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Eastern Coachella Valley Social Change Collaborative--Diabetes Task Force Programa Dulce del Valle

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					Eastern Coachella Valley Social Change Collaborative

Diabetes Task Force Programa Dulce del Valle
Presented by Diana Nancy A. De Leon, MPH Manager, Health Education Diabetes & Wellness Center Borrego Community Health Foundation
May 8, 2009

Eastern Coachella Valley Social Change Collaborative Diabetes Task Force
Members Borrego Community Health Foundation Department of Public Health, Riverside County Clinicas de Salud del Pueblo Poder Popular Braille Institute Program Technical Support •Inland Empire Health Plan •Project Dulce, Whittier Institute for Diabetes California Diabetes Program California Department of Public Health

The Need for Diabetes Interventions
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The California Diabetes Control Program estimates that 8.33% of Riverside County’s total population has been diagnosed with diabetes. The rate is 10.18% for Hispanics.

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Of Diabetics, 67% of Latinos are overweight, an 26% are obese
11.5% of all children in Riverside County are obese. The prevelance of overweight and obese children is much higher in the Eastern Coachella Valley.

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Children
Coachella Valley School District Enrollment
Elementary School enrollment = 10,487  Middle school enrollment = 2,645  High School enrollment = 4,891  Other school types = 180 Total = 18,203 96.6% of students are Hispanic 90.5% receive free or reduced cost meals 61.4% are English Learners
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Adult Population
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92% of the population is Hispanic 84% of the population speaks Spanish 47% speaks English “not well” or “not at all” 70% live at or below 200% of poverty 34% live 99% or below the poverty line Agriculture is the largest Employer 78% of farmworkers have incomes less than $15,000 per year 70% do not have health insurance

Goals
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Improve access to quality health care services for underserved individuals in the Eastern Coachella Valley (ECV) with Diabetes Provide a diabetes program using a common Standard of Care (American Diabetes Association) Use HRSA diabetes outcome measures to evaluate program success Adopt the Evidence based Project Dulce delivery model to ECV Improve the diabetes health status of residents of ECV Reach Children through families (Adults at risk for or diagnosed with Diabetes)

Methods
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Collaborative Community Outreach Team Approach to Medical Care Cultural and Linguistic Sensitivity Emphasis on Diabetes Education & Self Management Skills Group & Individual Visits Use of Promotoras (Community Health Educators) Shared Resources & New Collaborations Common Patient Data Registry Monthly Partnership Meetings

Funding
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Borrego Community Health Foundation and Riverside County Health Department took the lead on developing a grant proposal to support the collaborative project. Funding was received from
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IEHP – provides funding for clinic rotating team and promotoras California Wellness Foundation – supports the Diabetes & Wellness Center and Health Education staff In-kind staff by partners

Training & Support
Provided by Project Dulce Staff from the Whittier Institute for Diabetes, San Diego

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Site Visits for Needs Assessment Basics of Diabetes Training (April 08) Project Dulce/Peer Education Training Job Shadowing Professional Education Programs Site Visits for Observation and Feed Back Patient Education Materials, Class Curriculums

Activities
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Joint outreach: Health Fairs, Open Houses Core Team Rotation – Monthly between sites – Registered Nurse (RN), Registered Dietitian (RD), Medical Assistant, CDE Team Leader. Health Education: Peer Education Class Series, taught by Diana Nancy De León, M.P.H., provided at Borrego Clinics and various community locations. Group Medical Visits: Currently at Indio, planned for Coachella, Oasis and Clinicas De Salud in Mecca. Promotoras: Outreach, case management, health education Shared Resources: Retinopathy, podiatry, Braille Institute on site care for the vision impaired and blind; Orthopedic shoes for selected patients (in development).

