diabetes education approaches for american indian

1. Diabetes Education Approaches for American Indian/Alaska NativePopulations

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/Diabetes/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) Utah�s AI/AN population is very young, with almost half 45 years or younger Utah�s AI/AN children have the highest rate of poverty compared to Utah overall

5. Utah�s Five Federally Recognized Tribes Goshute Navajo Shoshone Paiute Ute

7. Utah�s 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

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 Let�s 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 member�s 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

26. DSMEData Analysis

27. DSMEData Analysis

28. DSMEData Analysis

29. DSMEData Analysis

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.gov/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)

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