An Evaluation of the Diabetes Conversation Map™ Program—Are Program Factors Associated with Health Outcomes and Health Care Utilization at 12 Months Post-Enrollment?

Background: The Diabetes Conversation Mapࡊ Program serves Clalit Health Services members with type 2 diabetes Mellitus (T2DM) for over 7 years, administered by over400 trained certified nurses. A formal evaluation of the programmatic factors of Mapࡊ has not yet been performed. Methods: This was a retrospective cohort study of 5,597 participants with T2DM who enrolled in the Map™ program between 1.1.2010 and 4.1.2015. Using Gamma and Poisson regression models and testing for hierarchical regression with random effects, we assessed the association between program factors (nurse instructor, enrollment year, and number of Map™ sessions attended), and outcomes (laboratory test results, adherence, and healthcare utilization) during a 12 month follow-up period. Results: Introducing the random effect of nurses who conducted the sessions yielded a low explained variance. Similarly, there were no significant differences in the outcomes across year of enrollment. However, Map™ participants who attended at least one session had on average a 2.1% reduction in HbA1c levels compared to those who enrolled but did not attend any sessions. Among participants who attended 1 session, the frequency of hospital admissions decreased by 55%, a decreased that did not change up to 4 sessions, compared to those who attended 0 sessions. There was no increased benefit in attending more than 4 sessions on frequency of hospital admissions within the follow-up period. The number of sessions was not associated with any other outcomes. Conclusions: Our results suggest that attending up to four sessions in the Map™ program is associated with improved HbA1c and decreased hospitalizations, and this does not vary by enrollment year or instructor. We suggest that nurses who instruct the Map™ program should try to improve participants' attendance to at least four sessions in order to maximize reductions in these two outcomes. Disclosure E. Srulovici: None. M. Leventer-Roberts: None. B. Curtis: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. X. He: None. A. Akriv: None. M.B. Hoshen: None. M. Rotem: None. I. Gofer: None. E. Shadmi: None. C. Key: None. N. Levin-Iaina: Employee; Self; Eli Lilly and Company. A. Strizek: None. B.S. Feldman: None.