Question: Planning for Community and Organizational Change

Proposing Evidence-Based Change 1

Proposing Evidence-Based Change

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Change Proposal Summary Report

Over the past two decades, the prevalence of diabetes has increased by orders of magnitude (Abuyassin, & Laher, 2016). Non-stop violence not just in the United States, but also in Middle Eastern and Northern African nations (Abuyassin, & Laher, 2016). Type 1 Diabetes Mellitus (T1DM) and Type 2 Diabetes Mellitus (T2DM) are on the rise across the globe (T2DM). According to the Centers for Disease Control and Prevention (2018), more than 100 million Americans have been diagnosed with diabetes or pre-diabetes. In this executive summary, the themes of interventional programs, as well as the ways in which other parts of the globe are tackling this problem, will be addressed.

Executive Summary

Proposed Change:

Adults all over the globe are seeing an increase in the prevalence of type 2 diabetes, which has a negative impact on their youth and life expectancy. Only in the United States do more than 10% of the people over the age of 18 have been diagnosed with diabetes (CDC, 2018). Despite considerable progress made over the last decade in education and prevention, about one-third of the population has diabetes or pre-diabetes and is completely unaware of it (CDC, 2018).

The proposed adjustment is intended to alleviate the burden on individuals who have been diagnosed with type 2 diabetes while also improving their quality of life. It has previously been shown that successful implementation of certain diabetes preventive programs and their cost-effectiveness may be achieved via education and practice of self-monitoring, according to Garg (2013). (p. 7). It is possible for the United States to lower their rates of type 2 diabetes through increasing education and early diagnosis, as well as by using technology advances (Shomali, 2012).

Desired Outcomes:

Ideally, the following outcomes will be achieved:

The reduction of type 2 diabetes is the intended result in the next decades. T2DM is diagnosed when the A1C level in a blood sample is 6.4 percent or above on two consecutive occasions, while a pre-diabetic range is an A1C level between 5.7 percent and 6.3 percent on the same two occasions. The American Diabetes Association [ADA] published a report in 2015 stating that Patients with uncontrolled type 2 diabetes are at increased risk for heart disease, hypertension, vascular insufficiency, and renal disease, among other complications (ADA, 2015).

It is the primary aim of a person with type 2 diabetes to avoid increased cardiovascular mobility and mortality that are associated with this condition. Using the appropriate information, training, interventions and treatments, an individual may decrease his or her A1C and thus minimize the likelihood of developing comorbidities associated with uncontrolled Type 2 diabetes. Despite the fact that therapy and therapeutic treatments for type 2 diabetes seem straightforward, there are many obstacles to achieving good results. Patient motivation and self-management, as well as insurance coverage for supplies and medicines, are the most often encountered problems in primary care settings today (Shomali, 2012).

Successful diabetes management requires patient motivation to make the required adjustments in their way of life. Patient behavior initiatives include healthy food modifications, physical exercise, and illness self-management activities such as medication administration, glucose monitoring, foot care, eye check, and laboratory testing (ADA, 2015). A1C levels steadily decrease in patients who are vigilant about self-monitoring and actively participate in their diabetes treatment, and some have been able to get their readings back into prediabetic ranges as a result of their efforts (American Medical Association [AMA], 2017).

The cost of diabetic treatment and consumables is a significant financial burden on the vast majority of the population that has diabetes. According to the American Medical Association (2017), several insurance companies have increased their coverage of diabetes supplies and needs in the aim of increasing the effectiveness of treatments and reducing medical costs as a contributing reason to a lack of treatment.

Physicians' worries regarding diabetic coverage have prompted Medicare to suggest adjustments to coverage and out-of-pocket expenses for their patients, while also collaborating with healthcare providers to address those issues (AMA, 2017). The Centers for Medicare and Medicaid Services (CMS) is proposing a performance-based payment system to provide an incentive for improved performance.

