Diabetes affects over 30 million Americans. Type 2 diabetes, when the body cannot effectively lower blood sugar levels, is most common among these adults. Nearly 25% of Veterans who receive care from VA have diabetes and VA is committed to improving their health outcomes. For Veterans with hard-to-control diabetes, self-management can feel like a burden. This is especially true for Veterans in rural areas, who may face challenges accessing care and self-management services.
Dr. Matt Crowley, an Endocrinologist at Durham VA Medical Center recognized that some Veterans with type 2 diabetes continued to show poor diabetes control despite clinic-based care.
“The clinic is not an ideal venue for providing diabetes care because diabetes imposes such a high burden of self-management tasks on our Veterans. Some just need more support than is possible in this setting,” said Dr. Crowley.
With a mission to connect Veterans to additional support services, Dr. Crowley created Advanced Comprehensive Diabetes Care (ACDC). The program provides critical access to diabetes self-management and medication support through Home Telehealth services.
VA is leading the way in improve access to care using telehealth innovation, and telehealth for diabetes management offers a way to improve Veteran health outcomes. Following this strategy, in 2013, Dr. Crowley and team collaborated with the VA Telehealth At Home program to design and pilot ACDC at Durham VA.
ACDC is uniquely designed to enhance standard Home Telehealth services and support Veterans with hard-to-control diabetes with three key components: telemonitoring, self-management support, and specialist-guided medication management. The program is delivered over six months using existing VA clinical staff and equipment. Initial data collected through a trial from 2014-2015 proved the ACDC pilot a success. ACDC improved hemoglobin A1c (a measure of blood sugar levels) by 1.3% for Veterans compared to clinic-based care and standard Home Telehealth diabetes services.
In 2017, the ACDC team collaborated with the VA Office of Rural Health to further develop the program. With a drive to expand to other VA facilities, the team entered ACDC in the 2018 Diffusion of Excellence VHA Shark Tank Competition and the practice was selected as a winner to replicate to VA Montana Healthcare System.
After successfully implementing the practice at the Fort Harrison VA Medical Center in Montana, the team continued to expand ACDC across VA. The ACDC team has now implemented their innovation in 30 sites, reaching over 700 Veterans with hard-to-control type 2 diabetes.
“Veterans appreciate the way ACDC is delivered,” said Tiffany Beaver, VHA Office of Rural Health ACDC Project Coordinator, noting how Veterans report high satisfaction with the program. By improving access to diabetes management, the practice supports VA’s priority to connect Veterans to the soonest and best care.
With support from the Dynamic Diffusion Network QUERI Program, the team is evaluating implementation support strategies to promote uptake of evidence-based practices, including ACDC, at later adopting sites.
In the future, the team hopes to expand ACDC to all VA facilities. “ACDC improves health outcomes for Veterans with diabetes,” said Dr. Crowley. “There is a need for programs like ACDC to be implemented across the country.”
To learn more about ACDC and where it's available, explore their page on Diffusion Marketplace.
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