blood Pressure and Body Mass Index (BMI) improved, although were not statistically significant in the multilevel modeling statistical analysis that controlled for differences among the communities.  These improvements demonstrate that care is being delivered in a way that is consistent with national treatment guidelines and that people are improving their health. View the final data fact sheet.
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Publications
Final results were e-published and appear in the September/October 2014 print issue of JAPhA. The two peer-reviewed articles, collectively highlight the clinical and process outcomes as well as the unique characteristics of the patients and care delivery in the local communities that participated in the project. 
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Improving outcomes for diverse populations disproportionately affected by diabetes:  Final results of Project IMPACT: Diabetes 

Integrating pharmacists into diverse diabetes care teams: Implementation tactics from Project IMPACT: Diabetes  

View a full list of scholarly publications, presentations and posters that have been presented on Project IMPACT: Diabetes.

Presentations
Some of the Project IMPACT: Diabetes communities have given presentations to share best practices and outcomes from their experiences.