Local Efforts to Scale the National Diabetes Prevention Program
Friday, March 25, 2016
Tony Kuo, MD, MSHSJennifer Torres, MSSW, MPH, PhD(c)
Division of Chronic Disease and Injury PreventionLos Angeles County Department of Public HealthLA Health Agency
1
Overview
Burden of diabetes and prediabetes Approach to address the burden in Los Angeles County Federal and local initiatives aligned with health services delivery National Diabetes Prevention Program local progress
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Los Angeles County
The Landscape
4,000 square miles
10 million residents 24% obese adults 23% obese children varies widely by region
88 cities
80 schools districts + LACOE
Opportunity for broad reach
Burden of Diabetes and Prediabetes
Age-adjusted rate/100,000
Cause of Death 2001 2010 % Change
Coronary heart disease 220 138 -37%Stroke 56 36 -36%Lung cancer 42 33 -21%
Emphysema 36 30 -17%Alzheimers disease 12 25 108%Pneumonia & influenza 32 22 -31%Diabetes 24 21 -13%Colorectal cancer 18 14 -22%Chronic liver disease 12 12 0%Breast cancer (female) 24 21 -13%
Source: Office of Health Assessment and Epidemiology, Los Angeles County Department of Public Health
Trends in the Leading Causes of Death Los Angeles County, 2001-2010
4
0
5
10
15
20
25
0
1
2
3
4
5
6
7
8
1958 61 64 67 70 73 76 79 82 85 88 91 94 97 00 03 06 09
Num
ber
with
Dia
bete
s (M
illion
s)
Perc
enta
ge w
ith D
iabe
tes
Year
Percentage with Diabetes Number with Diabetes
Number and Percentage of U.S. Population with Diagnosed Diabetes, 1958-2009
Source: CDCs Division of Diabetes Translation. National Diabetes Surveillance System 5
Chart1
0.931.575
0.871.485
0.911.594
1.051.867
1.061.908
1.152.101
1.242.313
1.272.385
1.452.772
1.613.091
1.623.175
6969
7070
7171
7272
2.044.191
7474
2.294.78
2.364.974
7777
2.375.193
2.495.466
2.545.528
2.515.645
2.525.729
2.455.613
2.596.004
2.626.134
2.786.563
2.776.609
2.566.162
2.666.467
2.526.212
2.97.206
2.937.365
3.067.783
2.987.744
3.38.655
2.897.627
3.810.106
3.910.484
410.873
4.412.052
4.7513.114
4.8413.487
4.9314.098
5.2915.241
5.6116.323
5.917.321
5.8617.397
6.2918.808
6.8620.667
Percentage with Diabetes
Number with Diabetes
Year
Percentage with Diabetes
Number with Diabetes (Millions)
Sheet1
YearPercentage with DiabetesNumber with Diabetes
19580.931.575
590.871.485
600.911.594
611.051.867
621.061.908
631.152.101
641.242.313
651.272.385
661.452.772
671.613.091
681.623.175
69
70
71
72
732.044.191
74
752.294.78
762.364.974
77
782.375.193
792.495.466
802.545.528
812.515.645
822.525.729
832.455.613
842.596.004
852.626.134
862.786.563
872.776.609
882.566.162
892.666.467
902.526.212
912.97.206
922.937.365
933.067.783
942.987.744
953.38.655
962.897.627
973.810.106
983.910.484
99410.873
004.412.052
014.7513.114
024.8413.487
034.9314.098
045.2915.241
055.6116.323
065.917.321
075.8617.397
086.2918.808
096.8620.667
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Prevalence of Obesity and Diabetes Among Adults in Los Angeles County, 1997-2011
14.3%16.7%
18.9%20.9%
22.2%23.6%
5.7% 6.7%7.0% 8.1%
8.7% 9.5%
0%
10%
20%
30%
40%
97 98 99 00 01 02 03 04 05 06 07 08 09 10 11
Prev
alen
ce (%
)
Year
ObesityDiabetes
Source: Los Angeles County Health Survey
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Combined Treatment Expenditures and Lost Productivity (in billions), by Chronic Disease, U.S.
