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In searching for a computerized multimedia program to assist patients in managing diabetes, Cook County Ambulatory and Community Health Network in Illinois found what they were looking for in an AHRQ-supported research tool called "Living Well with Diabetes."

The multimedia application was integrated into Cook County's Care Improvement Collaborative-Strategies to Advance Rational Therapy (CIC-Start), a special Ambulatory Screening Clinic for patients with diabetes, hypertension, and no primary care physician. The computer-based intervention is designed to provide diabetes education to individuals who otherwise would be waiting in physicians' waiting rooms for many hours during the day.

Mohammad A. Khan, MD, Attending Physician for the Department of Medicine says, "We required the educational process to be of high quality and inexpensive. Our solution was to use [´óÏóAPPresearcher] Ben Gerber's program 'Living Well with Diabetes.' The software educational multimedia program has made a difference in patients 'buying in' to medical therapy and starting insulin."

"Living Well with Diabetes" is available in both English and Spanish and uses illustrations and animations that make it patient friendly. Testimonial videos provide real-world stories of barriers to diabetes self management, as well as offer potential solutions. Self-assessment questions are provided at the end of each section. Among the topics included are: what diabetes is; complications of the disease; the importance of exercise and diet changes; how to use insulin; and how to measure blood sugar at home.

CIC-Start uses a classroom setting in order to reach many patients. Groups of five or six patients gather around a computer with a volunteer to answer questions and steer them though the educational process. The volunteer teaches the patients to monitor their glucose, fasting blood sugar or A1C, and blood pressure. Khan continues, "This program is loved by all of our patients. It works well as an introduction to the subject and has the depth to keep them engaged. Our clients are able to relate to the people in the program. The language is simple and the messages are not judgment statements."

Follow-up visits are used to provide more diabetes education. Khan states, "We think that repetition is a key component of selling our message. This [software] program has helped us to do that in a constant and standard manner." Khan is currently collecting new data for quality improvement evaluation.

CIC-Start was created as a collaborative activity of the Fantus Clinics, Hypertension and Network Diabetes programs, Department of Medicine, and Collaborative Research Unit of John Stroger Hospital of Cook County. It attempts to apply a focused, systematic, and coordinated strategy to assist patients in managing diabetes as they access the health system in the Ambulatory Screening Clinic (ASC). The ASC has nearly 100,000 visits a year, with diabetes and hypertension the two top-ranking diagnoses.