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Certification of Recognition Status for the VA and Department of Defense's Joint Diabetes Self-Management Training and Support Program.

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Joint Department of Veterans Affairs and Department of Defense Collaborative Virtual Diabetes Self-Management Training and Education Program

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Diabetes affects all aspects of an individual's life. Globally diabetes impacts approximately 10% of the adult population while the incidence amongst Veterans receiving care within the VA nears 25%. The American Diabetes Association along with the VA and Military Health System recommends all people with diabetes received Diabetes Self-Management Education and Support at four critical times (1) at diagnosis, (2) annually and/or when not meeting treatment targets, (3) when complicating factors develop, and (4) when transitions in life and care occur.

Diabetes Self Management and Training /Diabetes Self Management Education and Support (DSMT/DSMES) helps people with diabetes learn, integrate, build trust and maintain behaviors as part of their overall treatment program. Providing DSMT/DSMES via multiple platforms including virtual, face to face and telephone improves access to care. The American Diabetes Association has awarded Recognition to this global pilot program for meeting all Diabetes Self-Management Education and Support standards of excellence.

This innovation is scaling widely with the support of national stakeholders. See more scaling innovations.

Adoptions:

71 successful, 29 in-progress, 2 unsuccessful

Awards and Recognition:

Diffusion of Excellence Promising Practice

Partners:

Diabetes and Endocrinology, National Center for Health Promotion and Disease Prevention, Nursing, Nutrition and Food Services, Pharmacy Benefits Management Services

Overview

Problem

The VA/DOD Clinical Practice Guidelines for Diabetes strongly recommended that all individuals with the diagnosis of diabetes be offered Diabetes Self-Management Education (DSMES). Currently, yet less than 25% of the Veterans and only 1% of our Department of Defense population have access to DSMES services, this represents a major access gap. The American ... See more

Images

Moving clockwise
Upper left woman wearing black pants and pink top telling man in green shirt and black pants that he is newly diagnosed with diabetes and is referred to DSMES.
Upper right, woman wearing pink dress looking at chart, going for annual diabetes visit learns she is not meeting targets and is referred  to DSMES
Lower right: 3 males, aging.  First is a teenaged male, followed by an adult male, followed by an elderly male.  As this individual transitions through the various stages of life, a referral to DSMES and support is recommended
Lower left shows a woman wearing a teal dress visiting an eye specialist to learn that she is experiencing visual issues and is referred to DSMES

Four Key Times for Diabetes Self Management Education and Training

Solution

April 2019, a Joint Incentive Fund between VA Subject Matter Experts (SME's) and DOD Subject matter experts was awarded. Teams convened to focus on the creation of a national VA/DOD evidence based, structured, standardized Diabetes Self-Management Education and Support program.
A national curriculum including implementation guide, facilitator guide, pati
... See more

Results

The VA/DOD Virtual DSMT/DSMES program is replicating quickly due to hosting quarterly Train the Facilitator sessions followed by productive interactions with qualified healthcare staff. The VA has 42 successful sites and 19 promising new VA locations across the country. The Department of Defense is actively using VA/DOD Virtual DSMT/DSMES #006585 for thei ... See more

Metrics

  • Our annual status report for 2022-2023 demonstrated an average A1c lowering of 1.65 for VA and DOD
  • Behavioral Goal Attainment was partially achieved for over 90% of patients during the reporting period of 2022-2023.