The Centers for Medicare and Medicaid Services (CMS) proposes that reimbursement and coverage be conditional on patient involvement in physician-ordered treatments such as weight reduction, preventive screening, and setting objectives (AMA, 2017). The goal of this strategy is to decrease the number of individuals who move from pre-diabetes to type 2 diabetes mellitus diagnosis.

Health Care System Comparative Analysis

In the Middle East and North Africa, the incidence of type 2 diabetes has risen dramatically during the last two decades. Obesity has been identified as the main issue affecting this group, according to studies. According to the World Health Organization (n.d.), Pakistan's T2DM cases would increase from 5.2 million to 13.9 million by 2030. In the Middle East, the prevalence of T2DM outnumbers the prevalence of T1DM by a factor of ten (Abuyassin, & Laher, 2016). This figure demonstrates that there is a health problem in certain parts of the globe.

This patient group is severely underserved in terms of education, research, and resources. “The Middle Eastern and North African area has the second highest rate of growth in diabetes everywhere in the world,” according to Abuyassin and Laher (2016). (p.2). The lack of effective diabetes prevention programs and strategies has resulted in a significant worsening of the disease's course throughout the Arab globe. The factors that are presently contributing to the rise of T2DM may be changed.

The increasing urbanization of the nation, poor eating habits, and a lack of physical exercise are the major changes in the past two decades that have been attributed to the fast rise in T2DM (Abuyassin, & Laher, 2016). Aside from physical causes for inactivity, the Middle East's conditions obstruct access to healthcare and resources. According to Abuyassin and Laher (2016), the governments of these nations are unstable, and access to nutritious food and medical treatment is limited.

Unfortunately for this demographic, present research in Arab countries does not meet the severity of the present health problem (Abuyassin, & Laher, 2016). According to the paper by Abuyassin and Laher (2016), this area of the nation spends much less than is required to make a meaningful impact. To combat the increasing incidence of T2DM, a large part of this population needs education and health care. In Northern Africa, new lifestyles, foreign eating habits, and globalization have washed across and produced a significant problem in this growing nation during the last several decades.

Due to the spread of this disease, the African government is being forced to pay greater attention to the consequences, which may result in thousands of Africans dying young (Azevedo & Alla, 2008). Because of the increasing severity of T2DM, epidemiologists anticipate that it will have a much greater effect and death toll than HIV and AIDS in the near future (Azevedo & Alla, 2008). Because to the rising incidence of diabetes in Northern Africa, more people are need healthcare and medicines. “A disproportionate rise in the number of diabetes patients has a clear detrimental effect on the government's capacity to manage diabetes complications,” write Azevedo and Alla (2008). (p. 14).

Patients are liable for more than 75% of the cost of diabetes supplies and prescriptions due to a lack of resources, access to insulin, alternative treatments, and preventive methods, while the government refuses to pay (Azevedo & Alla, 2008). Training of diabetes managers, clinical treatment programs, and access to healthcare should all be prioritized in order to make a meaningful difference in this group. It is said that there is no “best” method since medical treatment is seen as a luxury, and the government is not financially nor physically equipped to give the required care to its citizens (Azevedo & Alla, 2008).

The United States is able to sustain modest gains while continuing to help individuals diagnosed with T2DM. Unlike other nations, the United States is keeping track of progress and taking measures to enhance education, training, incentive programs, and payments to providers and patients. The United States has not mastered preventive methods and is currently developing measures to lower the continuously rising diabetes rates.

What the United States may learn from these other countries' methods is that the more insurance companies and movements participate in prevention and treatment, the more successful and healthier their citizens become. Although the United States has a high incidence of Type 2 diabetes, our government spends around 6.5 percent of its budget on diabetes patients and treatments, compared to 2.5 percent in the Middle East and Northern Africa (ADA, 2015). Despite billions spent on diabetes treatment and prevention, the global incidence of T2DM is rising, and there is still space for improvement.

