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Diabetes Education Approaches for American IndianAlaska Native Populations


American Indian/Alaska Native. Populations. Nathan Peterson, MPH ... at scheduled clinic appointments, clinic 'Diabetes Day,' once a year, etc. ... – PowerPoint PPT presentation

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Title: Diabetes Education Approaches for American IndianAlaska Native Populations

Diabetes Education Approaches for American
Indian/Alaska NativePopulations
Nathan Peterson, MPH Utah Diabetes Prevention
Control Program www.health.utah.gov/diabetes
Quiz Time
  • 1) How many American Indians Alaska Natives
    (AI/AN) are in the U.S. (2007)?
  • 2) Number of Federally-recognized AI/AN Tribes?
  • 3) Percent of AI/AN adults who have diagnosed
  • 4) Percent of AI/AN with diabetes who have type 2
  • 5) Average annual medical care cost for a person
    with diabetes?

Quiz Time
  • 3.3 million
  • 561
  • 16.3
  • 95
  • 13,243 (compared to 2,560 for a person without
  • Source http//www.ihs.gov/MedicalPrograms/Diabete

Utah Tribal Facts
  • Salt Lake County has the largest number of AI/AN
    at 9,000 (largest urban area in Utah)
  • San Juan County has the second largest number of
    AI/AN at 8,000 (4 Corners Area)
  • Utahs AI/AN population is very young, with
    almost half 45 years or younger
  • Utahs AI/AN children have the highest rate of
    poverty compared to Utah overall

Approximately 33,000 American Indians live in
Utah, representing at least 35 tribes.
Source Utah Bureau of Indian Affairs, 2006
Utahs Five Federally Recognized Tribes
  • Goshute
  • Navajo
  • Shoshone
  • Paiute
  • Ute

(No Transcript)
Utahs Seven Tribal Governments
  • Confederated Tribes of the Goshute Reservation
  • Navajo Nation 8,100
  • Northwestern Band of Shoshone 460
  • Paiute Indian Tribe of Utah 840
  • Skull Valley Goshute Indians 125
  • Ute Tribe 3,100
  • Ute Mountain Ute (White Mesa Ute) 380

Utah Tribal Facts
  • I/T/U organization in Utah
  • One IHS program Ute Tribe
  • Six Tribal programs Goshute, Skull Valley,
    Shoshone, Paiute, Navajo, Ute Mountain Ute
  • One Urban program Indian Walk-In Center

Why the Utah DPCP Collaborates with Tribes
Age-Adjusted Percentage of Utahns with Diabetes
by Race/Ethnicity, 2001
Why the Utah DPCP Collaborates with Tribes
  • At the 2006 DDT Conference in Denver, it was
    recommended that DPCPs initiate or improve
    collaboration with AI/AN tribal organizations
  • Due to that call, we decided to improve our
    tribal partnerships and activities

Systems Change Approach
  • Implement comprehensive and basic diabetes
    education programs in AI/AN communities and
    tribal lands
  • Many tribal organizations lack funding and
    especially resources
  • State Diabetes Programs may be in a position to
    provide some resources for implementing new
    programs or improving current ones

Systems Change Approach
  • Components of a diabetes self-management
    education (DSME) program can include the
    following, among other methods
  • Population needs assessment
  • Patient/program forms
  • Curriculum
  • Patient education plan
  • Patient-defined goals and outcomes
  • Follow up plan
  • Continuous quality improvement plan

Ideas for Innovation
  • How can a State Diabetes Program support AI/AN
    diabetes education programs with innovative ideas
    and approaches?
  • Develop forms/policies in electronic format that
    conform with the National Standards for DSME
  • Provide a written curriculum with learning
    objectives covering the ADA content areas
  • Coordinate a needs assessment-driven training for
    healthcare staff

Ideas for Innovation
  • Provide a patient registry to manage data and for
    quality improvement purposes
  • Offer data analysis from your best available data
  • Establish agreements/contracts to identify a
    formal partnership and to facilitate data
    collection and evaluation, for basic or formal

Ideas for Innovation
  • Develop relationships with each tribe by making
  • in-person visits
  • Offer or coordinate as many free resources as
  • Implement elements of the Chronic Care Model for
    improving the measurement and performance of
    diabetes care

Ideas for Innovation
  • Even if tribes do not have resources for formal
    education programs (National Standards for DSME),
    they may still benefit from developing basic
  • Basic programs can still lead to improved patient
    outcomes by creating a structured program that
    addresses aspects of diabetes care with a focus
    on quality improvement