Diffusion tracker

Does not include Clinical Resource Hubs (CRH)

Statuses

AK: Colonel Mary Louise Rasmuson Campus of the Alaska VA Healthcare System (Anchorage)
  • Started adoption on 12/2023.
AL: Central Alabama VA Medical Center-Montgomery (Montgomery)
  • Started adoption on 01/2024.
AR: Fayetteville VA Medical Center (Fayetteville, Arkansas)
  • Started adoption on 07/2022.
AZ: Phoenix Midtown VA Clinic (Phoenix Midtown) CA: Chico VA Clinic (Chico)
  • Started adoption on 02/2024.
CA: Cypress Avenue VA Clinic (Cypress Avenue)
  • Started adoption on 02/2024.
CA: Fairfield VA Clinic (Fairfield)
  • Started adoption on 02/2024.
CA: Mare Island VA Clinic (Mare Island)
  • Started adoption on 08/2022.
CA: Martinez VA Medical Center (Martinez)
  • Started adoption on 02/2024.
CA: McClellan VA Clinic (McClellan Park)
  • Started adoption on 02/2024.
CA: Modesto VA Clinic (Modesto)
  • Started adoption on 02/2024.
CA: Redding VA Clinic (Redding)
  • Started adoption on 02/2024.
CA: Richard A. Pittman VA Clinic (Stockton)
  • Started adoption on 02/2024.
CA: Sacramento VA Medical Center (Sacramento)
  • Started adoption on 02/2024.
CA: Sierra Foothills VA Clinic (Sierra Foothills)
  • Started adoption on 02/2024.
CA: Sierra Foothills VA Clinic (Sierra Foothills)
  • Started adoption on 02/2024.
CA: Sonora VA Clinic (Sonora)
  • Started adoption on 02/2024.
CA: Yreka VA Clinic (Yreka)
  • Started adoption on 02/2024.
CA: Yuba City VA Clinic (Yuba City)
  • Started adoption on 02/2024.
CO: Rocky Mountain Regional VA Medical Center (Aurora Rocky Mountain)
  • Started adoption on 09/2024.
DE: Wilmington VA Medical Center (Wilmington, Delaware)
  • Started adoption on 06/2024.
FL: Bruce W. Carter Department of Veterans Affairs Medical Center (Miami)
  • Started adoption on 06/2023.
FL: C.W. Bill Young Department of Veterans Affairs Medical Center (Bay Pines)
  • Started adoption on 01/2023.
FL: Daytona Beach VA Clinic (Daytona Beach)
  • Started adoption on 11/2024.
FL: Orlando VA Medical Center (Orlando)
  • Started adoption on 11/2022.
GA: Augusta VA Medical Center-Uptown (Augusta Uptown)
  • Started adoption on 12/2023.
HI: Spark M. Matsunaga Department of Veterans Affairs Medical Center (Honolulu)
  • Started adoption on 11/2024.
IA: Iowa City VA Medical Center (Iowa City, Iowa)
  • Started adoption on 11/2022.
ID: Boise VA Medical Center (Boise)
  • Started adoption on 10/2024.
IL: Jesse Brown Department of Veterans Affairs Medical Center (Chicago, Illinois)
  • Started adoption on 09/2022.
IN: Adam Benjamin Jr., Veterans' Administration Outpatient Clinic (Crown Point)
  • Started adoption on 09/2024.
IN: Marion VA Medical Center (Marion, Indiana)
  • Started adoption on 09/2023.
KY: Franklin R. Sousley Campus (Lexington Leestown)
  • Started adoption on 03/2024.
KY: Troy Bowling Campus (Lexington Cooper)
  • Started adoption on 10/2022.
LA: New Orleans VA Medical Center (New Orleans)
  • Started adoption on 06/2024.
MA: Hyannis VA Clinic (Hyannis)
  • Started adoption on 03/2024.
ME: Togus VA Medical Center (Togus)
  • Started adoption on 02/2022.
MI: Oscar G. Johnson Department of Veterans Affairs Medical Facility (Iron Mountain)
  • Started adoption on 06/2024.
MI: Saginaw VA Clinic (Saginaw Barnard Road)
  • Started adoption on 02/2023.
MO: Harry S. Truman Memorial Veterans' Hospital (Columbia, Missouri)
  • Started adoption on 03/2022.
MT: Fort Harrison VA Medical Center (Fort Harrison)
  • Started adoption on 12/2022.
NC: Charles George Department of Veterans Affairs Medical Center (Asheville)
  • Started adoption on 04/2024.
NC: Fayetteville VA Medical Center (Fayetteville, North Carolina)
  • Started adoption on 02/2023.
NC: Greenville VA Clinic (Greenville, North Carolina)
  • Started adoption on 08/2022.
NE: Omaha VA Clinic (Omaha Dorcas Street)
  • Started adoption on 06/2024.
NE: Omaha VA Medical Center (Omaha, Nebraska)
  • Started adoption on 10/2024.
NV: Reno East VA Clinic (Reno East)
  • Started adoption on 03/2024.
NY: Buffalo VA Medical Center (Buffalo, New York)
  • Started adoption on 02/2023.
NY: Syracuse VA Medical Center (Syracuse)
  • Started adoption on 09/2024.
OH: Akron VA Clinic (Akron)
  • Started adoption on 01/2022.
OH: Chalmers P. Wylie Veterans Outpatient Clinic (Columbus, Ohio)
  • Started adoption on 01/2024.
OH: Cincinnati VA Medical Center (Cincinnati, Ohio)
  • Started adoption on 12/2022, ended on 09/2023.
OH: Columbus VA Clinic (Columbus Airport Drive)
  • Started adoption on 12/2023.
OH: Lorain VA Clinic (Lorain)
  • Started adoption on 03/2023.
OH: Louis Stokes Cleveland Department of Veterans Affairs Medical Center (Cleveland, Ohio) OH: Parma VA Clinic (Parma)
  • Started adoption on 01/2022.
OH: Sandusky VA Clinic (Sandusky)
  • Started adoption on 04/2023.
PA: Butler VA Medical Center (Butler New Castle Road)
  • Started adoption on 04/2024.
PA: Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center (Philadelphia, Pennsylvania)
  • Started adoption on 09/2024.
PA: Philadelphia VA Domiciliary (Philadelphia Domiciliary)
  • Started adoption on 03/2024.
RI: Providence VA Medical Center (Providence)
  • Started adoption on 02/2024.
SD: Hot Springs VA Medical Center (Hot Springs, South Dakota)
  • Started adoption on 03/2023.
TN: James H. Quillen Department of Veterans Affairs Medical Center (Mountain Home, Tennessee)
  • Started adoption on 03/2023.
TX: Charles Wilson Department of Veterans Affairs Outpatient Clinic (Lufkin)
  • Started adoption on 04/2023.
TX: Michael E. DeBakey Department of Veterans Affairs Medical Center (Houston)
  • Started adoption on 03/2023.
TX: San Antonio-Southwest Military VA Clinic (San Antonio Southwest Military)
  • Started adoption on 09/2022.
UT: George E. Wahlen Department of Veterans Affairs Medical Center (Salt Lake City)
  • Started adoption on 09/2022.
WA: Mann-Grandstaff Department of Veterans Affairs Medical Center (Spokane, Washington)
  • Started adoption on 09/2022.
WV: Hershel "Woody" Williams VA Medical Center (Huntington, West Virginia)
  • Started adoption on 06/2024.
VISN 19 Clinical Resource Hub (Remote)
  • Started adoption on 09/2024.
VISN 20 Clinical Resource Hub (Remote)
  • Started adoption on 11/2022.

