Recruitment, Screening & Enrollment

1. Recruitment, Screening & Enrollment MT/WY SDPI Healthy Heart Project Consortia Fort Belknap Site

2. The MT/WY SDPI HH Project Consists of 3 Montana federally recognized Indian Reservations; Fort Belknap, Rocky Boy, and Crow Nations. Each site utilizes unique screening and recruitment methods because of their clinical care settings.

3. Site 1 Fort Belknap • Fort Belknap’s Health care system is an Indian Health Service ambulatory clinic.. Site 2 Rocky Boy • Chippewa Cree Health Care system is tribally operated under P.L. 106-260 Self-Governance Site 3 Crow Nations • Crow Nations Health Care system is an Indian Health Service Hospital

4. Diabetic Clinic has proven to be most effective in terms of recruitment, screening and enrollment. Diabetic Clinic is offered monthly to 15 pre selected diabetic patients.

5. Diabetic Clinic provides comprehensive diabetic health care to Indian people through service units which includes hospitals and clinics, preventive health and outreach to address patient needs . Annual Diabetic Wellness Appointment Foot Exam Nutrition Education Eye exam Dental Exam Immunizations Tobacco Counseling Diabetes Education Physical Fitness Education Healthy Heart Education/Recruitment & Consenting BH/MH Depression Screening

6. Prior to Diabetic Clinic

7. Diabetic Clinic patient selection • 1 month before; the Healthy Heart Case Manager performs chart review on 15 patients previously diagnosed with diabetes. Patients are selected from the RPMS Diabetes Management Masters list. • HH case Manager utilizes EHR and does lab referrals electronically to the Providers. Note: Case Manager can use EHR tabs to insert comments for additional services.

8. Provider makes lab orders • Health Care Provider assess the diabetics patients lab needs and make orders. • Required labs: Lipid Panel, A1C, AC Ratio, Fasting Blood Glucose, & Urinalysis • Note: Labs that are within dates of lab measure will not be reassessed.

9. Initial Notification, Verification of Labs & HH Consenting Interview • Patient is notified via telephone of Diabetic Clinic selection and lab collection needs (some patients may have labs drawn same day as clinic) • Patient is notified of the Healthy Heart Project and is asked if he/she would be interested in becoming a HH Participant. If Yes, Prepare recruitment packet.

10. Sample Diabetic Wellness appointment sheet • Sample Telephone Contacts made – January 25, 2011 • Fort Belknap Diabetic Wellness Clinic List • 2/8/2011 • NAME HRN DOB ADDRESS PHONE LABS NEEDED • Jane. Doe 001 12-24-52 12 Hopi Ave 353-2001 Lipid panel, A1C, creatinine, A/C Ratio, microalbumin • Jane. Doe 001 12-24-52 12 Hopi Ave 353-2001 Lipid panel, A1C, creatinine, A/C Ratio, microalbumin • Jane. Doe 001 12-24-52 12 Hopi Ave 353-2001 Lipid panel, A1C, creatinine, A/C Ratio, microalbumin • Joe Wellness 002 01-11-11 12 Blackbird Ave ----- Lipid panel, A1C, creatinine, A/C Ratio, microalbumin • Joe Wellness 002 01-11-11 12 Blackbird Ave ----- Lipid panel, A1C, creatinine, A/C Ratio, microalbumin • Joe Wellness 002 01-11-11 12 Blackbird Ave ----- Lipid panel, A1C, creatinine, A/C Ratio, microalbumin • Joe Wellness 002 01-11-11 12 Blackbird Ave ----- Lipid panel, A1C, creatinine, A/C Ratio, microalbumin • Joe Wellness 002 01-11-11 12 Blackbird Ave ----- Lipid panel, A1C, creatinine, A/C Ratio, microalbumin • Jane. Doe 001 12-24-52 12 Hopi Ave 353-2001 Lipid panel, A1C, creatinine, A/C Ratio, microalbumin • Jane. Doe 001 12-24-52 12 Hopi Ave 353-2001 Lipid panel, A1C, creatinine, A/C Ratio, microalbumin • Joe Wellness 002 01-11-11 12 Blackbird Ave ----- Lipid panel, A1C, creatinine, A/C Ratio, microalbumin • Joe Wellness 002 01-11-11 12 Blackbird Ave ----- Lipid panel, A1C, creatinine, A/C Ratio, microalbumin • Joe Wellness 002 01-11-11 12 Blackbird Ave ----- Lipid panel, A1C, creatinine, A/C Ratio, microalbumin • Add: New recruitment Left message at Home Number. • Add: New recruitment Will come in Tuesday morning before diabetic clinic – Fasting • ***Dr. MOORE • ***Dr. THOMAS-Diabetic Provider

11. Appointment Notification • Providers Nurse mails the Diabetic patient his/her Diabetic Appointment letter. • Diabetic Coordinator is responsible for Diabetic Wellness appointment sheet.

12. Clinic Setting - Diabetic ClinicDay of Diabetic Wellness Clinic

13. Care Model for DM Wellness Clinic Scan and Insert Bubble Model

14. Appointment List Patient Registration Clerk shares appointment list with Healthy Heart recruiter. Note: appointment list is shared with Healthy Heart recruiter or other persons that apply to make telephone contacts to the patients as a method for reminding patient to keep scheduled appointment.

