3. Three Areas From the
Community Assessment
Wheel
0 1. Community Core
0 2. Education
0 3. Health and Social Services
4. 1. Community Core
0 The core of the community is its people: history,
values, characteristics and beliefs.
0 Essential data: Describes the people and boundaries
of your community.
5. 1. Community Core
Questions
0 What are the vital statistics of the community?
0 How has the population changed?
0 What is the ethnic distribution?
0 What is the income distribution?
0 What is the age distribution in Novi, MI?
0 What is the geographic distribution in Novi, MI?
0 What is the obesity rate in Oakland County?
6. What are the vital statistics of
the community?
0 Vital statistics are quantitative data concerning a
population, such as the number of births, marriages,
and deaths.
7. What are the vital statistics of
the community?
0 For population 15 years and over in Novi city:
0 Never married: 25.1%
0 Now married: 61.4%
0 Separated: 0.6%
0 Widowed: 4.3%
0 Divorced: 8.6%
8. How has the population of the
community changed?
0 Population, 2010
0 Novi 55,224
0 Michigan 9,883,640
0 Population, percent change, 2000 to 2010
0 Novi 16.5%
0 Michigan 0.6%
0 Population, 2000
0 Novi 47,386
0 Michigan 9,938,444
9. What is the ethnic
distribution in Novi, MI?
0 White alone - 39,228 (71.0%)
0 Asian alone - 8,756 (15.9%)
0 Black alone - 4,451 (8.1%)
0 Hispanic - 1,634 (3.0%)
0 Two or more races - 1,019
(1.8%)
0 American Indian alone - 96
(0.2%)
0 Other race alone - 38 (0.07%)
10. What is the income
distribution in Novi, MI?
In In
Nov
i MI
11. What is the income
distribution in Novi, MI?
0 In 2010, Novi High School had:
0 8% of students eligible for free or reduced price lunch
programs*
0 Michigan had:
0 41% of eligible students for free or reduced price lunch
programs*
*Eligibility for the National School Lunch Program is based on family income levels.
12. What is the age distribution in
Novi, MI?
0 Persons under 5 years, percent, 2010
0 Novi 5.8%
0 Michigan 6.0%
0 Persons under 18 years, percent, 2010
0 Novi 25.5%
0 Michigan 23.7%
0 Persons 65 years and over, percent, 2010
0 Novi 11.3%
0 Michigan 13.8%
13. What is the geographic
distribution in Novi, MI?
0 Persons per square mile, 2010
0 Novi 1,824.8
0 Michigan 174.8
0 Land area in square miles, 2010
0 Novi 30.26
0 Michigan 56,538.90
14. What is the obesity rate in
Oakland County?
0 Michigan's estimated 2007 total population is 10 million, with
approximately 7.6 million adults. Of those adults, 36% are
considered overweight and another 28% are considered obese,
according to 2007 Behavioral Risk Factor Surveillance System
data. Problems are also seen in factors related to obesity and
other chronic diseases.
0 One-in-five Michigan adults report no leisure time physical
activity in the past month.
0 Only 21% of adults report eating fruits and vegetables at least
five times a day.
0 The problem is not limited to adults alone. Over 16% of Michigan
youth (9th–12th grades) are overweight, and another are 12%
obese, according to 2007 Youth Risk Behavior Survey data.
15. 2. Education
0 The general educational status describes the
adequacy of education for the needs of the community
0 Essential data: Institutions, vocational skill needs.
16. 2. Education Questions
0 What are the education levels of adults of the
community?
0 What is the per pupil spending on education in Novi,
MI?
0 What is the teacher to student ratio in Novi, MI?
0 What is the test rating in Novi, MI?
0 What schools exist to Novi, MI?
17. What are the education levels
of adults of the community?
0 49% of Novi residents age 25 and older have a bachelor's or
advanced college degree
0 High school graduates, percent of persons age 25+, 2006-2010
0 Novi 95.8%
0 Michigan 88.0%
0 Bachelor's degree or higher, percent of persons age 25+, 2006-
2010
0 Novi 55.7%
0 Michigan 25.0%
18. What is the per pupil
spending on education in
Novi, MI?
0 The Novi spends $11,160 per pupil in current
expenditures
0 The district spends 64% on instruction, 32% on
support services, 3% on other elementary and
secondary expenditures.
19. What is the teacher to student
ratio?
0 In 2010, Novi High School had 17 students for every
full-time equivalent teacher.
21. What schools exist to Novi,
MI?