AL: Birmingham VA Medical Center (Birmingham, Alabama)
  • Started adoption on 06/2024.
AL: Central Alabama VA Medical Center-Tuskegee (Tuskegee)
  • Started adoption on 06/2024.
CA: San Francisco VA Medical Center (San Francisco)
  • Started adoption on 07/2024.
FL: Bradenton VA Clinic (Bradenton)
  • Started adoption on 03/2023.
FL: Pensacola VA Clinic (Pensacola)
  • Started adoption on 11/2022.
FL: Tampa VA Domiciliary (Tampa Domiciliary)
  • Started adoption on 05/2024.
FL: West Palm Beach VA Medical Center (West Palm Beach)
  • Started adoption on 12/2023.
GA: West Cobb County VA Clinic (West Cobb County)
  • Started adoption on 09/2023.
IL: Edward Hines Junior Hospital (Hines)
  • Started adoption on 06/2024.
KS: Captain Elwin Shopteese VA Clinic (Kansas City, Kansas)
  • Started adoption on 05/2024.
KS: Dwight D. Eisenhower Department of Veterans Affairs Medical Center (Leavenworth)
  • Started adoption on 06/2024.
KS: Robert J. Dole Department of Veterans Affairs Medical and Regional Office Center (Wichita)
  • Started adoption on 06/2024.
LA: Overton Brooks Veterans' Administration Medical Center (Shreveport)
  • Started adoption on 11/2023.
ME: Bangor VA Clinic (Bangor)
  • Started adoption on 11/2024.
MI: Ironwood VA Clinic (Ironwood)
  • Started adoption on 04/2024.
MN: St. Cloud VA Medical Center (St. Cloud)
  • Started adoption on 08/2024.
NC: W.G. (Bill) Hefner Salisbury Department of Veterans Affairs Medical Center (Salisbury)
  • Started adoption on 05/2024.
NM: Raymond G. Murphy Department of Veterans Affairs Medical Center (Albuquerque)
  • Started adoption on 06/2024.
NY: Castle Point VA Medical Center (Castle Point)
  • Started adoption on 12/2023.
OH: Dayton VA Medical Center (Dayton)
  • Started adoption on 01/2021.
OR: Portland VA Medical Center (Portland, Oregon)
  • Started adoption on 11/2026.
PA: Coatesville VA Medical Center (Coatesville)
  • Started adoption on 09/2024.
PA: Erie VA Medical Center (Erie)
  • Started adoption on 11/2023.
PA: Pittsburgh VA Medical Center-University Drive (Pittsburgh)
  • Started adoption on 11/2024.
PR: San Juan VA Medical Center (San Juan)
  • Started adoption on 11/2024.
TN: Nashville VA Medical Center (Nashville)
  • Started adoption on 03/2024.
UT: Cache Valley VA Clinic (Cache Valley)
  • Started adoption on 09/2022.
WA: American Lake VA Medical Center (American Lake)
  • Started adoption on 06/2024.
VISN 2 Clinical Resource Hub (Remote)
  • Started adoption on 09/2023.

