Download The College of Nursing`s Role in Decreasing Disparities for Diabetes

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.
Session Plan
• 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?
REACH 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:
–
–
–
–
–
–
• Higher 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*
– 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)
REACH Charleston and Georgetown
Diabetes Coalition
Tennessee
North Carolina
SC DHEC
Region 6
South Carolina
Statewide REACH home-based
in Columbia:
Georgetown
Diabetes
CORE Group
East Cooper
Community
Outreach
Enterprise Health
Center
Enterprise Community
Georgia
Georgetown
County
Library
 Welvista
 SC DHEC
 SC DPCP
 American Diabetes Association
Carolina Center for Medical Excellence
S. Santee
St. James
Senior Center
Tri County
Black
Nurses
St. James
Santee Health
Center
TriCounty Family
Ministeries
Alpha Kappa
Alpha Sorority
SC DHEC
Region 7
Charleston
County
Library
Trident United
Way
Franklin C. Fetter
Family
Health Center
MUSC, MUHA
VA Medical Center
Diabetes Initiative
College of Nursing
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 selfmanagement 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.
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.
Our Community Systems Wheel
Faith
Based
E.T. Anderson and J.M. McFarlane (2006)
Evaluation Logic Model
External Influences
Existing Activities
Understanding Context,
Causes, & Solutions
for Health Disparity
Coalition
Community
Action Plan
Targeted REACH
Action
Community &
Systems
Change
Change Agents
Change
Planning &
Capacity Building
Widespread Change
in Risk/Protective
Behaviors
Other
Outcomes
Reduced Health
Disparity
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)
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
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
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
Changes in Health
Professionals
• 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”
Policy Change
•
•
•
•
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.
The Community Chronic Care Conceptual Model
REACH Charleston and Georgetown Diabetes Coalition
External Environment, Resources, and
Dissemination influences:
Health Care Provider
Systems
Community Resource
Systems
Community
Information System
Prepared, Proactive
Community
Systems
Clinical
Information System
Informed,
Activated
Persons
Community &
Service System
Design
Influences
Community Decision
Support
Prepared, Proactive Health
Systems
Policies & Actions
Delivery System
Design
Influences
Social,
Health, &
Economic
Clinical Decision
Support
Self-Management
Support
Improved Community-Wide Health Outcomes and
Elimination of Health Disparities
Patient SelfManagement
Support
(Jenkins, Pope, Magwood et al., PCHP 4 (1): 73)
Limitations
• 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