Rationale for the Proposed Change:

Diabetic-related fatalities have surpassed heart disease as the sixth largest cause of mortality in the United States (CDC. 2018). Diabetes has been related to heart disease, renal disease, and other illnesses that affect tissue perfusion in the body. Over the last two decades, the age ranges of the US population have been gradually expanding (WHO, n.d.). In the last ten years, we've seen more young people and children with T2DM than we've ever seen before (WHO, n.d.).

Endocrine disorders have risen by 15% in the United States during the last two decades, including circulatory problems, malignancies, and diabetes-related injuries (CDC, 2018). Diabetes not only affects patients' physical health, but it also has an impact on their mental health. According to the Centers for Disease Control and Prevention (CDC), individuals with T2DM have a higher incidence of mental health problems. In terms of diabetes control and health, the United States is well ahead of other nations.

Despite the fact that the United States is statistically more advanced and has made progress in reducing T2DM rates and complications, there are still treatments that may be improved (CDC, 2018). More than 552 million people will have type 2 diabetes by 2030, according to estimates (Garg, 2013). According to studies, healthcare professionals and systems must emphasize teaching and create incentives to assist people manage their diabetes on their own. “Education has a major role not only in the prevention of diabetes itself, but also in the prevention of its complications,” writes Garg (2013). (p. 3).

When addressing diabetes, the goal of self-management education and training should be to achieve a healthy body weight. This may be accomplished through a mix of food change handouts, visual aids, and physical activity practice (Garg, 2013). To promote and try to dispel misconceptions regarding diabetes and treatment, an education campaign should be launched and utilized in healthcare faculties and schools.

Each program and informative session will be tailored to the patient population's culture and objectives. Starting with information and motivating training sessions may not be sufficient; effective implementation of diabetes outcome reduction will need incentives as well. Cost-cutting methods have previously been used as incentives by healthcare systems such as Medicare (ADA, 2015). The greater a patient's ability to achieve objectives and manage their diabetes, the more expenses they pay, and insurance companies encourage healthier patients and lower T2DM prevalence in return.

Financial and Health Implications:

According to the American Diabetes Association (2017), the cost of diabetes in 2017 was $327 billion USD. Since 2012, when it was $245 billion dollars, this has grown. Diabetes patients spend an average of $17,000 per year on medical expenses. (American Diabetes Association, 2017). This has a significant financial impact on health-care systems and people. The more effectively we can manage and decrease overall diabetes statistics, the more money patients and the government as a whole will save. The expense of launching diabetes education initiatives and encouraging doctors and nurses to continue their education is still considered a win.

If a small number of patients engaged in these programs and were successful, the financial savings of not being classified as a type 2 diabetes or regressing to a pre-diabetic would be thousands of dollars for the patient and the healthcare system (Garg, 2013). The lower the risk of diabetes complications, the more individuals who are deemed managed diabetics. Diabetic individuals who develop cardiovascular disease cost the United States approximately $200 billion each year (ADA, 2017). The projected cost of diabetes-related health expenditures in the United States is projected to exceed $500 billion if these improvements are not made. The failure to adopt interventions to get ahead of increasing T2DM rates has cost the United States a lot of money.

Conclusion

Every year, the number of people diagnosed with type 2 diabetes rises throughout the globe. Diabetic programs and implementations that are successful will encourage a healthy lifestyle and provide chances for patients to exercise self-management of their health. A national effort to decrease diabetes rates across the globe is required to properly and positively begin this effort. Diabetes preventive programs have the ability to show patients and the government that they are cost-effective.