OH: Chillicothe VA Medical Center (Chillicothe)
  • Started adoption on 02/2020, ended on 12/2021.
  • Lack of sufficient leadership/key stakeholder buy-in
VISN 4 Clinical Resource Hub (Remote)
  • Started adoption on 06/2022, ended on 07/2023.
  • Lack of sufficient leadership/key stakeholder buy-in

Implementation

Timeline

  • September 2022 - March 2025
    DSMT/ DSMES Needs assessment Template CPRS and CERNER-GENESIS for Dept of Defense
    DSMT/DSMES Group class Templated note CPRS and CERNER which will allow national clinical and behavioral outcome gathering.
    Continuous Glucose Monitoring (CGM) inclusion in curriculum with focus on competency training for clinicians.
  • September 2025
    Obtain correct reimbursement. Engage fiscal for VERA and also Third party when indicated. Of note TRICARE requires DSMES from ADA recognized programs for individuals to be issued CGM devices. Proper coding is essential. VERA support for multiprofessional codes G-0108 and G-0109 are still pending. This is a major barrier.
  • September 2023 - December 2024
    Class PDF's presentations are now 508 compliant. Class handbooks are also 508 compliant. These materials have been posted and are available to all. For those under the umbrella of this national program, an implementation handbook and also a facilitator guide will be issued along with access to CPRS templates or CERNER templates for documentation purposes. A national CPRS database build is currently in phase 2.