0 The Novi school district comprises 9 schools that
serves 6,295 students in grades PK-12
22. What schools exist to Novi,
MI?
0 Primary and secondary schools
0 Novi includes all or part of four public school districts
including:
0 Novi Community Schools
0 Northville Public Schools
0 South Lyon Community Schools
0 Walled Lake Consolidated School District.
0 Detroit Catholic Central High School
0 Franklin Road Christian School
0 Higher education
0 One of Walsh College's three campuses
0 The Art Institute of Michigan
0 South University
23. 3. Health and Social Services
0 Resources in the community for health and social
services
0 Essential data: Consider the structure (what types of
services), and the process (how accessible).
24. 3. Health and Social Services
Questions
0 How many hospitals are in the city of Novi?
0 How many home care facilities are in Novi, MI?
0 Who in the community are the informal health care
"consultants", offering advice, education, and
opinions?
0 How many full-service restaurants are in Oakland
County? How does this compare to the state of
Michigan?
0 How many grocery stores are in Oakland County?
25. How many hospitals are in
the city of Novi?
0
There isone hospital in Novi, MI. Providence Park
Hospital opened on September, 5th 2008
26. How many home care
facilities are in Novi, MI?
0 There are seven home care facilities in Novi, MI
0 Fox Run Home Health Agency
0 Caring Nurses of Michigan, Inc.
0 Briarwood Home Healthcare, Inc.
0 Advanced Home Health Care, Inc.
0 Erickson Retirement Communities Dba/foc Run Home
Health
0 Mercy Continuing Care
0 The Would Care Team
27. Who in the community are
the informal health care
"consultants", offering advice,
education, and opinions?
0 Informal health workers are found in every health
system, and the impact of their role increases as the
strength of the formal sector weakens. Informal
health workers who are not breaking any regulations
can be significant players in some communities and
deserve to be acknowledged, encouraged and
supported.
28. Who in the community are
the informal health care
"consultants", offering advice,
education, and opinions?
0 Political and other leaders in the community
0 Family members
0 Vendors acting as informal health workers
0 Markets
0 Media
32. Several factors in the
community assessment aid in
the prevalence of chronic
disease
33. Indicators/statistical information to show
how/why this is a problem
How many people are affected?
0 The Diabetes Burden Report was developed by the DPCP
using the latest diabetes data in Michigan which shows
that:
0 Diabetes affects 25.8 million Americans (8.3% of the
population) and an estimated 1.65 million Michigan citizens.
0 Pre-diabetes, a condition in which individuals have blood
glucose levels higher than normal but not high enough to be
classified as diabetes, affects 79 million Americans, including
2 million citizens in Michigan.
34. Wait…
How many people are That is A LOT of
people!!!
affected?
0Diabetes prevalence in Michigan has consistently
been higher than the nation as a whole. It is estimated
0701,000 Michigan adults have been diagnosed
with diabetes, and another 364,400 have
undiagnosed diabetes.
0Over 1 million adults in Michigan have
diabetes.
35. What contributes to or causes
this problem?
0 Diabetes affects some groups of people more than others
0 Certain racial/ethnic groups
0 People of certain age
0 People of certain socioeconomic status
0 Physically inactive people
0 Overweight people
0 Those with familial predisposition to the disease
36. Table 1. Prevalence of Diagnosed Diabetes by Demographic
Characteristics- Michigan, 2007-2009.
0 Diabetes affects some
groups of people more
than others:
0 Certain racial/ethnic
groups
0 People of certain age
0 People of certain
socioeconomic status
37. Referring to Table 1. Prevalence of Diagnosed Diabetes by
Demographic Characteristics- Michigan, 2007-2009.
Highest Prevalence by:
0 Age: 65+(22.3% + 19.1%)
0 Gender: Male (9.8%)
0 Race/Ethnicity: Black,
non-Hispanic (13.3%)
0 Household Income:
<20,000 (15%)
39. What is the ethnic
distribution in Novi, MI?
0 White alone - 39,228 (71.0%)
0 Asian alone - 8,756 (15.9%)
0 Black alone - 4,451 (8.1%)
0 Hispanic - 1,634 (3.0%)
0 Two or more races - 1,019
(1.8%)
0 American Indian alone - 96
(0.2%)
0 Other race alone - 38 (0.07%)
40. Narrowing down the factors by
comparing Novi to the State of Michigan
Is ethnicity a factor?
In
Nov
i
In Michigan
41. Narrowing down the factors by
comparing Novi to the State of Michigan
In
Is age a factor?
