Diabetes Care / Everyone with Diabetes Counts: HSAG QIN-QIO Addresses Cultural Barriers to Improve DSME Participation Rates

Providing Diabetes Self Management Education (DSME) to people with diabetes can significantly decrease the symptoms of the disease.

As the nation grows more culturally diverse, QIN-QIOs are facing new challenges in providing DSME resources to Medicare beneficiaries through the Centers for Medicare & Medicaid Services’ Everyone with Diabetes Counts (EDC) program. English is not the primary language of many beneficiaries across the nation. Often, a lack of English proficiency can inhibit a person’s ability to understand educational resources like DSME classes. Disparities in diabetes care have been attributed to cultural and language barriers.

Health Services Advisory Group (HSAG) – the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Arizona, California, Florida, Ohio and the U.S. Virgin Islands – has addressed this changing cultural climate through language initiatives to provide comprehensive DSME to Medicare beneficiaries.

In states with large Hispanic populations like Arizona, California and Florida, providing DSME resources in both English and Spanish is now common practice for many DSME programs. The biggest challenge lies in providing resources in other languages for increasingly diverse populations. In California, HSAG has seen an increase in Asian language speakers. To meet their needs, HSAG coordinated the translation of DSME materials and classes for many languages, including Vietnamese, Mandarin, Hmong, Korean and others.

In California and Florida, certain Native American communities prefer to learn from teachers within their own communities. HSAG provides the training and support that Native American health ambassadors need in order for them to go back to their respective communities to educate beneficiaries about DSME.

‍In addition to accommodating the language needs of beneficiaries, HSAG’s outreach methods include high-touch strategies like conducting weekly phone calls, sharing facilitator cell phone numbers and sending handwritten greeting cards to increase retention rates in the program.‍

“High touch is a really important part of the Diabetes Empowerment Education Program,” says HSAG’s Laura Gamba, who works to recruit and provide DSME resources in Florida. “When someone is supposed to get a meter [to monitor blood sugar], for example, we follow up to make sure they know how to use it.” HSAG also has met beneficiaries in person at public locations to provide catch-up sessions if they missed a class.

HSAG recently partnered with the Food is Medicine program in the Tampa Bay area of Florida to encourage beneficiaries in lower-income communities to attend DSME classes. The Food is Medicine program offered $10 vouchers to each DSME class attendee for local fruits and vegetables from its Food is Medicine truck. This helped stimulate initial interest in the class, as well as improve retention rates, because people were given access to healthy foods in an accessible manner.

In total for 2016, HSAG graduated 5,201 beneficiaries from DSME programs, 4,736 of whom were Medicare beneficiaries.

This story is one of 15 that were included in the 2016 QIO Program Progress Report.