Departments

  • Diabetes
  • Education and training
  • Nursing services
  • Information technology
  • Finance department
  • Primary care
  • Nutrition, food, and dietary
  • Claims

Core Resources

Resource type Resource description
PEOPLE
  • A minimum of ONE CDCES with dual credential of RD, RDN, RN, PharmD, PsychD, MSW, MCHES, OT, PT, plus the CDCES
  • CAC
  • Fiscal
PROCESSES
  • Curriculum Review
TOOLS
  • Patient Moduiles (508 compliant) will be posted to the NFS internet.
  • Facilitator Guide (508 compliant) for Qualified instructional team members, access restricted internat under construction
  • Implementation Guide (508 compliant) for qualified instructional team members, access restricted intranet under development.
  • Virtual Class PDF files (508 compliant) posted to NFS and endocrine internet
  • Clinical and Behavioral outcome Collection using CPRS Template

Files

Optional Resources

Resource type Resource description
PEOPLE
  • Software engineer 1-hour weekly
  • Pharmacy Informaticist .
PROCESSES
  • CGM interface with CPRS and Cerner
  • Phoenix CPRS template with Database for Quarterly outcome pull
TOOLS
  • Tidepool - Software system integrating all glucose monitors and CGM for direct interface with CPRS

Support Resources

Resource type Resource description
TOOLS
  • 508 compliance expert

Risks and mitigations

Risk Mitigation
Lack of National Program Office The Joint VA DOD Diabetes Self-Management Training program remains in the pilot phase due to lack of administrative support. The collateral duties to maintain this program are extensive.

Contact

Comment

Comments and replies are disabled for retired innovations and non-VA users.

VA User (RN) posted

Are there documentation templates for each session? And how are f/u education sessions addressed to evaluate pt's success with goals?

VA User (NESSU Outpatient Registered Nurse) posted

links do not work

VA User posted

I'm confused. I have a vet who just asked me for this kind of help. Im in CT. Is it available... thanks (i'm a psychologist in ptsd clinic)

VA User (Dietitian) Innovation adopter posted

Iowa City VA

About

Origin story

Jenni Osborne from DCPH-P and Mary Julius from Veterans Health Administration (VHA or VA) completed renewal requirements for the American Diabetes Association recognition for the joint Virtual Diabetes Self-Management Training (DSMT) program through 2027. This recognition allows all VA and Department of Defense (DoD) /Defense Health Administration (DHA)comma ... Jenni Osborne from DCPH-P and Mary Julius from Veterans Health Administration (VHA or VA) completed renewal requirements for the American Diabetes Association recognition for the joint Virtual Diabetes Self-Management Training (DSMT) program through 2027. This recognition allows all VA and Department of Defense (DoD) /Defense Health Administration (DHA)commands to participate in standardized diabetes education. In the DoD, there are currently 8 fully successful commands and 22 in progress commands participating all over the world. Diabetes education is a “strong for” recommendation in the VA/DoD Diabetes Clinical Practice Guidelines for patients to self-manage their condition and prevent costly complications.

Original team

Mary M Julius, RD/N, LD, CDCES

VA/VHA Quality Co-Manager DSMT/DSMES

Jenni Osborne, MPH, MCHES, CDCES

DoD/DHA Quality Co- Project Manager DSMT/DSMES

Brian Burke, MD

VA/VHA Primary Care Physician - Diabetes Field Advisor, VA-DSMES Program Manager

Ret. CAPT. Paul Rockswold, MD

DoD/DHA -Diabetes Field Advisor, Epidemiologists, Statistician

Ellen Kilpatrick, MSEL, BSN, RN, CDCES

Nursing Liaison

Katherine Werner, PharmD, CDCES, VHA-CM

VA/VHA DSME/DSTE Pharmacy Liaison

Jamie Olsen, MS, RDN, CDCES

VA/VHA Dietitian, Education Program Specialist, Incoming DSMT Quality Manager

Jessica Taylor Spurrier, DNP, RN, CDCES

Nursing Liaison