![REACH Charleston and Georgetown Diabetes Coalition: Decreasing Disparities in Diabetes-Related Amputations ,[object Object],[object Object],[object Object],[object Object]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
Recommended
Recommended
More Related Content
What's hot
What's hot (20)
Viewers also liked
Viewers also liked (17)
Similar to 5 13-10 reach sea-ceed final
Similar to 5 13-10 reach sea-ceed final (20)
Recently uploaded
Recently uploaded (20)
5 13-10 reach sea-ceed final
- 1. Acknowledgements This project is funded by the REACH Charleston and Georgetown Diabetes Coalition CDC Grant/Cooperative Agreements U50/CCU422184 and 1U58DP001015 from the Centers for Disease Control and Prevention. Additional grant funding to document disparities related to ED and Hospitalizations from NIH NINR 1 R15 NR009486-01A1 The contents are solely the responsibility of the author and community partners and do not necessarily reflect the official views of the funding agencies.
- 3. “ If our nation is committed to the proposition that all people are created equal, our most basic indicators of life and death should reflect this principle. The continuing gap in health indicators undermines the vision of one America.” One America, President’s Initiative on Race (1997) Historic Context
- 4. REACH U.S Grantees (CEED and AC Communities) CEED Communities Action Communities City of Chicago, IL Brooklyn Perinatal Network, Inc, NY Health Visions Midwest, Inc, IN Eastern Band of Cherokee Indians, NC Community Health Councils, Inc, CA Choctaw Nation of Oklahoma, OK Special Service for Groups, CA Southeast Chicago Development Commission, IL Wai’anae District Comprehensive Health & Hospital Board, HI Los Angeles Biomedical Research Institute at Harbor-UCLA, CA Children’s Hospital Corps, MA YMCA of the Santa Clara Valley, CA YMCA of Greater Cleveland, OH ABOR, University of Arizona, AZ Intertribal Council of Michigan, Inc, MI, WI, MN, IN Seattle King County Department of Public Health, WA The Vernon J. Harris East End Community Health Center, VA To Our Children’s Future with Health, Inc., PA Northern Arapaho Tribe, WY Virginia Commonwealth University, VA West Virginia Dept. of Health and Human Services, WV Center for Community Health, Education & Research, MA The Mount Sinai School of Medicine, NY Medical University of South Carolina SC, GA, NC Khmer Health Advocates, Inc, CT, MA, IL, CA, OR, FL Public Health Institute, CA The Regents of the University of California, CA Genesee County Health Department, MI, WI, IL, MN, IN, OH University of Alabama at Birmingham, AL, AK, KY, LA, MS, TN Orange County Asian and Pacific Islander Community Alliance, CA Institute for Urban Family Health, NY Hidalgo Medical Services, NM Boston Public Health Commission, MA Morehouse School of Medicine, GA, NC, SC The University of Illinois at Chicago, IL University of Colorado at Denver and Health Sciences Center, CO, AZ, NM, SC, WA, AK Oklahoma State Department of Health, OK NYU School of Medicine, NY University of Hawaii HI, American Samoa, North Mariana Islands, Guam Micronesia, Palau, Marshal Islands Greater Lawrence Family Health Center, MA, Six New England States
- 9. The Community Chronic Care Conceptual Model REACH Charleston and Georgetown Diabetes Coalition (Jenkins, Pope, Magwood et al., PCHP 4 (1): 73)
- 12. REACH South Eastern African American CEED Chronic Care Model for Community Empowerment Community Resource Systems Community Information System Community & Services System Design Community Decision Support Self-Management Support Clinical Information System Delivery System Design Clinical Decision Support Patient Self-Management Support Prepared, Proactive Health Systems Policies & Actions Social, Health, & Economic Informed, Activated Persons External Environment, Resources, and Dissemination influences: Prepared, Proactive Community Systems Improved Community-Wide Health Outcomes and Elimination of Health Disparities Influence Influence Health Care Provider Systems
- 13. Evaluation Logic Model External Influences Coalition Understanding Context, Causes, & Solutions for Health Disparity Community Action Plan Planning & Capacity Building Targeted REACH Action Existing Activities Change Agents Change Widespread Change in Risk/Protective Behaviors Reduced Health Disparity Community & Systems Change Other Outcomes
- 14. REACH Charleston And Georgetown Diabetes Coalition’s Efforts to Decrease Diabetes-Related Amputations
- 21. Check Yourself to Protect Yourself Take Care of Our Feet A Lesson Plan, Kit of Materials, and Slide Series/Flip Chart for Lay Leaders REACH Charleston & Georgetown Counties Diabetes Coalition Ezekiel 37:10 “So I prophesied as he commanded me, and the breath came into them, and they lived, and stood up upon their feet, an exceeding great host.”