15. ****** Confidential Patient Data by Privacy Act ****** 4:52PM HARELM HOSPITAL Feb 07, 2011 Appointment List for February 8, 20011 (Tuesday) Page: 1

16. Greetings and Registration • Patient is welcomed and guide to Clinic Registration office for appointment compliance with registration clerk. Insert picture of patient checking in with registration.

17. Diabetic Wellness Clinic Packet & Check list The patient is hand delivered a diabetic wellness education packet and Provider checklist. The folder contains IHS Standards of Care Type II Diabetes (March 2009 edition), Diabetes Education pamphlets, and the Healthy Heart Physical Examination Note: The patient is required to hand deliver and gain authorized signature from each encounter/station and return the sheet to the Healthy Heart Recruiter. HH PE is also collected at this point.

18. Diabetic Wellness Clinic Check List Thank you! Name: __________________________

19. Healthy Heart Physical Exam Form Page 1

20. Healthy Heart Physical Exam Form Page 2

21. Healthy Heart Physical Exam Form Page 3

22. Nursing Staff screens patient for vitals • Patient is screened for Blood Pressure, weight, height, and BMI

23. Diabetes Educator - DM Education JUMPSTART – Awareness Interview Diabetes Educator provides diabetes education. • Review of Labs (ie. A1C) • Review of Medications

24. Health Care Provider The Health Care Provider performs a 15 minute health care consultation with the patient and assesses the following; • Annual Diabetes Wellness Consultation – Review of lab measures, medication(s) & referrals for special needs • Healthy Heart PE and Clearance • Foot examination; Test sensation, Conduct a vascular assessment

25. Nutrition Education / JVN • Patient is given Diabetes Diet and Nutrition Education consultation for method of diet and weight control. • Joslin Vision Network (JVN) a retinal imaging device and clinical service to prevent blindness and vision loss for people with diabetes. Examinations can also be done by taking retinal photographs and having these read by experienced experts in this field. In-person exams are still necessary when the photos are unacceptable and for follow-up of detected abnormalities. This technology has its greatest potential in areas where qualified eye care professionals are not available. Results of eye examinations should be documented and transmitted to the referring health care professional. - IHS Standards of Care for Adults With Type 2 Diabetes

26. Diabetic Eye Exam Patients eye record is assessed and if a need is found (no appointment with in years period) a referral for appointment is made. To prevent the complications of retinopathy, cataracts, and glaucoma adults with diabetes should have a comprehensive dilated examination by an ophthalmologist or optometrist shortly after the diagnosis of diabetes. Re-examinations should be repeated annually. Examinations will be required more frequently if complications occur. - IHS Standards of Care for Adults With Type 2 Diabetes

27. Dental Appointment/Referral • Patients dental record is assessed and if a need is found (no appointment with in years period) a referral for appointment is made. All adults with diabetes should have an annual screen for periodontal disease and other oral pathology. Regular dental examinations provide opportunities for prevention, early detection, and treatment of periodontal disease. Regular dental cleaning has been shown to improve glycemic control in patients with poorly controlled diabetes. -IHS Standards of Care for Adults With Type 2 Diabetes

28. Immunizations (PHN) To provide services the PHN department Nursing staff observes the patients records with utilization of the Electronic Health Record system; if the patient has outdated immunizations or needs a flu shot the PHN nurse will give shots on the spot.

29. Physical Fitness Education Patients are given a 10 minute 1 on 1 or group education on stretching and exercise implement a150 minutes per week or to lose 7% weight loss from the baseline assessment weight measure. Note: At Fort Belknap Physical Fitness education is offered by the Tribal Physical Fitness Coordinator thru the SDPI Healthy Heart Project Staff and referral basis with Diabetes Prevention Program.

30. Healthy Heart Education, Recruitment & Consenting Healthy Heart staff collects the Healthy Heart Physical Exam Form, Diabetic Wellness Check List, and performs a PHQ-9 Depression Survey. If the patient agrees to a Healthy Heart Consenting; a 20 minute interview is performed. The HH Recruiter explains the consenting process and requests the patient to sign the following forms;

31. HH Brochure

32. HIPPAB

33. Consent Form

34. Registry Input FormPage 1

35. Registry Input FormPage 2

36. Registry Input FormPage 3

37. Registry Input FormPage 4

38. Registry Input FormPage 5

39. Registry Input FormPage 6

40. Registry Input FormPage 7

41. Registry Input FormPage 8

42. Registry Input FormPage 9

43. Registry Input FormPage 10

44. C2 Participant Questionnaire

45. Schedule the Patients 1st CVM Fort Belknap SDPI Healthy Heart Project RR 1, Box 66 Harlem, MT 59526 Phone : 406.673.3777 - Hays 406.353.8537 – Agency Dear ______________________________________, A monthly case management appointment has been scheduled for you on: Date: ___________________________ Time: __________________________ AM /PM Location: ________________________ Should this appointment date be of any inconvenience to you, please contact me at the number listed below. Thank you for participating in reducing your risk of cardiovascular disease associated health risks. I look forward to working close with you on a regular basis during you participation in the Healthy Heart Project. Sincerely, Ruth Burleigh, RN/BSN, MA SDPI Healthy Heart Project RN CDV Case Manager R.R. 1, Box 66 Harlem, MT 59526 CC: FILE

46. Transfer of Input Form into Electronic Excel Registry • Participants will be assigned a Participant ID • Helps provide you with a tool to document and organize patient information • Helps you track dates of screening, recruitment and enrollment • - Healthy Heart Head Quarters TOTW 10-20-10