Outcomes	Middle Eastern Counties	Northern Africa	USA
Prevalence of T2DM	T2DM is common in Arab nations, with an average incidence of 32 percent. This year's T2DM prevalence is on the rise. Over the last two decades, this has been growing (Abuyassin & Laher, 2016).	T2DM is prevalent at a rate of 16 percent in Northern Africa. This has also increased in recent decades and is expected to continue to do so. (Alla, Azevedo, & Azevedo, 2008).	T2DM affects approximately 10% of the population in the United States. Over the last two decades, this rate has been continuously rising, resulting in an epidemic (CDC, 2018).
Education/Health Access	Access is hampered by a lack of health knowledge and specific obstacles such as political instability. Many individuals in the Arab world struggle to get adequate education and health care because their governments do not prioritize them. There have been some minor improvements, but none that compare to the severity of increasing T2DM rates (Abuyassin & Laher, 2016).	Poor education and lack of access to health care and services provide a barrier to receiving the treatment required to combat increasing T2DM prevalence. As Northern Africa grows more urbanized, a lack of educational health initiatives is contributing to a more sedentary lifestyle (Azevedo, & Alla, 2008).	Healthcare and services are available in most parts of the United States. T2DM costs approximately $400 billion each year in the United States, whereas diabetes complications such as cardiovascular disease cost approximately $200 billion per year. The United States has the ability to decrease total expenditure and T2DM rates by implementing interventions such as education and training programs, as well as ongoing education for patients and healthcare professionals (ADA, 2017).
Health insurance Coverage	The Middle Eastern government presently does not prioritize the country's diabetes problem, leaving the people to foot the bill for almost all of the supplies and treatments. With these exorbitant prices and a lack of access to diabetes programs and, in certain regions, health care, T2DM rates are rising at an alarming pace (Abuyassin & Laher, 2016).	In Northern Africa, the government subsidizes the cost of diabetes care. Patients, on the other hand, are still responsible for up to 75% of the cost of supplies and therapies. Many conventional treatments, like as insulin, are not covered by insurance or the government. In most areas, care is also said to be of low quality, and government expenditure on diabetes is less than 3%. (Azevedo, & Alla, 2008).	Insurance companies, such as Medicaid, are offering incentive programs, and will pay more toward medical coverage if a patient can demonstrate that he or she is working toward and has achieved certain goals set by healthcare providers, as long as the patient demonstrates that they are working toward and have achieved those goals. A performance-based framework enables insurance companies to pay the bare minimum for patients who do not want to strive to improve their health and decrease their risk of problems, while rewarding those who do (ADA, 2015).

(ADA, 2015), (ADA, 2017), (CDC, 2018), (Abuyassin & Laher, 2016), (Azevedo, & Alla, 2008).

References:

American Medical Association [AMA]. (2017) Proposed fee schedule details Diabetes Prevention Program payments. Retrieved from https://www.ama-assn.org/practicemanagement/medicare/proposed-fee-schedule-details-diabetes-prevention-programpayments

Abuyassin, B., & Laher, I. (2016). Diabetes epidemic sweeping the Arab world. World journal of diabetes, 7(8), 165–174. doi:10.4239/wjd.v7.i8.165

Azevedo, M., & Alla, S. (2008). Diabetes in sub-saharan Africa: kenya, mali, mozambique, Nigeria, South Africa and zambia. International journal of diabetes in developing countries, 28(4), 101–108. doi:10.4103/0973-3930.45268

American Diabetes Association [ADA] (2015). Strategies for Improving Care. Retrieved from https://care.diabetesjournals.org/content/38/Supplement_1/S5

American Diabetes Association [ADA] (2017). The Cost of Diabetes. Retrieved from http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html

Center for Disease Control and Prevention [CDC] (2018). New CDC report: More than 100 million Americans have diabetes or pre-diabetes. Retrieved from https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html

Garg R. (2013). Diabetes education & prevention. The Indian journal of medical research, 138(6), 820–823.

Shomali M. (2012). Diabetes treatment in 2025: can scientific advances keep pace with prevalence?. Therapeutic advances in endocrinology and metabolism, 3(5), 163–173. doi:10.1177/2042018812465639

World Health Organization. (n.d.). Global Health Observatory (GHO) data. Retrieved from http://www.who.int/gho/en/