WELCOME

1. 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.

2. Session Plan • Welcome and Ground Rules • Brief REACH SEA-CEED overview • Opportunity to hear from you (efforts, successes and challenges)

3. 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?

4. REACH U.S. SEA-CEED Racial/ethnic groups include: Health Disparities are focused on: • African Americans • American Indians & Alaska natives • Asian Americans • Hispanics/Latinos • Native Hawaiians/Pacific Islanders • CVD • Diabetes • Infant Mortality • Breast & Cervical Cancer • AIDs/HIV • Adult Immunizations

5. 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 Disparities for African Americans with Diabetes in Charleston and Georgetown *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.

6. 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) Action Team for Change

7. REACH Charleston and Georgetown Diabetes Coalition Tennessee SC DHEC Region 6 NorthCarolina SouthCarolina • Statewide REACH home-based • in Columbia: • Welvista • SC DHEC • SC DPCP • American Diabetes Association • Carolina Center for Medical Excellence County Library Georgetown Georgetown Diabetes CORE Group East Cooper Community Outreach S. Santee St. James Senior Center Enterprise Health Center Enterprise Community TriCounty Black Nurses Georgia St. James Santee Health Center TriCounty Family Ministeries Trident United Way Alpha Kappa Alpha Sorority SC DHEC Region 7 Franklin C. Fetter Family Health Center Charleston County Library MUSC, MUHA VA Medical Center Diabetes Initiative College of Nursing

8. 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.

9. 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.

10. 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.

11. Our Community Systems Wheel Faith Based E.T. Anderson and J.M. McFarlane (2006)

12. Evaluation Logic Model External Influences Existing Activities Understanding Context, Causes, & Solutions for Health Disparity Community Action Plan Targeted REACH Action Coalition Community & Systems Change Change Agents Change Planning & Capacity Building Widespread Change in Risk/Protective Behaviors Other Outcomes Reduced Health Disparity

13. 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)

14. 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

15. 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

16. 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

17. Changes in Health Professionals • 10 new African American CDEs who trained with REACH (compared to 1 when REACH started)

18. 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”

19. Policy Change • Statewide Guidelines • Law requiring DSME coverage (ERISA) • PCMH and Care Coordination • Foot Care Training for Nurses

20. Change across States • PCMH • Care Coordination training for provider offices integrating SDOH. • Potential National Certification for Care Coordination.

23. External Environment, Resources, and Dissemination influences: Health Care Provider Systems Community Resource Systems Prepared, Proactive Health Systems Community Information System Prepared, Proactive Community Systems Clinical Information System Informed, Activated Persons Community & Service System Design Delivery System Design Influences Influences Policies & Actions Social, Health, & Economic Community Decision Support Clinical Decision Support Patient Self-Management Support Self-Management Support Improved Community-Wide Health Outcomes and Elimination of Health Disparities The Community Chronic Care Conceptual Model REACH Charleston and Georgetown Diabetes Coalition (Jenkins, Pope, Magwood et al., PCHP 4 (1): 73)

24. Limitations • Challenges • Health System in state of change • Time, funds and personnel changes • Contributions of external influences, community by-in • Legislative support

25. For additional information Carolyn Jenkins, DrPH e-mail: jenkinsc@musc.edu Phone: 843-792-4625