Chronic Disease Treatment Productivity CostsExpenditure Losses
_______________________________________________________________Cancers $48 $271 $319Diabetes $27 $105 $132Heart disease $65 $105 $170Hypertension $33 $280 $313Mental disorders $46 $171 $217Pulmonary conditions $45 $94 $139Stroke $14 $22 $36_______________________________________________________________Source: MEPS, National Health Care Expenses in the U.S. Civilian Noninstitutionalized Population, 2003. November 2005.
Source: Milken Institue, American Diabetes Association, CDC.
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Preliminary Findings: Diabetes Costs in Los Angeles County, 2007 and 2030
Type Estimated LA County In the U.S.Population Total Cost Total Cost
2007 2030 2007 2030_________________________________________________________________
Diabetes 642,000 780,214 $6.4 bil $11.4 bil $170 bilPre-Diabetes* 116,000 141,857 $51.4 mil $92.3 mil $25 bil_________________________________________________________________Projected population growth in LA County: 10.2 million (2007) to 11.7 million (2030); 7.4 million adults in 2007 vs. 8.9 millionadults in 2030. Population projections accounted for migration, mortality, fertility trends, no natural catastrophes, etc.* Includes only medical costs and not lost productivity.
Source: Los Angeles County DPH; Multiple data sources used including data from Calif. Dept of Finance and CHIS.
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Public Health Framework for Addressing the Diabetes/Prediabetes Problem in Los Angeles
Health Factors
Health Outcomes
Programs and Policies
Mortality (50%)Morbidity (50%)
Physical environment (10%)
Social & economic factors (40%)
Health behaviors(30%)
Clinical care(20%)
Unsafe sex
Alcohol use
Diet & exercise
Tobacco use
Access to careQuality of care
Community safety
Education
Family & social support
EmploymentIncome
Built environmentEnvironmental quality
County Health Rankings model 2010 UWPHI 11
All Determinants of Health Matters
Reducing the risk of
diabetes and metabolic syndrome
Regular physical activity
Healthy diet
Blood pressure control
Access to lifestyle change programs and community resources (e.g.,
National Diabetes Prevention Program)
Regular doctor visits and age appropriate preventive screenings
Community opportunities for physical activity
Health consumer information and protection (e.g., self-
management resources, home BP monitoring)
Community Resource Database, 211 LA
County
Social support groups and
services
Local farmers Markets, purchasing
cooperatives
Workplace wellness programs
Menu labeling, behavioral economicsSmoking cessation
programs
Increase green space and walkability
Depression screening and
treatment
Alcohol and drug abuse detection
and brief intervention
NDPP Providers
Community screening and MTM programs
Activetransportation
Safer and more walkable
communities
Healthiy Food Environments
Chart1
1
1
1
1
1
Sales
Sheet1
Sales
Decreased cholesterol1
Decreased blood pressure1
Decreased obesity1
Decreased sodium1
Increased cardiovascular strength1
To resize chart data range, drag lower right corner of range.
Framework for Action: General Model of Health & Improvement Strategies
Fielding J, Teutsch S. An Opportunity Map for Societal Investment in Health. JAMA, 2011, Vol 305, No 20, 2110-2111.
2015 Symposium Survey: Priority Actions for Scaling and Spreading of DPP in Los Angeles
Federal and Local Initiatives
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Chronic Disease Prevention Strategy in Los Angeles (1422)
Chronic Disease Prevention Strategy (1422) A four year initiative to implement community and health
system strategies to prevent and control chronic conditions such as hypertension and diabetes.
