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.