Ending Type 2 Diabetes One Exercise, Nutrition, and Gardening Class at a Time

Posts Tagged ‘Oral Glucose Tolerance Test (OGTT)’

OGTT Sketch

In OGTT Screening on February 10, 2012 at 11:18 AM

Some drink the Glucola solemnly, obediently. It’s unclear whether they know the full extent to which we are testing their health status this morning. Others seem somewhat nervous, and still others chat away cheerfully until their name is called for the needle and flat orange sugar drink event.

The kids are restless, sucking on the backs of chairs as they watch the phlebotomy, or any sign of movement in the room.

The best is the tough guy with the mohawk. His name is called and he stays sitting, in a sheepish stand-off with the clinician’s assistant. And then, as he eventually pulls his tee shirt up over his tattooed forearm, he describes how much he hates needles.

Amazing how for style or nostalgia, an inked needle is welcome! And for an oral glucose tolerance test, it is so thoroughly resisted.

And yet resistant or not, bored or cheerful, nervous or curious, the 21 adults and their families present today will leave here with knowledge of diabetes, their risk, and some implementable-tools for improving the quality of their health. Cheers to them!

Tatoo!

OGTT!

Not Giving Up, Even After 4 No-Shows

In Intensive Lifestyle Intervention - General on February 22, 2011 at 2:46 PM

I couldn’t figure out why all the intake equipment was set up in the conference room. It was a typical day in the Diabetes Prevention Program; soup being served that raises funds for the garden, administrators talking to Yale about the joint child-obesity program, patients calling throughout. Intakes usually take place before the start of a new Intensive Lifestyle Intervention, when the program needs to be filled with those whose results from OGTT screenings placed them in the category called prediabetic. We were six weeks into our twelve-week program, however. Hardly the time to begin filling the next program.

Mari flies in the office door, her scrubs swishing against a busting notebook. She mumbles to herself, ‘She’s not here!’

I couldn’t help but ask.

‘It’s the intake I had scheduled. This patient isn’t here…again.’

‘Again?’

‘She’s been scheduled four times.’

Mari picked up the phone with resolve. She plays with the patient, in a stern voice informing her of the missed appointment, and then laughing with compassion as the patient realizes her folly on the other end of the line. When they get off the phone, I ask how they decided to resolve the patient’s continued absence.

‘I’m going over to her house to do the intake.’ Mari exclaims proudly, like a woman who’s taken fate by the horns.

I couldn’t help wondering why – with 15,000 patients at FHCHC, how has this particular patient instigated a home visit? And what is Mari’s motivation for persisting?

‘It’s hard.’ She explained. ‘Weather, wrong numbers, messages left without call-backs. It’s difficult to generate participation. So when someone is interested and simply can’t get here, I’ll take an extra step.’

Why OGTT Screenings Should Not Take Place Between the 1st and 5th Days of any Month

In OGTT Screening on December 9, 2010 at 5:32 PM

This past Saturday, 36 patients were scheduled to attend our OGTT screening. As per the usual protocol, our DPP staff called people at risk for diabetes weeks in advance. The head DPP provider also called to confirm their attendance a few days before the screening. Despite repeated efforts to ensure a full house, only 17 patients were in their chairs that December 4th morning.

As is the DPP’s custom, the lead provider took a few minutes at the close of the screening to consider what worked and didn’t work. She directed her attention to the attendance. While most of the DPP staff were perplexed, the clinic’s social worker was incredulous.

“Today is December 4th! What did you expect?”

Silence. No one understood what the social worker was getting at.

She sighed and made another attempt to explain, “It’s when everyone gets their checks.”

In Connecticut, state aid, including SNAP and other entitlements, is distributed on the first day of every month. Federal aid, SSI, arrives on the third. By then, the social worker continued to expound, people’s pantries, bank accounts, and access to credit, have dried up. It is on the first Saturday of the month, after their checks have arrived and the work week has slowed down, that many Fair Haven residents go grocery shopping, and run around town paying their light, electricity, phone bills.

“Not to mention, November was a 5-week month. Extra long, and extra hard.”

Needless to say, we won’t be scheduling OGTT screenings on the first Saturday of the month moving forward.

