Presentation to Secretary of Ministry of Health and Human Service of Marshall Island.

1. Final Report
Presenter : Ting-Wei Chang (Willie)
Supervisor : Ying-Ting Wang (Ingrid)

2. Outline
Screen and Prevent - Community Lifestyle Program
Home care - Home Visit Program
Treatment - NCD Clinic
Continuous
Care

3. Community Lifestyle Program

4. Community Lifestyle
Program
• Goal :
1. Awareness of Disease
2. Education
• Target :
1. March - Glorina’s Community
2. April - World Health Month

5. CLP Data
2016 2017 2018
Overweight (%) 24% 29% 28%
Obesity (%) 40% 53% 44%
Hypertension (%) 40% 29% 36%
Diabetes (%) 24% 25% 23%
Referal Rates 15% 18% 36%
Clinic Attendance Rates 66% 34% 23%
60-70%

6. Refer and Clinic Attendance

7. New Model
Community Partnership
2 Health Workers
Hypertension and
Diabetes Detection
Assistance of Clinic
Attendance
Walking Club
Taiwan Health Center
MOHHS
MALGOV

8. Berrack 4 Weeks Results
7 pounds loss in Champion
66.7% Clinic Attendance
119 person-time screen

9. Some Suggestions
• Public Health Centers
1. Vaccination
2. Mobile Clinic
3. Cancer Screen
4. DOTs for TB

10. Some Suggestions
• Expend the NCD Clinic
1. More clinic hours
2. More doctors, nurse
practitioners, nurses

11. NCD Clinic

12. Process
Registration Check Vital signs Doctors
AppointmentPharmacyMedical Supply
Laboratory
CDEMS

13. Medical Record
• Cover of Basic Information
1. Past History
2. Medication History
3. Allergy History
• Organize the chart
1. Lab result
2. Image and Pathology report

14. Some Shortages
Laboratory
HbA1c reagent - N/A
Forgotten Biopsy result
Medical Supply
Insulin Syringes
Patient Safety

15. Some Suggestions
Enhance Hospital Management
1. Adapt Hospital Information System
2. Storage Alarm
3. Establish Accountability
More Lateral Communication
1. Monthly or Seasonly Report in All Department
2. For Example : NCD Clinic Meeting

16. NCD Clinic Meetings
Participants
Doctors, Nurses, Medxes
Topics
1. Accurate pressure measurement
2. CDEMS data input
3. Expend Laura Clinic
Participants
Doctors, Nurses, Medxes
Labs and Medical supply
representative, Pharmacy
Topics
1. CDEMS Goals
2. Storage management
3. Service extension
4. Clinic Process improvement
5. Etc

17. Home Visit

18. Team Members
Doctor Nurse
Lab TechnicianCase Manager Foot Care
Diabetes Educator

19. What We Do
Nurse
Arrange Home Visit
Check Vital Signs
Doctor
Assessment
Prescription
DM Educator
Insulin Storage and Injection
Hypoglycemia
Lab Technician
Blood Draw
Foot Care
Foot Assessment
Case Manager
Continuous Follow Up

21. What I Saw
Vulnerable Patients
Amputated, Low income, Life dependent, High CV and CKD risk
EX : Mrs. S, 45 y/o female, one below knee amputated.
Lack of Transportation
Most of cases not included in MIDPO bus
Refill With Medication Bag
EX : Mrs. N, 68 y/o female, both legs below knee amputated.

22. Some Suggestions
Nurse Practitioners
Lead home visit team
Call doctors when seeing red flag signs
Case Manager
Discharge preparation
High CV and CKD risk patients follow up

23. Conclusion
Hospital
Clinic
Admission
PHC
Screening
Promote Policy
Case Manager
Home Visit Team
Continuous Care

24. Kommol Tata