Programs include: Shared use agreement between schools and communities Increasing health food options Community plans to promote active transportation Health system strategies EHRs, meaningful use of electronic
data, CHWs/Health Navigators, Pharmacist Strategies, community-clinical linkages, team-based care
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National Diabetes Prevention Program local progress
The National Diabetes Prevention Program: Landscape in Los Angeles
Group-based medical model Community-based model Employer-based model Internet-based model
Los Angeles County Department of Public Health Partners working to scale the National Diabetes
Prevention Program in Los Angeles YMCA Black Women for Wellness (BWW) AltaMed Health Services Corporation Northeast Valley Health Corporation Los Angeles Department of Health Services (DHS) The LAC+USC Wellness Center at the Historic General Hospital
in Boyle Heights
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Community Advisory Board
Coalition formed in 2014 to help scale the National Diabetes Prevention Program in Los Angeles
Coalition Mission To scale the NDPP in Los Angeles To build the case for coverage of NDPP in Los Angeles and nationally To convene local stakeholders to educate community and providers
about NDPP Member Groups
Health Systems Community-based organizations Academic Partners Health sector practitioners (i.e. health educators, social workers)
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Community Advisory Board Accomplishments
Symposium Development of Strategic Plan Convening of local health plans Building community partnerships Sub-committee structure
Outreach and Education Referrals and Protocols Access and Coverage
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Next Steps in Scaling NDPP in Los Angeles
3rd Annual Diabetes Prevention Symposium Coalition
Network Analysis Implementation of Strategic Plan
NDPP pilot programs with health insurers White paper on opportunities for coverage of DPP Scaling Employer-based NDPP programs Provider Curriculum Provider and Patient Toolkits Best practice manuals
Referral process Bi-directional referral Health system protocols
Save the Date
https://www.eventbrite.com/e/3rd-annual-diabetes-prevention-program-symposium-tickets-23195943692
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What Health Systems and the Provider Community Can Do to Aid Diabetes Prevention Efforts
Champion or integrate practice protocols or reminder systems in the clinical setting to help refer patients to quality NDPP in the community
Establish peer workgroups/expert panels in the parent health system to tailor best or expected practices for managing prediabetes in particular or across the systems hospitals, ED, clinics/health centers, etc.
Make framework for diabetes prevention as part of the continuum in diabetes care (prevention to management, not siloed programming)
Develop team care approaches that can be used for diabetes prevention QA/QI for referral or bi-directional referral processes
Food Procurement resources
http://publichealth.lacounty.gov/chronic
Public education resources
www.choosehealthla.com
Division of Chronic Disease and Injury Prevention
http://publichealth.lacounty.gov/chronic/
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Resources & Contact Information
Jennifer Torres, MSSW, MPH, PhD(c)Program Manager, Diabetes Prevention and Health Systems StrategiesDivision of Chronic Disease and Injury PreventionLos Angeles County Department of Public [email protected]
Local Efforts to Scale the National Diabetes Prevention ProgramOverviewLos Angeles CountyBurden of Diabetes and PrediabetesSlide Number 5Slide Number 6Prevalence of Obesity and Diabetes Among Adults in Los Angeles County, 1997-2011Combined Treatment Expenditures and Lost Productivity (in billions), by Chronic Disease, U.S. Preliminary Findings: Diabetes Costs in Los Angeles County, 2007 and 2030Slide Number 10Public Health Framework for Addressing the Diabetes/Prediabetes Problem in Los AngelesSlide Number 12Slide Number 13Framework for Action: General Model of Health & Improvement Strategies2015 Symposium Survey: Priority Actions for Scaling and Spreading of DPP in Los AngelesFederal and Local InitiativesSlide Number 17Chronic Disease Prevention Strategy in Los Angeles (1422)Chronic Disease Prevention Strategy (1422)National Diabetes Prevention Program local progressThe National Diabetes Prevention Program: Landscape in Los Angeles Los Angeles County Department of Public Health Partners working to scale the National Diabetes Prevention Program in Los Angeles Slide Number 23Community Advisory BoardCommunity Advisory Board Accomplishments Next Steps in Scaling NDPP in Los Angeles Save the DateWhat Health Systems and the Provider Community Can Do to Aid Diabetes Prevention EffortsFood Procurement resourceshttp://publichealth.lacounty.gov/chronicPublic education resourceswww.choosehealthla.comDivision of Chronic Disease and Injury Preventionhttp://publichealth.lacounty.gov/chronic/