Nov
i
0 Persons 65 years and over,
percent, 2010
0 11.3% in Novi
0 13.8% in Michigan
In Michigan
42. Narrowing down the factors by comparing Novi to
the State of Michigan
Is household income a factor?
In Michigan
In
Nov
i
43. Diabetes in Oakland County
compared to Michigan
Oakland
County is
better than the
state… so what
is there to
worry about??
44. Age, income and ethnicity are
factors that increase risk of
diabetes. However, when
comparing Novi, MI to the
state you will see that these
factors are below the state.
45. The following methods can be used to get the
public opinion about the prevalence of
diabetes and its associating risk factors in
the community
0 A mixture of both qualitative and quantitative data
collection tools can be utilized:
0 Observation method
0 Census Data
0 Follow-up Interviews
46. With this particular issue what data collection methods would you use to get
public opinion about the problem and why? (Qualitative or Quantitative or a
mixture of both) Develop a data collection tool that contains at least 5 to 7
questions that you want/need to ask about this issue. Why are these questions
important?
0 A mixture of both qualitative and quantitative data
collection tools can be utilized:
0 Observation method
0 Census Data
0 Follow-up Interviews
48. Questions to be answered
using the observation method
0 What is the general lifestyle of people in the community?
0 Sedentary
0 Active
0 What methods of transportation does the community use?
0 Vehicles
0 Public transport
0 Walk
0 Bicycle
0 What healthy living choices are available?
0 Complete sidewalks?
0 Fruits and vegetables at school lunches?
0 Access to health care facilities?
50. Questions to be answered
using census data
0 How do you rank your socioeconomic status?
0 What is your occupation?
0 What is your work status in the past year?
52. Questions to be answered
using follow-up interviews
0 How do you feel about the communities view on
eliminating risk factors for diabetes?
0 If diagnosed with diabetes, have you been provided
with patient education for:
0 Review foot care?
0 Exercise goals?
0 Dietary goals?
53. So, what else could it be? Or, in
other words…
What are some barriers to solving
this problem?
0 Is this a risk factor issue?
0 Is this a priority issue and is it feasible to address?
0 Is there a lack of community interest?
0 Is there a lack of resources?
0 Is there a lack of information?
55. One more time:
What is the obesity rate in
Oakland County?
0 Of the adults in Michigan 36% are considered
overweight and another 28% are considered obese
0 One-in-five Michigan adults report no leisure time
physical activity in the past month.
0 Only 21% of adults report eating fruits and
vegetables at least five times a day
0 Over 16% of Michigan youth (9th–12th grades) are
overweight, and another are 12% obese
56. How are contributors to obesity
affecting the youth in Oakland
County?
0 Only 44% of the youth in these grade levels are
meeting current physical activity recommendation
levels.
0 Only 17% eat fruits and vegetables five or more times
a day
0 Almost 30% drink at least one non-diet soda each
day.
0 Approximately one third watch three or more hours
of television each day.
57. Is this a priority issue?
0Yes YES
YE
S
YES
YES
YES
58. Why is this a priority issue
and is it feasible to address?
0 Communities have the power to create change, to push for
funding and sources to promote health and to demand that
appropriate attention is given to the topics of their priority
0 During foodborne disease outbreaks, communities have
the power to force a recall of a suspected food item…
regardless of whether or not it caused the outbreak
0 If something is suspected to be a carcinogen, communities
can demand testing and even removal of that carcinogen…
even before its true effect is determined
0 …. It is definitely feasible
59. Is there a lack of community interest?
0 Possibly
0 At first glance one may assume there is a lack of
community interest
0 But the problem may be in the leadership method
0 Poor leadership may hinder a communities ability to
promote and create change
60. Is there a lack of resources and
information?
0 No. Resources are everywhere… but are they being
utilized?
61. No? Ok, then describe any
resources/assets in the
community that can help
provide solutions
63. Resources/assets in the
community that can help
provide solutions
0 Diabetes Partners in Action Coalition
0 DPAC is a partnership of individuals and representatives of
organizations who work to reduce the impact of diabetes
in Michigan.
0 DPAC Workgroups Include:
0 Advocacy and Public Policy
0 Communication and Public Awareness
0 Data, Research and Evaluation (DaRE)
0 Prevention
0 Training and Educations Programs
64. Resources/assets in the
community that can help
provide solutions
0 Diabetes Self-Management Education Certification
Program
0 To increase availability and improve the quality of diabetes self-
management education, the Michigan Department of Community
Health, Certification Program has developed review criteria,
based on national standards. The Certification Program staff
provide consultation services related to the standards and
certification process. Programs that meet criteria and are
certified are eligible for Medicaid reimbursement.