Changing the delivery system of care: Implementing HRSA Chronic Disease Care Model

Sites

Shared Services Team
Open House at Indio

Clinical Care Process & Patient Management
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Key Measures: Via PECS Registry
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Diabetes: HgbA1C Cardiac: BP, use of ACE/ARB’s, use of statins, use of antithrombotic agents Prevention of diabetic complications:
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Comprehensive foot exams, referrals for retinol/dental exams, microalbuminuria screening, flu/pneumonia vaccinations, exercise and weight reduction, self management goal setting

QA Plan
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Patient Knowledge: Pre/Post Test Patient Satisfaction: Survey Provider Satisfaction: Survey Clinical Care Process & Patient Management: PECS Registry/Chart Review Self Management Behavior: Survey

Patient Management Indio Family Care
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Total Enrolled as of 3/19/09: 67 # Patients w/ 3 or more visits = 20 Average HgbA1C July 31, 2008 = 10.2 Average HgbA1C March 19, 2009 = 8.5 # Patients w/ 2 or more HgbA1C’s=12 # Patients w/ 2 or more HgbA1C’s that showed a decrease = 9

Patient Management Centro Medico Coachella
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Total Enrolled as of 3/19/09: 23 # Patients w/ 3 or more visits = 13 Average HgbA1C July 31, 2008 = 8.8 Average HgbA1C March 19, 2009 = 8.7 # Patients w/ 2 or more HgbA1C’s= 7 # Patients w/ 2 or more HgbA1C’s that showed a decrease = 0

Patient Management Centro Medico Oasis
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Total Enrolled as of 3/19/09: 11 # Patients w/ 3 or more visits = 1 Average HgbA1C July 31, 2008 = 9.9 Average HgbA1C March 19, 2009 = 8.3 # Patients w/ 2 or more HgbA1C’s= 2 # Patients w/ 2 or more HgbA1C’s that showed a decrease = 0

Health Education

Promotoras
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Create more effective linkages between communities and program. Trusted by community members Inspire confidence to participate in program Provide culturally appropriate health education and information Provide informal counseling and social support

Challenges
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Delay in Assembling rotating health care team Garnering provider and administrator support Scheduling Training in Project Dulce Model Sorting normal implementation issues PECS Registry: Lack of technical support, software not available at all sites Difficulty obtaining retinol screening, dental exam and podiatry services for patients due to cost or wait list for low income providers.

Outreach & Health Education Classes
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Outreach:
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Total # of events attended: 15 Total contacts made: 1116
Braille Institute: 9 classes, 38 attendees Yoga & Stress Management: 2 classes, 7 attendees Physical Activity: 2 class, 6 attendees

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Health Education Classes
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Diabetes Classes
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Class Series: 2 sessions, 42 attendees

Next Steps
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Expand # of Groups for Group Medical Visits at Indio Expand Group Medical Visit Services to all Clinics Continue collaborations to develop shared resources for retinol, dental, and podiatry services that are affordable and available for our patients

Key Contacts
Diana Nancy A. De Len, MPH, Manager, Health Education BCHF Diabetes & Wellness Program, 55557 Campus Rd., Thermal, CA 92274, (760) 262-6196 office, (760) 391-2477 cell, ddeleon@borregomedical.org Nancy Pealing, Executive Vice President, BCHF, (760) 767-5051, npealing@borregomedical.org Evangelina Romero, RN, Clinic Manager, Clinicas del Salud del Pueblo, (760) 396-1249, evangelianr@cdsdp.org Steven C. Shubert, Vice President Grants & Development, BCHF, (760) 574-5179, scshubert@borregomedical.org Debra Suess, RD, CDE, Supervising Nutritionist, Riverside County Health Department (760) 863-8265, dsuess@co.riverside.ca.us Anna Lisa Vargas, Poder Popular, Executive Director, (760) 398-8184, annalisa@poderpopularcv.org

Proyecto Dulce

¡Unidos Contra La Diabetes! Together Against Diabetes!

Clinicas Del Pueblo de Salud


				
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Lingjuan Ma Lingjuan Ma MS
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