WELCOME • Host: Dr. David Bang Public Health Advisor, CDC • Lead: Dr. Carolyn Jenkins Latonya Fisher REACH U.S. SEA-CEED • Topic: Diabetes self-management and other related clinical practices and delivery care systems.
Dec 30, 2015
WELCOME• Host: Dr. David Bang
Public Health Advisor, CDC• Lead: Dr. Carolyn Jenkins
Latonya Fisher
REACH U.S. SEA-CEED• Topic: Diabetes self-management and other
related clinical practices and delivery care systems.
• Host: Dr. David Bang
Public Health Advisor, CDC• Lead: Dr. Carolyn Jenkins
Latonya Fisher
REACH U.S. SEA-CEED• Topic: Diabetes self-management and other
related clinical practices and delivery care systems.
Session Plan
• Welcome and Ground Rules
• Brief REACH SEA-CEED overview
• Opportunity to hear from you (efforts, successes and challenges)
• Welcome and Ground Rules
• Brief REACH SEA-CEED overview
• Opportunity to hear from you (efforts, successes and challenges)
Do YOU have a STORY?
• What aspect of your work would be best served through a storytelling format?
• What audience would react best to the storytelling format?
• What storytelling formats are successfully being used by REACH awardees?
• What aspect of your work would be best served through a storytelling format?
• What audience would react best to the storytelling format?
• What storytelling formats are successfully being used by REACH awardees?
REACH U.S. SEA-CEEDREACH U.S. SEA-CEED
Racial/ethnic groups include:
• African Americans• American Indians &
Alaska natives• Asian Americans• Hispanics/Latinos• Native Hawaiians/Pacific
Islanders
Health Disparities are focused on:
• CVD• Diabetes• Infant Mortality• Breast & Cervical Cancer• AIDs/HIV• Adult Immunizations
Disparities for African Americans with Diabetes in Charleston and Georgetown
• Lower levels of:– Per capita income– Access to health care– Funding and insurance– Care and education– Satisfaction with care*– Medications and
continuing care– Treatment– Trust in health systems*
• Lower levels of:– Per capita income– Access to health care– Funding and insurance– Care and education– Satisfaction with care*– Medications and
continuing care– Treatment– Trust in health systems*
• Higher levels of:– Prevalence of diabetes– Complications including:
• Amputations
• Renal failure (dialysis)
• CVD
– EMS and ED use– Hospitalizations– Costs of care paid by client*– Deaths, especially CVD
• Higher levels of:– Prevalence of diabetes– Complications including:
• Amputations
• Renal failure (dialysis)
• CVD
– EMS and ED use– Hospitalizations– Costs of care paid by client*– Deaths, especially CVD
*All disparities were first identified through focus groups and validated with epidemiological or quantitative data except those with asterisk. For those with asterisk, quantitative data showed difference in outcome.
Action Team for Change • 4 Coalitions
• Diabetes Initiative of South Carolina
• REACH Partners Coalition
• 2 County Coalitions
• 85 partner organizations (SC DHEC, Statewide and Community Organizations, Neighborhood Groups, Health Care Systems, Greek Organizations, Faith-Based Groups, Public Libraries, Academic Institutions)
• 4 Coalitions
• Diabetes Initiative of South Carolina
• REACH Partners Coalition
• 2 County Coalitions
• 85 partner organizations (SC DHEC, Statewide and Community Organizations, Neighborhood Groups, Health Care Systems, Greek Organizations, Faith-Based Groups, Public Libraries, Academic Institutions)
REACH Charleston and Georgetown
Diabetes CoalitionTennessee
South Carolina
SC DHECRegion 6
GeorgetownDiabetes
CORE Group
St. James Santee Health
Center
Enterprise HealthCenter
Enterprise Community
Tri County Black
Nurses
MUSC, MUHAVA Medical CenterDiabetes InitiativeCollege of Nursing
Alpha KappaAlpha Sorority
Franklin C. FetterFamily
Health Center
Trident United Way
GeorgetownGeorgetown
North Carolina
Georgia
CharlestonCharleston
County Library
Statewide REACH home-basedin Columbia: Welvista SC DHEC SC DPCP
American Diabetes AssociationCarolina Center for Medical Excellence
TriCounty FamilyMinisteries
SC DHECRegion 7
County Library
East Cooper Community
OutreachS. SanteeSt. James
Senior Center
Our Coalition Goals• Improve diabetes care and education in 5 health
systems for >13,000 African Americans with diabetes.
• Improve access to diabetes care and self-management education, diabetes supplies and social services for people with diagnosed diabetes.
• Decrease health disparities for African Americans at risk and with diabetes.
• Increase community ownership and sustainability of program.
• Improve diabetes care and education in 5 health systems for >13,000 African Americans with diabetes.
• Improve access to diabetes care and self-management education, diabetes supplies and social services for people with diagnosed diabetes.
• Decrease health disparities for African Americans at risk and with diabetes.
• Increase community ownership and sustainability of program.
Community Actions Community-driven educational activities and
healthy learning environments where people live, worship, work, play, and seek health care.
Evidence-based health systems change using continuous quality improvement teams (CQI).
Coalition power built through collaboration, trust, and sound business planning and focused on systems, community, and policy change.
Community-driven educational activities and healthy learning environments where people live, worship, work, play, and seek health care.
Evidence-based health systems change using continuous quality improvement teams (CQI).
Coalition power built through collaboration, trust, and sound business planning and focused on systems, community, and policy change.
Methods for Collaboration• The health professionals/scientists determine
“science” or “evidence-base” for diabetes care.
• Community leaders/members determine “what, when, where, and how” to apply “science” or “evidence” in their community while generating evidence for community empowerment.
