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Measuring Rural Health Nutrition Outreach Outcomes

Measuring Rural Health Nutrition Outreach Outcomes. Katherine Smalley katherines@yvfwc.org Planning and Development Yakima Valley Farm Workers Clinics. Community/migrant health center system Clinics in WA and OR Served >124,000 patients CY2009 67% Hispanic 77% Below 100% FPL

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Measuring Rural Health Nutrition Outreach Outcomes

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  1. Measuring Rural Health Nutrition Outreach Outcomes Katherine Smalley katherines@yvfwc.org Planning and Development Yakima Valley Farm Workers Clinics

  2. Community/migrant health center system Clinics in WA and OR Served >124,000 patients CY2009 67% Hispanic 77% Below 100% FPL 12% of adults with Diabetes Yakima Valley Farm Workers Clinic YVFWC P&D Dept.

  3. RHNO Project -Yakima County Yakima County YVFWC P&D Dept.

  4. Yakima County, Washington State • YVFWC service base and administrative headquarters • Produces more apples, winter pears, hops, and mint than any other U.S. county YVFWC P&D Dept.

  5. Population of Yakima County • County population 239,054 (2009 est) • 41.4% Hispanic • 31.8% Language other than English (>5yr old) • Highest concentration of migrant/seasonal farm workers in Washington State • 75,149 m/sfw + family members (2009 est) YVFWC P&D Dept.

  6. RHNO Project - Lower Yakima Valley2006 - 2009 * * * YVFWC P&D Dept.

  7. RHNO Project Goals For Hispanic and rural populations with Diabetes, Obesity and other Nutrition-related conditions: • Reduce health disparities • Improve access to Self Management Education • Improve the quality of health services YVFWC P&D Dept.

  8. RHNO Activities • Registered Dietitian at GV Primary Care • Spanish-language Chronic Disease Self Management classes • Spanish Public Radio health programs • Community individual diabetes education • Quarterly Consortium meetings YVFWC P&D Dept.

  9. RHNO Consortium Members • Yakima Valley Memorial Hospital • Public Radio KDNA • Prosser Memorial Hospital • Yakima Valley Farm Workers Clinic YVFWC P&D Dept.

  10. Registered Dietitian Output Measures • Number of patients seen per year • Number of encounters per year • Attendance at Interdisciplinary meetings • Patient Hemoglobin A1c & Body Mass Index pre & post RD visit YVFWC P&D Dept.

  11. Self Management Education Output Measures • Participant Attendance • Pre and Post Survey • Physiological Measures • Model Fidelity • Participant Satisfaction YVFWC P&D Dept.

  12. Spanish Language Public Radio Output Measures • Number of Health-related programs • Number of PSA advertising CDSMP classes YVFWC P&D Dept.

  13. Individual Diabetes Education Output Measures • Number of clients served • Number of visits per client • Change in Hemoglobin A1c YVFWC P&D Dept.

  14. Consortium Function Output Measures • Quarterly Consortium meeting minutes • Quarterly Consortium Survey YVFWC P&D Dept.

  15. Helpful Data Collection Tips • Develop forms for collection (where possible use pre-existing forms or systems) • Train your data team • Budget for staff to collect & enter data • Schedule data compiling at least quarterly • Provide feedback to your team YVFWC P&D Dept.

  16. Example: Data Collection for Chronic Disease Self Management Classes

  17. Number of Classes Attended YVFWC P&D Dept.

  18. Challenges with Attendance • Inconsistent record keeping • Different Names • Retention Issues YVFWC P&D Dept.

  19. Pre and Post Survey • Attitude toward Diabetes • Self Care • Stages of Change YVFWC P&D Dept.

  20. Challenges with Pre-Post Survey • Length of Survey • Limited Literacy • Language Differences • Difficulty with Gradations of Agreement YVFWC P&D Dept.

  21. Gradations of Agreement • Strongly Agree, Agree, Neutral, Disagree, Strongly Disagree • Stair Step – Strongly Agree is Top Step Strongly Disagree is Bottom Step • Face Expressions <-> – Strongly Agree is Big Smile - Strongly Disagree is Big Frown YVFWC P&D Dept.

  22. Physiological Measures • Hemoglobin A1c • Body Mass Index YVFWC P&D Dept.

  23. Challenges with Physiological Measures • Pre-Electronic Medical Record inconsistent records • Patients’ financial limitations (↓labs) • Limited response from outside our clinic system YVFWC P&D Dept.

  24. Model Fidelity • Stanford Training of Master Trainers and Lay Leaders • Class Fidelity Checklist • Master Trainer Periodic Monitoring YVFWC P&D Dept.

  25. Class Fidelity Checklist YVFWC P&D Dept.

  26. Challenges with Model Fidelity • Inconsistent record keeping • Lack of feedback • Distant supervision YVFWC P&D Dept.

  27. Addressing Challenges • Project Coordinator at local level • Data Collection Training for all Lay Leaders • Consistent, timely feedback • Electronic Medical Records • Continuous Improvement (i.e. PDSA cycles) YVFWC P&D Dept.

  28. Noemi, a busy mom with 3 and 6 year old sons, says Tomando "has helped my family eat healthier – especially my kids.” Noemi says with the help of Tomando she feels better, no longer needs medication to control her Diabetes and has lost weight. "I learned a lot of things.  I learned about supporting one another, there are people going through the same thing I was going through.” YVFWC P&D Dept.

  29. Maria Benavides Nora Clemmons Rose Jasso Christina Muro Laurie Ozanich Sue Plaster Norma Renteria Joni Sobel Terri Trisler Connie Ayala Bertha Bustos Maria Carillo Lily Gonzalez Diana Lucero Grace Pablo Thelma Perches William Roller Raquel Sanchez KUDOS YVFWC P&D Dept.

  30. YVFWC P&D Dept.

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