 

FHCHC’s DPP Intensive Lifestyle Intervention – An Overview

In Intensive Lifestyle Intervention - General on December 8, 2010 at 4:01 PM

ILI Overview & Intake Procedure

If a Hispanic woman between the ages of 18-55 has had a blood test in the past three months that has rendered her pre-diabetic, and she is a patient at the Fair Haven Community Health Center, she is eligible to participate in the Diabetes Prevention Program’s Intensive Lifestyle Intervention (DPP’s ILI). There are two study tracks: delayed and immediate. Those randomized to participate in the delayed group see their provider every three months for a year, as well as a nutritionist once during that time. Those in the immediate track participate in a 12-week exercise and nutrition program, seeing a provider weekly and having the opportunity to continue participating after the initial 12-weeks. At the end of one year, all delayed and immediate-track ILI participants have an OGTT screening to distinguish any changes in their physical wellbeing. Those in the delayed group can then enter into the immediate track if they choose. Those randomized to participate in the immediate study group begin their weekly nutrition and exercise classes immediately.

Prior to the randomization process, pre-diabetic patients are invited to the clinic for an intake (click here to see the Intake Checklist). There, their labs are confirmed, vitals taken, and they are given the opportunity to join the ILI study (click here to see intake checklist). These intakes are free, and are scheduled by the DPP staff, rendering most of the process outside the clinic’s traditional admission and billing processes. Typically, the appointment takes around 30 minutes, and is conducted by a trained DPP administrator.

The intention of the intake is to determine whether a pre-diabetic patient is interested in participating in the ILI study, and if so, collect all the essential study data to get them started. The consent form solidifies their participation, after which vitals and other medical-related data is collected, and physical activity and nutrition-related questionnaires are filled out. As part of the initial data collection, patients are also given pedometers and a pedometer tracking form, the data from which will indicate the amount of walking each patient does on a typical weekday or weekend. The DPP awards $10 gift certificates to Walmart if they return the pedometers and the pedometer tracking form after a complete week, a strategy that has fueled participation.

FHCHC DPP OGTT Screening Follow-Up

In OGTT Screening on December 8, 2010 at 3:50 PM

The following checklist takes the reader through a step-by-step process of completing the group OGTT screening.

 

FHCHC DPP OGTT Screening Billing Flow

In OGTT Screening on December 8, 2010 at 1:06 PM

FHCHC’s Diabetes Prevention Program has strived to create a financially sustainable billing system. This is a month in the life of the OGTT billing process.

This document refers to several related documents:

Click here for a sample Encounter Form

Click here for sample coupons

Click here for a sample OGTT attendance, billing, and insulin data spreadsheet

FHCHC DPP OGTT Billing Spreadsheet

In OGTT Screening on December 8, 2010 at 1:06 PM

The FHCHC Diabete Prevention Program maintains spreadsheets for all data to ensure research accuracy. This spreadsheet chronicles the relevant patient, billing, and insulin numbers for all OGTT screening attendees.

For a look at the whole billing flow, click here.

FHCHC OGTT Execution Checklist

In OGTT Screening on December 8, 2010 at 1:03 PM

This checklist is meant to guide DPP staff in conducting a successful OGTT screening.

DPP Financial Sustainability: No Special Treatment

In About the Program on December 8, 2010 at 1:03 PM

“The DPP gets no special treatment” declares FHCHC’s billing manager Marian Zayas. She is referring to the billing system used to ensure DPP financial sustainability. Knowing that neither the clinic nor grants could finance the program for more than several years, exploring and establishing an effective billing system has been a key objective from day 1.

Like other health clinics, FHCHC positions patients on a sliding fee scale based on their income and insurance status (see scales below). Those with no insurance combined with lowest income level are given the biggest discounts, while those with insurance and/or high income are given the lowest discount. The DPP has fully adopted this system so that each patient seen in an OGTT screening or participating in the Intensive Lifestyle Intervention is charged for their visit based on their position on the sliding fee scale. The DPP uses a coupon system to ensure that the DPP is charged for serves not covered by patients’ insurance (click here for a sample coupon sheet).

Click here to see the OGTT billing process which ensures insurance reimbursement and program sustainability.

FHCHC DPP OGTT Billing Coupon System

In OGTT Screening on December 8, 2010 at 1:02 PM

These are the coupons that the DPP staff pastes on Encounter Forms after OGTT Screenings. By using a coupon system, the Billing Department can charge the DPP the amount that isn’t covered by the OGTT screening patients’ insurance.

Click here to see the whole OGTT billing process.

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