- 26. A Book on Diabetes Care and Management & Patient-Held Mini-Record (available on website www.musc.edu/reach)
- 27. Skill-Building for CHAs and Volunteers Neighborhood Walk and Talk Groups Individual and Group Education Sessions Community and Media Activities reached >45,000 African Americans Community Screening and Education Photos used with permission of clients and partners
- 30. We all work with political systems
- 31. Results
- 32. Awareness Foot Inspection Foot Care Purchasing Shoes Patient-Provider Interactions People with Diabetes Family/Community Health Providers Health Systems #/Timing of Visits Feet Exams Amputations
- 34. Figure 3: Annual Foot Exam b y Race and Gender Charleston and Georgetown Counties % of Patients
- 35. Charleston and Georgetown Counties LEA Rate per 1000 DM Hospitalizations Data Source: SC Hospital Discharge Data, Office of Research and Statistics Prepared by SCDHEC Office of Epidemiology and Evaluation
- 37. Note: release for photo
- 40. For additional information Carolyn Jenkins, DrPH e-mail: [email_address] Phone: 843-792-4625
Editor's Notes
- Thank you. It is an honor to share our work in decreasing disparities and health care costs for African Americans with diabetes.
- Multiple partners worked together to identify differences or disparities in diabetes self-management, health care, and outcomes. Our community is composed of 2 counties and covers about 1600 square miles. The population of African Americans in the two counties is >300,000 and more than 20% report that they have been diagnosed with diabetes.
- During the planning year (1999-2000), many health disparities were identified. We used qualitative and quantitative approaches and CBPR to identify the disparities.
- In the Year 1 planning period, we developed the coalition and enhanced our understanding of context, causes, and solutions for health disparities. Additionally, we built capacity for planning and developing our community action plan. As our targeted actions and existing activities are implemented, we examine community and systems change and change agents change, as well as changes in risk and protective behaviors. We examine changes in disparities as well as other outcomes in the context of the environment and external influences. Recently, we are examining the SDOH in our communities. In addition to the REACH model, we are using RE-AIM as an evaluation framework.
- The HADME program provided the preliminary data for obtaining CDC finding for our REACH Program to decrease disparities for African Americans with diabetes.
- We have several different aims focused on eliminating disparities for more than 1300 AA with diabetes. The two I will talk about today are focused on improving foot care and decreasing amputations.
- REACH activities were focused on: **Community skill-building **Health professionals training and education, and health systems change **Coalition building and policy change.
- REACH activities were focused on: **Community skill-building **Health professionals training and education, and health systems change **Coalition building and policy change.
- Lets look briefly at some of our methods and interventions.
- Our focus has been on community skill-building rather than importing others to do the work in communities. Thus, a major focus has been on training community members based on their identified needs.
- Nurses, especially those interested persons from the Tri-County Black Nurses Association, have participated in the Foot and Nail Care Review Course. The course is currently on DVD but was originally offered on site by the College of Nursing and Dr. Teresa Kelechi. There was actually a practice component in the course. One of the REACH nurses actually works collaboratively with those trained.
- We developed a lesson plan on Feet. The plan is available on the community table. It is divided into specific activities so the lesson can be done as a whole or one activity can be selected and offered in the community. Over 100 persons have been trained to deliver the lesson.
- The lesson objectives are listed here.
- One of the components is testing for loss of feeling and over 6,000 monofilaments have been distributed by pharmacies, other groups, and volunteers in the communities. Many persons with diabetes have done a return demonstration.
- The CHAs and volunteers provide outreach to the communities. The volunteers are the “Heart of the Community” and are so vital to the success of this program.
- Additionally, we have offered foot checks and ongoing DSMT classes in the community. On both a positive and negative side, the shoe sales persons have marketed special shoes, ALTHOUGH we teach that most can select regular shoes with care. We have expanded access to medications but find access to strips for monitoring is a major challenge.
- Together, we have developed MGTSD and a card for tracking diabetes care. Many health professionals scientists did not want to include sugar but about 45-50% still say “I got sugar.” so we use both terms but say if your HCP says you have sugar, then you have diabetes. In next month, we will have a new updated version of My Guide available on our website.
- Here are a few of our activities: Skill building activities such as learning about foot care and then teaching foot care to others. Neighborhood activity groups where we “walk and talk” are most popular. Many do not like to sit in a class Volunteer networks are growing and we now have Volunteer Health Ministers for Diabetes who work with hospitalized patients after discharge. Group and individual education sessions are becoming more popular, and Media messages are expanding our reach. This month we have messages on the area buses.
- And we focus on health systems changes using CQI.
- We have two active diabetes coalitions, one in each county that also work to improve diabetes. Their major activities are listed here. They raise funds to help with supplies for those unable to afford them.
- And we work with political and government systems to change health policies. In the past years we have linked reimbursement for diabetes education to minimal standards of care in South Carolina and we have a state funded diabetes initiative. This year our Health Department received several million to decrease disparities for diabetes.
- Lets look briefly at some of our data.
- For example, today Ms. Dilligard is 76 years old. She was a patient in a community hospital and her leg was to be amputated. A family member attended one of the foot care classes offered by a REACH community health advisor, and requested a second opinion from an MUSC physician, who “saved her leg.” She says, “I’ll show my leg to anybody.” She has scars, but she has her leg. She walks without assistance, and has a quality of life she almost lost… She got a referral…she got hope…she got quality care. Health information and advocacy, along with quality care, work well together.
- Yes, this is not a randomized control trial and it has many limitations, but there is no question. Our communities have changed.