How a Community Hospital Tackles Diabetes

A community hospital on the edge of Appalachia is becoming a leader in diabetes management and prevention. It's found a way to shorten patients' length of stay, boost prevention efforts, and help train endocrinology specialists.

The fight against diabetes is being fought hard in places as far flung as school lunch rooms and large academic medical centers. But there's one place that's in the vanguard: a community hospital in Athens, OH.

OhioHealth O'Bleness Hospital, a 132-bed acute care facility is on the front lines of the battle against diabetes, a killer that claims thousands of American lives every year.

It's facing a diabetes epidemic, says Jay H. Shubrook, DO, FACOFP, FAAFP. Shubrook is director of the clinical division of The Diabetes Institute at the Ohio University Heritage College of Osteopathic Medicine, and he serves in leadership positions at O'Bleness Hospital including director of diabetes services.

The southeastern Ohio community around the hospital is economically disadvantaged and in poor health. The incidence of diabetes in the area is 40 percent, which is more than four times the national average, according to the American Diabetes Association.

"They get diagnosed early and have complications early," says Shubrook.

The Athens rate even exceeds the projection for the US population in 2050. It's expected that about one third of the adult US population will have the illness by then.

Inpatient Management
Shubrook identifies several chronic disease management initiatives at O'Bleness Hospital that have led have improved clinical outcomes and cut treatment costs.

Efforts to improve the management of patients' glucose levels at the hospital, such as a standardized insulin protocol, have reduced the length of hospital stays, he says.

"We went to IV drips on the floor when only 10 percent of the other hospitals nationwide had done so. That was significant for a small community hospital," he says, noting that research he conducted on the impact of improved glucose-level management showed a shortening of hospital stays by 1.6 days.

O'Bleness evaluates the effectiveness of its glucose-level management efforts regularly, Shubrook says. "This year, we have found our hyperglycemia rates have gone up," he said. "We think this active reassessment of quality measures benefits our patients."

In fact, the inpatient glu­cose-control protocols Shubrook helped develop are now a standard recommended by the American College of Endocrinology.

Prevention Efforts
O'Blenness Hospital doesn't stop at trying to improve management of diabetes as a chronic illness. The hospital also provides diabetes education and patient support services through a navigator program for adult and child diabetes patients. It is boosting prevention efforts, which in turn improve quality of life and cut treatment costs, Shubrook says.

The navigator who works with young Type 1 diabetes patients in local schools has been a key player in launching early interventions before children experience serious complications, says the physician leader. "We have been able to reduce the number of hospitalizations, reduce the number of missed days of school, [and] reduce the number of parents' missed days of work," he says.

O'Bleness Hospital is also participating in a diabetes prevention program developed by the Centers for Disease Control and Prevention that could cut billions of dollars off the nation's annual spending on diabetes treatment, Shubrook says. Patients enrolled in the year-long program are screened for pre-diabetes conditions and commit themselves to lifestyle and behavior changes.

A national study conducted on YMCA members who participated in the CDC program found a 50 percent reduction in the rate of people with pre-diabetic conditions developing a full diabetes diagnosis.

At O'Bleness, 45 people with pre-diabetic conditions have participated in the prevention program, with none of them receiving a diabetes diagnosis so far. "It appears to be doing the right thing, two years into it," Shubrook says of the hospital's prevention program.

Specialist Training
O'Bleness is also co-sponsoring a year-long fellowship program with a West Virginia hospital to prepare primary care physicians to play an active role in managing their patients' diabetes. It is estimated that there are not enough endocrinology specialists in the United States to handle the inundation of diabetes cases nationwide.

One of the goals of the fellowship program is to spread the use of glucose monitor "downloading stations" at primary care physician offices. The technology provides primary care staff access to the full records of a home glucose monitor. "It really makes our visits more efficient," Shubrook says "All you have to do is have a computer in your office, and the software is free."

Shubrook says the O'Bleness diabetes care fellowship program can and should be replicated at hospitals across the country. "This is something we need to nationalize and have all over."