Arkansas’s chronic disease profiles show significant morbidity, hospitalizations, and premature deaths due to diabetes, stroke, cardiovascular disease (CVD), and obesity, a strong risk factor for prediabetes. According to Behavioral Risk Factor Surveillance System (BRFSS) data, the state currently ranks 4th among US states for persons with diagnosed diabetes and obesity, and 5th and 7th respectively among states for diagnosed high cholesterol and hypertension. Arkansas’s health burden and risk factor rankings have improved in part over the past five years from previous ranks among the top three states with the worst health burdens through Centers for Disease Control and Prevention’s (CDC) DP13-1305-funded activities. Under the 1305, Arkansas expanded Diabetes Self-Management Education and Support (DSMES) in the state by 22 new programs, established 13 Diabetes Prevention Programs (DPP), and witnessed a 30.5% reduction in age-adjusted hospitalization rates for diabetes. Arkansas also saw 8-10% increases in blood pressure control among different population groups over this 5-year period as a result of healthcare system interventions, and a 17.0% reduction in hospitalizations for heart disease and hypertension during this period.
With DP18-1815 funding, the ADH Chronic Disease Prevention and Control Branch in collaboration with key partners will build on the accomplishments and outcomes of the 1305 grant using a multi-pronged approach to improve diabetes and cardiovascular disease outcomes among Arkansans. Diabetes management and type 2 diabetes prevention strategies include: increased participation in ADA-recognized/AADE-accredited DSMES programs in underserved areas (A.1); DSMES coverage policy among employers (A.2); identification of people with prediabetes and referral to DPPs (A.4); collaboration with payers to expand DPP as a covered benefit for ADH employees (A.5); and DPP enrollment strategies (A.6). Cardiovascular disease prevention and management strategies include: increased adoption and use of electronic health records (EHR) and health information technology (HIT) to improve provider and patient health outcomes for undiagnosed and diagnosed hypertension (B.1); adoption of evidence-based quality measurement at the provider level (B.2); engagement of non-physician team members in hypertension and cholesterol management in clinical settings (B.3); and self-measured blood pressure monitoring (SMBP) with clinical support for hypertensive adults (B.6). A.3 and B.4 are mutually reinforcing strategies in the same settings for the engagement of pharmacists to provide medication therapy management (MTM) for people with diabetes, and adoption of MTM between pharmacists and physicians to manage hypertension, high blood cholesterol, and increase lifestyle modification. A.7 and B.5 are mutually reinforcing strategies for the development of a statewide infrastructure to promote long-term sustainability/reimbursement for Community Health Workers (CHWs) to work with patients for access to DSMES/DPP, and for the management of hypertension and high blood cholesterol.
The 1815 funding award is estimated to reach approximately 1,000,000 Arkansans with prediabetes, diabetes, hypertension, high cholesterol, and risk factors during the course of this grant cycle. Significant impacts will be assessed for diabetes and cardiovascular outcomes of interest particularly for reduced AIC >9.0% for people with diabetes, achieving 5-7% weight loss for people with prediabetes, and increased blood pressure and high blood cholesterol control. We will target disparate populations such as Blacks, Hispanics and Marshallese, disabled persons, and other groups of Arkansans to promote equitable outcomes. It is hoped to measure significant changes in health outcomes and impacts for people with diabetes, prediabetes, hypertension and high cholesterol in targeted settings and statewide through proposed strategies.