65. Resources/assets in the
community that can help
provide solutions
0 Diabetes Prevention Program
0 Michigan's Diabetes Prevention Program began in 2005 as
one of five state programs funded by the Centers for
Disease Control and Prevention's Division of Diabetes
Translation (DDT). Through the Michigan Diabetes
Prevention Program, public health programs have been
created with community partners to address pre-diabetes
and the primary prevention of type 2 diabetes.
66. Resources/assets in the
community that can help
provide solutions
0 Michigan Partners on the PATH
0 PATH (Personal Action Toward Health) is a chronic disease
self-management program that helps participants build the
skills they need for the day-to-day management of a
chronic disease. PATH is a six-week workshop and covers
topics including healthy eating, relaxation techniques,
problem solving and communication skills.
68. What impact is it having on the
community? Yikes!
0 Diabetes costs the United States $174 billion annually and
over $9 billion per year in Michigan.
0 If diabetes prevalence continues to grow at the same
pace, the economic burden of diagnosed diabetes
alone will double in size to $336 billion by 2034
0 Obesity also affects the state's economy. In Michigan,
the medical costs associated with adult obesity was
$2.9 billion in 2003.
69. What stakeholders would care about addressing
this issue? What resources do they offer to help
address the issue?
0 Healthcare providers
0 Insurance companies/payers
0 Public health officials
0 Michigan’s Nutrition, Physical Activity, and Obesity
Program (NPAO)
70. What stakeholders would care about
addressing this issue?
0 Healthcare providers
0 Providers are incentivized by getting more money per-
member-per-month (PMPM) from payers if the health of
their patients is above a certain measure
0 Healthcare providers have changed the way they
practice from tertiary prevention (i.e. treating an
already diagnosed disease) to first and secondary
prevention, in which they try to reduce risk factors and
health outcomes before they develop
71. What resources do healthcare
providers offer to help address the
issue?
0 Nutritional counseling
0 Referrals to appropriate weight control programs and
dieticians
0 Professional advice and education
72. What stakeholders would care about
addressing this issue?
0 Insurance companies
0 Insurance companies have now found benefit to keeping
patients healthy….
0 Healthy patients means less administration costs and
more profit for the company
0 Insurance companies want to avoid the cost of health
consequences that develop from risk factors
73. What resources do insurance
companies/payers providers offer
to help address the issue?
0 Incentives for providers to keep patients healthy
0 Require follow-up and diagnostic testing for early
detection and early response of risk factors and
disease
74. What stakeholders would care about
addressing this issue?
0 Public health officials
0 To fulfill their mission statement
0 Schneider (2011) defines the mission of public health as:
“the fulfillment of society’s interest in assuring the
conditions in which people can be healthy” and goes
further to explain that public health is “organized
community efforts aimed at the prevention of disease and
the promotion of health.”
75. What resources do public health
officials offer to help address the
issue?
0 Advocacy for Medicaid coverage of childhood obesity
0 Healthy food access in underserved areas
0 Safe routes to school
0 Complete streets (streets designed for all users,
including bicyclists and pedestrians)
76. What stakeholders would care about
addressing this issue?
0 Michigan’s Nutrition, Physical Activity, and Obesity
Program (NPAO)
0 This project combines federal and state dollars to assess
community environments and implement changes to
improve access to healthy foods and places for physical
activity while changing individual behaviors and
educating residents.
77. What resources do Michigan’s Nutrition,
Physical Activity, and Obesity Program
(NPAO)
offer to help address the issue?
0 Improvements to community gardens.
0 Walking trail construction and/or enhancements;
park enhancements and promotion.
0 School changes (mobile salad bars, adding healthy
options to lunch choices, and replacing vending
machine items with healthier options).
0 Increasing the fruit, vegetable, and low-fat dairy
options at area gas stations and convenience stores.
79. After completing your mini-report, discuss the
surprising things you learn about your community?
Were there things you found disturbing? What
were some positive aspects?
0 It is unfortunate that risk factors for such a
debilitating disease are so prevalent. In some cases,
familial genetics play a role in developing diabetes.
However, in many other cases there are risk factors
that could be eliminated through:
0 Close follow-up
0 Lifestyle changes
0 Attitude changes
0 Public policy
0 Community coalition organizations to promote healthy
living
80. After completing your mini-report, discuss the
surprising things you learn about your community?