• Together we translate into skills for individual, organizational, systems, and community behavior change, advocacy, and policy change and we evaluate/report our results.
• The health professionals/scientists determine “science” or “evidence-base” for diabetes care.
• Community leaders/members determine “what, when, where, and how” to apply “science” or “evidence” in their community while generating evidence for community empowerment.
• Together we translate into skills for individual, organizational, systems, and community behavior change, advocacy, and policy change and we evaluate/report our results.
E.T. Anderson and J.M. McFarlane (2006)
Our Community Systems Wheel
External InfluencesExternal Influences
Evaluation Logic Model
CoalitionCoalition
Understanding Context, Causes, & Solutions for Health Disparity
CommunityAction Plan
Planning & Capacity Building
Targeted REACH Action
Existing Activities
Change Agents Change
Widespread Change in Risk/Protective
Behaviors
Reduced HealthDisparity
Community & Systems Change
OtherOtherOutcomesOutcomes
Changes within Organizations• Partners working together developed database to
collect health information (in their programs)
• Wellness programs (exercise/physical activity, cooking classes, screenings for glucose, A1C, BP, lipids, kidney function, foot problems) based in and sustained by the community
• Community gardens (four community in GT, 2 Chas., master gardener classes, and 4 in LPs)
• Media Awareness (Television, Radio, Billboards, bus placards, Banners)
• Partners working together developed database to collect health information (in their programs)
• Wellness programs (exercise/physical activity, cooking classes, screenings for glucose, A1C, BP, lipids, kidney function, foot problems) based in and sustained by the community
• Community gardens (four community in GT, 2 Chas., master gardener classes, and 4 in LPs)
• Media Awareness (Television, Radio, Billboards, bus placards, Banners)
Changes within County• Organizations have come into the community
(FQHC, Public Library, MH, Youth Org., Park & Rec.)
• Park & Rec. adding several activities sites in GT (workout, court, pool, tennis, daycare)
• GT county schools removal junk food & sodas from vending machines
• Local churches have changed foods served
• Organizations have come into the community (FQHC, Public Library, MH, Youth Org., Park & Rec.)
• Park & Rec. adding several activities sites in GT (workout, court, pool, tennis, daycare)
• GT county schools removal junk food & sodas from vending machines
• Local churches have changed foods served
Changes within Health Systems
• DSME classes and group visits
• Weight management classes
• CQI Teams
• Community Health Workers for community education and linkage to health systems
• Diabetes “PECS” (now EHRs)
• Continuous Quality Improvement Teams
• DSME classes and group visits
• Weight management classes
• CQI Teams
• Community Health Workers for community education and linkage to health systems
• Diabetes “PECS” (now EHRs)
• Continuous Quality Improvement Teams
Changes within Health Systems• 2 AADE certified sites• Mandatory attendance at DSME classes• Foot, shoe and wound clinics at sites• New transportation systems• New benefits bank to determine eligible services• Influenza vaccines regardless of ability to pay• Reduced payment for uninsured (some systems)• Expansion of clinic hours• Clinic based physical activity intervention
• 2 AADE certified sites• Mandatory attendance at DSME classes• Foot, shoe and wound clinics at sites• New transportation systems• New benefits bank to determine eligible services• Influenza vaccines regardless of ability to pay• Reduced payment for uninsured (some systems)• Expansion of clinic hours• Clinic based physical activity intervention
Changes in Health Professionals
• 10 new African American CDEs who trained with REACH (compared to 1 when REACH started)
• 10 new African American CDEs who trained with REACH (compared to 1 when REACH started)
Statewide change•Diabetes Advisory Council established the Guidelines for Diabetes Care
•Adopted in 9/2011 and updated in 3/2012
•Presented at the Diabetes Symposium September 2011, by MUSC President Dr. Greenburg
•“Diabetes Under the Dome”
•Diabetes Advisory Council established the Guidelines for Diabetes Care
•Adopted in 9/2011 and updated in 3/2012
•Presented at the Diabetes Symposium September 2011, by MUSC President Dr. Greenburg
•“Diabetes Under the Dome”
Policy Change
• Statewide Guidelines
• Law requiring DSME coverage (ERISA)
• PCMH and Care Coordination
• Foot Care Training for Nurses
• Statewide Guidelines
• Law requiring DSME coverage (ERISA)
• PCMH and Care Coordination
• Foot Care Training for Nurses
Change across States
• PCMH– Care Coordination training for provider
offices integrating SDOH.– Potential National Certification for Care
Coordination.
• PCMH– Care Coordination training for provider
offices integrating SDOH.– Potential National Certification for Care
Coordination.
The Community Chronic Care Conceptual Model REACH Charleston and Georgetown Diabetes Coalition
(Jenkins, Pope, Magwood et al., PCHP 4 (1): 73)
Community Resource Systems
Community Information System
Community & Service System
Design
Community Decision Support
Self-Management Support
Clinical Information System
Delivery System Design
Clinical Decision Support
Patient Self-Management
Support
Prepared, Proactive HealthSystems
Policies & Actions Social,
Health, &Economic
Informed, Activated Persons
External Environment, Resources, and Dissemination influences:
Prepared, Proactive Community
Systems
Improved Community-Wide Health Outcomes and Elimination of Health Disparities
Influences Influences
Health Care Provider Systems
Limitations
• Challenges– Health System in state of change– Time, funds and personnel changes– Contributions of external influences,
community by-in– Legislative support
• Challenges– Health System in state of change– Time, funds and personnel changes– Contributions of external influences,
community by-in– Legislative support
For additional information
Carolyn Jenkins, DrPH
e-mail: [email protected]
Phone: 843-792-4625
Carolyn Jenkins, DrPH
e-mail: [email protected]
Phone: 843-792-4625