Regionwide initiative to treat, reduce diabetes and hypertension is yielding results

Release date: 2/13/2015

Regionwide initiative to treat, reduce diabetes and hypertension is yielding results

NEW BRUNSWICK, N.J. – Saint Peter’s Healthcare System announced today that it has identified and enrolled more than 210 participants in its “patient-centered medical home” for high-need uninsured and  underinsured adults with diabetes mellitus and hypertension who reside in central New Jersey. Of those individuals, roughly 120 have completed their initial health assessments and have been fully educated in the care and treatment of diabetes and hypertension.

As a result, the Saint Peter’s initiative will shed its pilot status and be “fully implemented” on April 1. The Saint Peter’s effort to provide education and preventive care was launched on July 1 of last year as part of a $20.5 million state grant awarded under New Jersey’s Delivery System Reform Incentive Payment Program, or DSRIP, a component of the federal Affordable Care Act.

“The Saint Peter’s program is designed to result in better care for individuals  - including access to care, quality of care, and healthier outcomes - better health for the population, and lower costs by transitioning hospital funding to a model by which payment is contingent on achieving health-improvement goals and benchmarks,” said Lorraine Nelson, PhD, DSRIP program manager. “Judging by the results thus far, we are on pace to attain our goals for the region’s better health.”

Photo Caption:  Yolanda Jorge, an advanced practice nurse at Saint Peter’s Healthcare System’s Family Health Center on How Lane in New Brunswick,  listens to the heartbeat of Teodora Cisnero-Cajero of New Brunswick, a patient in the Saint Peter’s “patient-centered medical home” for high-need  uninsured and underinsured adults with diabetes and hypertension.

“The patient-centered medical home is a way of organizing primary care that emphasizes care coordination and communication,” said Margaret Drozd, RN, a family nurse practitioner and director of Community Mobile Health Services for Saint Peter’s. “Such a model enables us to transform primary care into ‘what patients want it to be.’ Medical homes in turn can lead to higher quality and lower costs, and can improve patients’ and providers’ experience of care.”

Patients are referred into the Saint Peter’s program via outpatient and inpatient services, the emergency department, same-day service locations, and community health screenings conducted by Saint Peter’s clinical staff. The program includes the use of multi-therapeutic outpatient evidence-based management, lifestyle modification, nutritional consultation, intensive hospital discharge planning, a dedicated patient navigation system, and improved social services.

“This highly targeted effort takes direct aim at two of the most serious but often preventable threats to human health today,” said Meena Murthy, MD, an endocrinologist and chief of the Division of Endocrinology, Nutrition and Metabolism at Saint Peter’s University Hospital. “Comprehensive community outreach is crucial if diabetes and hypertension are to be defeated.”  

Diabetes – especially if left untreated - can lead to heart disease, kidney disease, blindness, and nerve damage to nerves in the feet. Hypertension or high blood pressure, also known as “the silent killer,” is as an important risk factor for stroke but also contributes to the development and acceleration of many complications of diabetes. Those conditions include diabetic eye diseases and kidney disease. Most people with diabetes will develop hypertension during their lives.
 
“It is estimated that nearly 800,000 New Jersey residents are affected by diabetes and that nearly one-third of those people have no idea they have this very serious condition,” said Ronald C. Rak, JD, president and CEO of Saint Peter’s Healthcare System. “The preventive model of care we now can provide will result in larger numbers of those people living longer and healthier lives, while it will also lower hospital admissions and emergency room visits, improve the processes surrounding delivery of care, and result in a long-term reduction of healthcare costs.”

A $20.5 million five-year (2012-2017) state grant is funding the project. DSRIP is one component of the state’s Comprehensive Medicaid Waiver as approved by the Centers for Medicare and Medicaid Services.

A 2012 Community Health Needs Assessment study by Saint Peter’s Healthcare System and Robert Wood Johnson University Hospital, in tandem with a variety of community partners, demonstrated that diabetes and hypertension are two of the most prevalent health issues affecting the residents of central New Jersey. More than half (56.2 percent) of adults surveyed had been diagnosed with at least one chronic condition, and 30.8 percent had been diagnosed with high blood pressure. According to the assessment, diabetes is also more prevalent in communities with a noted concentration of Latino, African-American and South Asian individuals. Diet, obesity, age, disease, stress, and even smoking are believed to contribute to the onset of diabetes.

In addition, approximately one-quarter of residents in the survey reported at least one major barrier to desired care and more than half reported difficulty navigating the healthcare system.

“Saint Peter’s effort to educate the public about diabetes and hypertension, while coupling those lessons with preventive care, is the way of the future in medicine,” Drozd said. “The health care of yesterday was too often about treating advanced disease symptoms in a hospital setting. Tomorrow is about nipping disease in the bud before it can cost us both dollars and lives.”

About Saint Peter’s Healthcare System

Saint Peter’s Healthcare System Inc., parent company of the Saint Peter’s healthcare delivery system, is comprised of Saint Peter’s University Hospital, a 478-bed acute-care teaching hospital; Saint Peter’s Foundation, the fundraising arm of the hospital; and Saint Peter’s Health and Management Services Corp., which oversees the system’s outpatient facilities. These include the CARES Surgicenter; New Brunswick Cardiac Cath Lab; the Margaret McLaughlin McCarrick Care Center Inc., a residential skilled nursing facility in Somerset; the Saint Peter’s Comprehensive Care Group locations in Monroe and New Brunswick; Saint Peter’s Urgent Care Center in Skillman, and Saint Peter’s Adult Day Center in Monroe Township. Saint Peter’s Healthcare System is sponsored by the Roman Catholic Diocese of Metuchen. For more information about Saint Peter’s Healthcare System, please visit www.saintpetershcs.com or call 732-745-8600.