Were there things you found disturbing? What
were some positive aspects?
0 I was pleased to find that the community I live in has a
lower prevalence for diabetes when compared to the state.
This, however, should be taken with a grain of salt.
Michigan has a very high rate of obesity, therefore, a better
measurement for the health of my community would be to
compare the health statistics with that of other states.
0 This statistic is very impressive/surprising and makes me
proud to live in such a well-educated community:
High school graduates, percent of persons age 25+, 2006-
2010
0 Novi 95.8%
http://www.education.com/schoolfinder/us/michigan/novi/novi-high-school/#test-scores Woodards, Shantee. " School district pushes $109 million bond ." The Detroit News . September 3, 2004. Metro 3D. Retrieved on April 29, 2011. "Northville Schools are seeing an additional 300 students a year as more homes are built in the area. The district encompasses all or parts of Northville and Novi, along with Northville Township, Salem Township and the city of South Lyon."
^ Woodards, Shantee. " School district pushes $109 million bond ." The Detroit News . September 3, 2004. Metro 3D. Retrieved on April 29, 2011. "Northville Schools are seeing an additional 300 students a year as more homes are built in the area. The district encompasses all or parts of Northville and Novi, along with Northville Township, Salem Township and the city of South Lyon."
----- Meeting Notes (8/16/12 14:36) ----- Clinical services at Providence Park Hospital include: Orthopaedic Surgery including hip and joint replacement, general surgery; Neurosciences including neurosurgery; Women’s and Pediatric services, and a wide range of other medical and surgical specialties. Providence Park also boasts a large and convenient outpatient center which houses outpatient surgery, endoscopy services, laboratory, imaging, and a sleep center as well as many physician subspecialties.
http://www.who.int/bulletin/volumes/84/2/editorial20206html/en/index.html Care is mostly provided by close family members who have no formal training in health care, though in some cases they may receive guidance from professional health visitors. Formal health visitors as a professional category should be rapidly expanded in order to provide needed support to the growing numbers of home-based informal caregivers.
http://www.who.int/bulletin/volumes/84/2/editorial20206html/en/index.html Care is mostly provided by close family members who have no formal training in health care, though in some cases they may receive guidance from professional health visitors. Formal health visitors as a professional category should be rapidly expanded in order to provide needed support to the growing numbers of home-based informal caregivers.
http://www.city-data.com/city/Novi-Michigan.html
http://www.city-data.com/city/Novi-Michigan.html
CDC Diabetes Program: Ann Albright Testimony to Congress July 1, 2010.
The Diabetes Burden Report and the Michigan Diabetes Action Plan 2011-2014 (2011). Michigan Department of Community Health.
Michigan Department of Community Health. Diabetes in Michigan 2010 – The Facts. Lansing, MI: Michigan Department of Community Health, Diabetes Prevention and Control, 2010. http://www.michigan.gov/documents/mdch/Diabetes_in_Michigan2010_331597_7.pdf
The Diabetes Burden Report and the Michigan Diabetes Action Plan 2011-2014 (2011). Michigan Department of Community Health.
Michigan Behavioral Risk Factor Surveillance System. Michigan Department of Community Health, Division of Genomics, Perinatal Health and Chronic Disease Epidemiology, Surveillance and Program Evaluation Section, Chronic Disease Epidemiology Unit. [Unpublished data]. Danaei G, Friedman AB, Oza S, Murray CJL, and Ezzati M. Diabetes prevalence and diagnosis in US states: analysis of health surveys. Population Health Metrics 7:16, 2009.
Michigan Behavioral Risk Factor Surveillance System. Michigan Department of Community Health, Division of Genomics, Perinatal Health and Chronic Disease Epidemiology, Surveillance and Program Evaluation Section, Chronic Disease Epidemiology Unit. [Unpublished data]. Danaei G, Friedman AB, Oza S, Murray CJL, and Ezzati M. Diabetes prevalence and diagnosis in US states: analysis of health surveys. Population Health Metrics 7:16, 2009.
http://www.city-data.com/city/Novi-Michigan.html
http://www.city-data.com/city/Novi-Michigan.html
Source: “Collecting Data: Deciding Which Approach Is Best.” In: Tools and Resources: Outcome Toolkit. Seattle: University of Washington IBEC (Information Behavior in Everyday Contexts). http://ibec.ischool.washington.edu/toolkitstep2a.php
Source: “Collecting Data: Deciding Which Approach Is Best.” In: Tools and Resources: Outcome Toolkit. Seattle: University of Washington IBEC (Information Behavior in Everyday Contexts). http://ibec.ischool.washington.edu/toolkitstep2a.php
Why are these questions important? These questions are essential and establishing the health needs of a community. Through assessment of a community through the observational method one is able to accurately assess the components of the health of a community. These questions assess the risk factors and contributing factors to disease.
