Scalable Technology-Enabled, Evidence-Based Diabetes Care Pathway for Older Adults
In this podcast, Livleen Gill, MBA, RDN, LDN, FAND, discusses creating a standardized care delivery system for older adults with type 2 diabetes in Maryland, connecting health care with community-based organizations, and ways to replicate it nationwide. She also spoke about this topic during her poster presentation at ADCES 2023 titled “A model for a scalable technology-enabled evidence-based diabetes care pathway for older adults."
Additional Resource:
Gill H, Engelman H, MacLeod J. A model for a scalable technology-enabled evidence-based diabetes care pathway for older adults. Talk presented at: ADCES 2023. August 4-7, 2023. Accessed September 5, 2023. https://www.adcesmeeting.org/2023/ADCES23/
TRANSCRIPTION:
Jessica Bard:
Hello everyone and welcome to another installment of Podcast360, your go-to resource for medical education and clinical updates. I'm your moderator, Jessica Bard, with Consultant360, a multidisciplinary medical information network. Livleen Gill is here to speak with us today about her poster presentation at ADCES 2023.
Livleen Gill:
I'm Livleen Gill, a registered dietician and President and Chief Executive Officer of Apostle Group, LLC, and Bethesda Newtrition and Wellness Solution, which is the health care delivery side of our entity.
Jessica Bard:
Thank you again for joining us. We're talking about your poster presentation at ADCES 2023. Please provide us with an overview of the presentation, “A Model for a Scalable Technology-Enabled, Evidence-Based Diabetes Care Pathway for Older Adults”
Livleen Gill:
So, the purpose of this project was to create a standardized system of care delivery for older adults with type two diabetes in the state of Maryland, and it was to connect health care with community-based organizations. This model is then to be replicated in the rest of the country once our results are published and it comes out, so that was the purpose.
Jessica Bard:
Can you tell us a little bit more about this importance? Why did you choose this topic to study here?
Livleen Gill:
In 2019, in the state of Maryland, type two diabetes came out as the number one condition that was affecting older adults, and the state of Maryland made it their project to look at the access and outcomes of these individuals and how they could be impacted. So we wrote a grant to the Administration on Community Living to look at older adults, and in this case, older adults are 60 years or older, to look at how type two diabetes outcomes could be improved in the state by, one, using technology to not only bridge between health care and community-based organizations, using that to provide the communication and access to older adults. And lastly, using technology to improve the social isolation that older adults have while they're aging, so those are the reasons why we wrote this grant.
Jessica Bard:
Now, can you get into a little bit more about the technology? How was technology used to create a standardized system of care delivery for older adults with diabetes?
Livleen Gill:
So what we did was, first of all, the state of Maryland, all healthcare is connected through what is called the Chesapeake Regional Information System. So one, we use for any referrals to come from the healthcare side to us, we use technology. So they would use technology to send the referral through this. We use technology for communication with the health care team, with the community-based organization, and with the participants who were enrolled in this. In this, we did emails, we provided medical nutrition therapy to the participants, and we provided them group diabetes management program. And then lastly, they use technology once a program, then the third year of the program, they use technology to order out just like you would do Uber Eats and DoorDash. Younger people are familiar with that. Older adults are not. So we wanted to see if they could use technology to do that using the education and knowledge that they had received and how good were they going to be in order to use it, so that's how we used technology in this.
Jessica Bard:
And what did you find? What were the results?
Livleen Gill:
There were two things that were very surprising. One was that individuals, older adults, are really interested in caring for their health. They want to be empowered with education and knowledge to take care of themselves. Number two was that the health care team, which is the physician side, the provider side of it, don't refer these individuals for medical nutrition therapy. The third was you need a lot of support. These individuals need a lot of technology support to make that technology accessible and also that it will be used in the future. A lot of hands-on.
Jessica Bard:
And how would you say that those conclusions really impact clinical practice?
Livleen Gill:
So, what it does is, if we are going to use technology with older adults in any way to deliver education or even for regular scheduling appointments or stuff, there needs to be somebody who understands that they need a lot more help, so there needs to be somebody who is understanding of technology who can assist them. And number two, medical nutrition therapy is by far the most helpful for older adults with type two diabetes and healthcare providers should refer them so they can gain knowledge and improve their outcomes. Those are the two main things. Our results have shown that the outcomes with the education really improved in lowering their hemoglobin A1C, the choices that they make after they have gone through the program.
Jessica Bard:
And how can this really be implemented across other states and other facilities?
Livleen Gill:
What they can do is to make sure that any individual, any participant, when they diagnose them with type two diabetes, they are providing them support by referring them to, in their team, if there is a registered dietician or the nearest diabetes management program, which can help assist these individuals to take care of it. That is really, really the number one key in order to improve their outcomes. Because as we know, it takes a while for older adults to get to and they really trust their providers. They really trust their physicians and the physician single-handedly can really help their outcomes by referring them to the appropriate programs.
Jessica Bard:
What would you say is next for this topic? What's next for research? What's next for implementation on this topic?
Livleen Gill:
What we found was that a lot of individuals are much more comfortable with a provider who speaks the same language and understands their culture. We were able to do quite a bit, but I think that is the next step in order for any kind of delivery of education or programs, that that should be looked at and be embedded as part of the program.
Jessica Bard:
Certainly. That makes sense. Is there anything else that you'd like to add today that you think I missed or didn't ask you about?
Livleen Gill:
I do want to say what surprised us about this program is we had thought, as I said earlier, we designed this program that we would get referrals from the health care side of the team. What we found was that the referrals from the health care side were really low. What we got was 58% of the referrals were self-referrals. People had heard about the program if we were at senior centers or otherwise, and they would just call us because they wanted to enroll. So, what that is is people want to know about it. I think the mechanism of referral isn't there.
And the last thing I would like to add is Medicare has this benefit, which is a zero-cost benefit for all Medicare beneficiaries, so they get this free of charge with medical nutrition therapy, with the dietician, and they also get diabetes self-management education. They should connect them. And when health care and the community gets connected, there are other resources that individuals can get, which can help overcome if they're food insecure, if they're socially isolated, they have transportation challenges, all of that. Healthcare by themselves cannot do all of them. They need the support from others.
Jessica Bard:
Absolutely. That's well said. Livleen, thank you so much for joining us on the podcast today. We appreciate it.
Livleen Gill:
Thank you so much, Jessica, for having me.