MedStar Health Research Evaluates Diabetes Survival Skills Education for Behavioral Health Inpatients

Researchers from across MedStar Health sought to adapt Diabetes to Go (D2Go), a diabetes survival skills education (DSSE) program for delivery on inpatient behavioral health units (BHU) and to evaluate the feasibility of implementing D2Go-BHU within nursing unit workflow. “Diabetes Education for Behavioral Health Inpatients: Challenges and Opportunities” was published in the Journal of the American Psychiatric Nurses Association. The study assessed the need for diabetes survival skills education to help patients with self-care during their transition from the hospital.

The study team used the practical robust implementation and sustainability model implementation science framework to conduct the research. There were 1989 patient admissions observed, among which 264 were discharged with a diagnosis of type 2 diabetes. Interviews, focus groups and feedback were provided from support staff and nurses to design various adaptations for the D2Go-BHU program. Adaptions to the program included (a) delivering education through facilitated group learning sessions, (b) providing paper surveys and a hard copy D2Go survival skills education booklet, (c) and developing videos which were delivered using a secure DVD versus a tablet.

During the study period, two psychiatry behavioral health units conducted a total of 9 group sessions. The primary diagnosis at hospital discharge was obtained for 29 patients and included suicide attempt (n = 10; 35%), depression (n = 7; 24%), schizophrenia (n = 5; 17%), psychosis (n = 7; 17%), bipolar (n = 3; 10%), posttraumatic stress disorder (n = 1; 3%), delusion (n = 1; 3%), homicidal (n = 1;3%), and other (n = 2; 7%). After completing assessment surveys, the results showed that those with diabetes had lower ASK12 scores compared with those without diabetes. Persons with diabetes answered most items related to what to eat correctly, but less than 33% correctly answered items related to target blood glucose (BG) after a meal, need for checking BG, symptoms of high BG, and where to store oral medicines.

The study team identified multiple barriers to implementation including lack of standardization of education content by nurse facilitators and difficulty engaging patients for the time required for completion of surveys plus group education. Both nurses and patients preferred a book as it relates to educational materials.  Further research would be needed to determine if individual diabetes education alone or a model which combines individual and group sessions is preferable for this population.

The team included Joan K. Bardsley MBA, RN, CDE, FAADE, from MedStar Health Research Institute, Michelle F. Magee, MD, from MedStar Diabetes Institute and Georgetown University; Kelly M. Baker, MA, and Kelly M. Smith, Msc, PhD, from MedStar Institute for Quality and Safety.

The study was funded by the National Institutes of Health, National Institute for Diabetes, Digestive, and Kidney Diseases (Grant Number R34-DK-109503).

Journal of the American Psychiatric Nurses Association, DOI: 10.1177/1078390319878781