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Diabetes Education Approaches for American IndianAlaska Native Populations

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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


1
Diabetes Education Approaches for American
Indian/Alaska NativePopulations
Nathan Peterson, MPH Utah Diabetes Prevention
Control Program www.health.utah.gov/diabetes
2
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
    diabetes?
  • 4) Percent of AI/AN with diabetes who have type 2
    diabetes?
  • 5) Average annual medical care cost for a person
    with diabetes?

3
Quiz Time
  • 3.3 million
  • 561
  • 16.3
  • 95
  • 13,243 (compared to 2,560 for a person without
    diabetes)
  • Source http//www.ihs.gov/MedicalPrograms/Diabete
    s/FactSheets/fs_index.asp

4
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
5
Utahs Five Federally Recognized Tribes
  • Goshute
  • Navajo
  • Shoshone
  • Paiute
  • Ute

6
(No Transcript)
7
Utahs Seven Tribal Governments
  • Confederated Tribes of the Goshute Reservation
    410
  • 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

8
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

9
Why the Utah DPCP Collaborates with Tribes
Age-Adjusted Percentage of Utahns with Diabetes
by Race/Ethnicity, 2001
10
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

11
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

12
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

13
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

14
Ideas for Innovation
  • Provide a patient registry to manage data and for
    quality improvement purposes
  • Offer data analysis from your best available data
    person
  • Establish agreements/contracts to identify a
    formal partnership and to facilitate data
    collection and evaluation, for basic or formal
    programs

15
Ideas for Innovation
  • Develop relationships with each tribe by making
  • in-person visits
  • Offer or coordinate as many free resources as
    possible
  • Implement elements of the Chronic Care Model for
    improving the measurement and performance of
    diabetes care

16
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
    programs
  • 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

17
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

18
Chronic Care Model Application
19
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

20
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

21
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

22
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 _______

23
Chronic Care Model Application
  • Decision Support (4)
  • Assure that providers have access to
    evidence-based guidelines
  • National DSME Standards case management
    interventions
  • Integrating specialist expertise and primary care
  • Using proven provider education methods
    (trainings and continuing diabetes education
    opportunities)
  • Sharing information with patients to encourage
    their participation

24
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
    setting)
  • How often is education provided at scheduled
    clinic appointments, clinic Diabetes Day, once
    a year, etc.

25
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
editions.
26
DSMEData Analysis
27
DSMEData Analysis
A1C Level
28
DSMEData Analysis
A1C Level
29
DSMEData Analysis
A1C Level
30
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
    organization
  • Certifying at the State level, where feasible
  • Contracts in place with three tribes to address
    health disparities

31
AI/AN Projects in Utah
  • Monthly continuing education program called the
    Diabetes Telehealth Program (http//health.utah.go
    v/diabetes/telehealth/telehealth.htm)
  • 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

32
AI/AN Projects in Utah
  • Formal data analysis agreement with the IHS
    program
  • Hypertension control initiative with the IHS
    program program integration project between
    Heart Disease Diabetes Programs
  • Language-specific resource.

33
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/
    diabetes/resourcesmain/multicultmanuals.htm)

Diabetes Ats77s Chiy11n Doo Hazh00 Choyoo98
da Bee _at_2h Dahaz3 (D77 47 1sh88h ikan ein7t9
dein77n7t66)
34
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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