Chronic Care Model Application
  • The HRSA Health Disparities Collaboratives
    program uses the structure of the Chronic Care
    Model. This model identifies 6 major categories
    that must be addressed to achieve change
  • Health care organization
  • Community resources and policies
  • Self-management support
  • Decision support
  • Delivery system design
  • Clinical information systems

Chronic Care Model Application
Chronic Care Model Application
  • The Chronic Care Model (CCM) identifies the
    essential elements of a health care system that
    encourages high-quality chronic disease care
  • Evidence-based change concepts under each
    element, in combination, foster productive
    interactions between informed patients and
    prepared providers
  • In theory, the result is better health outcomes
    and a better diabetes education program
  • Lets apply it to our DSME concept

Chronic Care Model Application
  • Health Care Organization (1)
  • Administrative support for the DSME program
  • Organizational structure leading to the diabetes
    education program
  • Mission statement
  • DSME Program goals

Chronic Care Model Application
  • Community Resources and Policies (2)
  • Link with community programs and resources
  • Partnerships formed with community organizations
    to support interventions that fill gaps in needed
    services (i.e., smoking cessation for persons
    with diabetes)
  • Materials and resources to provide ongoing
    diabetes self-management support
  • Advocate for policies to improve patient care

Chronic Care Model Application
  • Self-Management Support (3)
  • To help patients acquire skills and confidence to
    self-manage their diabetes
  • DSME is at the heart of this CCM component
  • Strategies to strengthen SMS include
  • Assessment
  • Goal setting
  • Action planning
  • Problem solving
  • Follow up
  • Fill in the blank for other ideas _______

Chronic Care Model Application
  • Decision Support (4)
  • Assure that providers have access to
    evidence-based guidelines
  • National DSME Standards case management
  • Integrating specialist expertise and primary care
  • Using proven provider education methods
    (trainings and continuing diabetes education
  • Sharing information with patients to encourage
    their participation

Chronic Care Model Application
  • Delivery System Design (5)
  • Defines the care team (RN, RD, LPN, MA, etc.) and
    each members role
  • Where is the diabetes education being provided
    clinic, wellness program, pharmacy, at home, by
    phone, etc.
  • Is the program delivered in a culturally
    appropriate manner (staff, materials, office
  • How often is education provided at scheduled
    clinic appointments, clinic Diabetes Day, once
    a year, etc.

Chronic Care Model Application
  • Clinical Information Systems (6)
  • System change approach
  • Organizes patient and population data to
    facilitate efficient and effective care
  • Allows for the sharing of information to reduce
    errors and unnecessary procedures
  • Identify patients in need of diabetes services
    and treatments
  • Generate diabetes program performance reports
  • In Utah, we use CDEMS, DQCMS and Excel

Information on CCM drawn from www.healthdisparitie
s.net and AADE in Practice Fall 2007/Winter 2008
DSMEData Analysis
DSMEData Analysis
A1C Level
DSMEData Analysis
A1C Level
DSMEData Analysis
A1C Level
AI/AN Projects in Utah
  • Case management initiative with the urban program
    addressing the ABCs of diabetes care program
    integration project
  • Improving DSME programs with each tribal
  • Certifying at the State level, where feasible
  • Contracts in place with three tribes to address
    health disparities

AI/AN Projects in Utah
  • Monthly continuing education program called the
    Diabetes Telehealth Program (http//health.utah.go
  • Providing and installing free patient registries
    as a quality improvement strategy
  • Providing healthcare resources such as journals
    for providers, cultural-specific materials,
    donated meters
  • Trainings for Native American clinic support staff

AI/AN Projects in Utah
  • Formal data analysis agreement with the IHS
  • Hypertension control initiative with the IHS
    program program integration project between
    Heart Disease Diabetes Programs
  • Language-specific resource.

Navajo Language Resource
  • In April 2008, we partnered with a Navajo tribal
    member in Shiprock, NM to develop a basic
    diabetes education manual in Navajo
  • Audio version is planned to address literacy
    challenges and needs
  • Will soon be available at (http//health.utah.gov/

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Contact Information
  • Utah Department of Health
  • Diabetes Prevention Control Program
  • www.health.utah.gov/diabetes
  • Nathan Peterson, MPH
  • nathanpeterson_at_utah.gov
  • (801) 538-6248
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