Source: “Collecting Data: Deciding Which Approach Is Best.” In: Tools and Resources: Outcome Toolkit. Seattle: University of Washington IBEC (Information Behavior in Everyday Contexts). http://ibec.ischool.washington.edu/toolkitstep2a.php
Why are these questions important? This type of quantitative data is useful for collection of data that can be used to compared data in other states, counties or even in the same location at different times. A temporal comparison is useful to identify if a community has improved and the contrary over time.
Source: “Collecting Data: Deciding Which Approach Is Best.” In: Tools and Resources: Outcome Toolkit. Seattle: University of Washington IBEC (Information Behavior in Everyday Contexts). http://ibec.ischool.washington.edu/toolkitstep2a.php
Why are these questions important? Communities can benefit from such data collected from these interviews. Follow-up interview questions are always important for the assessment of effectiveness and efficiency of health measures. Information from this type of data collection method can be used to determine if health measures should be maintained, changed or eliminated.
2007 Behavioral Risk Factor Surveillance System data. 2007 Youth Risk Behavior Survey data
2007 Behavioral Risk Factor Surveillance System data. 2007 Youth Risk Behavior Survey data
Why or why not?
Schneider, Mary-Jane, PhD (2011). Introduction to Public Health. Massachusetts: Jones and Bartlett Publishers.
Good leadership is not only a factor when conducting a community assessment, but it is also important when bringing various groups together to work toward a common goal. To sustain the level of productivity necessary over time, requires an environment that supports innovation and collaboration, and where the leadership of the organization recognizes and reward this effort. Petersen, D.J. & Alexander G. R. (2001). Needs assessment in public health: A practical guide for students and professionals. New York, NY: Kluwer Academic/Plenum Publishers.
The Diabetes Burden Report and the Michigan Diabetes Action Plan 2011-2014 (2011). Michigan Department of Community Health.
The Diabetes Burden Report and the Michigan Diabetes Action Plan 2011-2014 (2011). Michigan Department of Community Health.
Why?
Schneider, Mary-Jane, PhD (2011). Introduction to Public Health. Massachusetts: Jones and Bartlett Publishers.
*Information adapted from diabetes registry at PrimeCare of Novi under the supervision and consent from Dr. Theodore Shively and Dr. Robert Zaid As a chronic care coordinator for a family practice comprised of three physicians, my goal is to reduce the number of patients on the diabetes registry through various methods. I work with a total of fifteen registries for this practice but for the purpose of this assessment, I will be analyzing data strictly for diabetes patients. Patients are placed on the diabetes registry if test results (HbA1c or random blood glucose) indicate abnormal levels. My attempts to reduce the number of people on this registry involves constant communication with the patients. I send registry letters, make follow-up visits and counsel diabetes patients in the office about appropriate methods for maintaining their blood glucose levels. I began this registry in February, 2012. On March 1 st ,192 patients met the criteria for placement on the registry. This is compared to 183 people on the registry 5 months later on August 1 st , 2012. This means that nine people were taken off of the registry. While improvements are seen throughout this data collection process, it would be naïve of the practice to assume that the reason for these improvements were solely based on our interventions. A confounding factor would be patients that left the practice… The total patients with a HbA1c of 7.0 or above in March was 66, compared to 64 in August, 2012. This means that two patients tested below a HbA1c of 7.0 which is a very good accomplishment for a patient with diabetes. This indicates that the practice is maintaining control over the blood sugars of their diabetes patients. As a method of determining the effectiveness of the registry letters, the number of letters that were sent to patients with a HbA1c of 7.0 or higher who have not been seen within 3 months was counted. This was 34 in March, 2012 and decreased to 23 in August, 2012. In other words, 11 people were seen who otherwise had not been seen within 3 months of their last appointment. Protocol in this practice requires diabetes patients be seen every three months to evaluate the disease. Confounding factors should be addressed. These factors may play a role in the findings and cannot be ruled out. For example, a patient may have already intended to come into the office for a visit, regardless of whether or not this letter was sent.
