Denton County Public Health (DCPH) has a longstanding history of providing preventative and clinical services to residents of Denton County, Texas. Denton County is the eighth largest county in Texas with an estimated population of 906,422 and 3.11% growth rate, according to the U.S. census data. Denton County is a community with diverse resources and engaged community partners, aiming to meet the community's needs with the vision of leading our communities to a healthier future. Currently, DCPH is one of eight local health departments in Texas to receive a national accreditation from Public Health Accreditation Board (PHAB), and one of four local health departments statewide with dual accreditation from PHAB and Project Public Health Ready (PPHR).
Despite DCPH promoting and preserving sustainable community health through exceptional education, compassionate care, and quality of service, chronic diseases continues to be an area of concern. In Texas, diabetes is an epidemic being the 7th leading cause of death. According to the American Diabetes Association (ADA), approximately, 2,333,000 individuals in Texas have a diagnosis of diabetes, and 621,000 individuals have undiagnosed diabetes. Annually, there are about 162,000 newly diagnosed individuals with diabetes in Texas. The estimated cost of diagnosed diabetes in Texas is about $26 billion each year. Diabetes is a complex, chronic illness affecting most of the organ systems, leading to severe complications if not properly managed.
As part of the Texas Medicaid transformation 115 waiver, the Delivery System Reform Incentive Payment (DSRIP) program has allowed DCPH to secure funding and develop a Diabetes Education and Case Management Program (DECM). DSRIP incentivizes DCPH to improve access and delivery of care targeting low income, uninsured individuals in Denton County. Diabetes is a chronic illness requiring continuous medical care, support, education, and self-management. The ultimate goal of DECM is to assist individuals with diabetes to acquire the knowledge, skills, and behaviors needed to maintain glycemic control and prevent health related complications. Patients enrolled in DECM are 100% low income; uninsured and about 94% are Hispanic/Latino, non-English speakers. To heighten quality of life for patients living with diabetes and reduce healthcare costs associated with unmanaged diabetes, DECM established measurable program goals and objectives.
1. Reduce the proportion of adults with diabetes 18-75 years of age, who have a HbA1c value above 9%
- Provide culturally and linguistically diabetes education through "Si Yo Puedo" "Wisdom Control" in a group or individual setting
- Provide glucose meter, supplies and education
- Provide diabetes medication
2. Reduce patient 18-75 years of age biometric health indicators, blood pressure control <140/90mm Hg
- Provide blood pressure medication
- Provide blood pressure monitor for home testing
3. Reduce multiple patient visits by increasing in-house Point-of-care (POC) testing.
- Available POC testing: Retina Scan, Lipid Panel, Microalbumin, HbA1c
Through DSRIP funding, DCPH and DECM have been able to provide access to care to underserved communities in Denton County. This funding has reduced out-of-pocket financial barriers for diabetes patients. Point-of-Care allows patients to receive the recommended test by the ADA in one visit, retina scan, lipid panel, microalbumin, HbA1c, and monofilament foot exam. Patients also receive their diabetes, blood pressure, cholesterol medications during the same visit at no cost to the patient.
With continuous health care through primary care, diabetes health educators, community health workers, diabetes case managers, and community partners, DECM, has successfully accomplished every milestone, metric and goal. DECM focuses in providing patients with the tools needed to take control and increase self-confidence in maintaining a healthy blood pressure and blood glucose levels.
The specific factors leading to the success of this practice were due to improving cultural competency, health literacy and community support. As about 94% of patients experience a language barrier, DCPH provides language accessibility for accurate communication with their medical provider. Furthermore, diabetes education being an important tool for successful glucose management, DECM utilizes "Si, Yo Puedo" an exemplary community health program curriculum, recognized by the National Institute of Food and Agriculture (NIFA); targeting low-literacy Hispanic/Latinos with diabetes. In addition, community support, peer supporters, and community health workers is a vital strategy to improve health outcomes in diabetes management.
Today, 78% of DECM patients have an HbA1c value below 9%, 44% have an HbA1c value below 7.0% as recommended by the American Diabetes Association, and 60% have reduced their blood pressure under 140/90mmHg.
The website for Denton County Public Health is https://www.dentoncounty.gov/643/Public-Health. The website for Diabetes Education and Case Management is https://www.dentoncounty.gov/656/Diabetes-Education-Case-Management.