California Area Diabetes Surveillance Project

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					California Area Data Improvement
                                                                              P ROJECT U PDATE
                                      September 25, 2000                      F ALL 2 0 0 0
                                                                               In 1997, Congress allo-       This project, called the Cali-
                                                                             cated an additional appro-      fornia Area Diabetes Sur-           ing opportunities to en-
                                                                             priation to Indian Health       veillance Project (CADSP),          sure adequate data col-
                                                                             Service (IHS) to help Indian    began March 1, 1999. Ad-            lection and diabetes sur-
                                                                             Health care programs ad-        ditional funding has been           veillance;
                                                                             dress the increasing epi-       obtained by the California
                                                                             demic of diabetes. Because      Endowment Foundation and         3) To analyze incidence and
                                                                             of concern about the quality    allowed the Project to ex-          prevalence data to deter-
                                                                             of health data, IHS ear-        pand services to an addi-           mine rates of diabetes;
                                                                             marked a portion of the         tional 34 sites for a total of   4) To identify site goals and
                                                                             new diabetes funds for data     66 sites. These sites are           objectives to ensure sus-
                                                                             improvement.                    currently working to estab-
                                                  California Area Diabetes

                                                                                                                                                 tainability of the tracking
                                                                                                             lish effective diabetes track-
                                                                                In 1998, the Northwest                                           system.
THE NORTHWEST PORTLAND AREA INDIAN HEALTH BOARD




                                                                                                             ing systems for California
                                                                             Portland Area Indian Health
                                                                                                             communities.
                                                                             Board (NPAIHB) was
                                                                             awarded a competitive              Paralleling strategies de-     The Changing Needs of the Data
                                                                             grant from the California       veloped by the Northwest                 Improvement Project
                                                                             Area Indian Health Service                                       Year 1
                                                                                                             Tribal Diabetes Surveillance          Data Improvement
                                                                             to assist 32 California Area    Project, CADSP includes               many Sites began
                                                                             Indian health care sites: (1)   four primary objectives:
                                                  Surveillance Project



                                                                                                                                                   from scratch)
                                                                             improve the accuracy of
                                                                             health data for diabetes and    1) To assess program ca-             Year 2
                                                                             associated complications,          pacity for diagnosing               Clinical Improvement
                                                                             and (2) build sustainable          and monitoring diabetes;              through the local use of
                                                                                                                                                      the data
                                                                             infrastructure to monitor       2) To provide training, as-
                                                                             and track diabetes and as-         sistance, and skill build-             Year 3
                                                                             sociated complications.                                                   Shifting the focus to early
                                                                                                                                                       detection and prevention


                                                                              Benefit to the Tribes
                                                                                 Through a combina-           ties, (2) identify pre-          lined by CADSP, this in-
                                                                               tion of on-site assess-        vention opportunities            formation will soon be
                                                                               ments, intensive techni-       for the onset of associ-         available.
                                                                               cal assistance, com-           ated complications of
                                                                               puter software training,       diabetes (3) generate
                                                                               and interactive work-          information for grants
                                                                               shops, CADSP has pro-          and funding submis-
                                                                               duced far more than a          sions, (4) generate a
                                                                                                                                                     INSIDE THIS ISSUE:
                                                                               “snapshot” of diabetes         better idea of the cur-
                                                                               prevalence. CADSP has          rent health status of           Staff Introductions         2
                                                                               begun the process of           the particular commu-           Why Diabetes Data           3
                                                                               building a sustainable         nity 5) estimate the
                                                                               infrastructure among           long term health trend          Data Tracking Elements      3
                                                                               California Area Indian         of the particular com-
                                                                                                                                              Upcoming CADSP              3
                                                                               health care sites to           munity.
                                                                               manage, monitor, and              Currently this infor-
                                                                                                                                              Year 1 Data From            4
                                                                               track diabetes. Im-            mation is not available
                                                                                                                                              CADSP
                                                                               proving this capacity          and these assessments
                                                                               will allow the for Cali-       are not currently possi-        Contact Information         4
                                                                               fornia AI/AN tribes to:        ble. However, by col-
                                                                               (1) identify diabetes          lecting information out-
                                                                               prevention opportuni-
Staff Introductions
  Project Director
                                      As the Project Director, I have                     While my office is located in
                                    had the great pleasure of working                   Portland, Oregon at the Northwest
                                    with the tribes of California since                 Portland Area Indian Health Board,
                                    March 1999. Prior to working on                     I travel to California almost weekly
                                    the Project, I was the Principal                    to work with the California tribes
                                    Investigator for a nationally                       for improved data on diabetes.
                                    based project designed to evalu-                      I am grateful to have this oppor-
                                    ate the accuracy of RPMS and to                     tunity, and I look forward to con-
                                    determine its ability to describe                   tinuing this relationship and dis-
                                    health conditions among AI/AN                       covering new opportunities to op-
                                    communities (www.npaihb.org                         timize the health of AI/AN commu-
         Kelly Gonzales, MPH        for project results). In 1998 I                     nities.
           Project Director         was one of eight women selected                             kgonzales@npaihb.org
                                    to participate in the Native
                                    Women Cancer Research Fello w-
                                    ship Program.


    Northern Regional Diabetes Project Specialist
                                       My name is Steve Viramontes,                     I have always had a strong in-
                                     and I am the new Northern Re-                    terest in developing health care
                                     gional Project Specialist. I                     databases to be used to improve
                                     started working for CADSP in                     health care delivery systems to
                                     April 2000. In this position I am                Native American People. Working
                                     working directly with tribes to es-              for CADSP gives me the opportu-
                                     tablish sustainable diabetes track-              nity to expand this interest and to
                                     ing systems. This involves mak-                  work with tribes in discovering
                                     ing site visits and traveling.                   ways to effectively tackle the im -
                                      I have been a Public Health                     pact on AI/AN communities
                                     Nurse for over 15 years and have                 caused by the increasing rates of
               Steve Viramontes      spent 10 of those years working                  diabetes and associated complic a-
              Northern Specialist
                                     for Indian Health Clinics in North-              tions.
                                     ern California.
                                                                                             sviramonetes@npaihb.org

    Central Regional Diabetes Project Specialist
                                       I am the new Cemtral Regional Pro-               having worked with several
                                     ject Specialist, and I began with the              Indian communities, I have first
                                     Project in June 2000. I too am work-               hand knowledge of the burden of
                                     ing directly with the tribes, setting up           diabetes.
                                     systems to track accurate health data.               Working with CADSP will give me
                                       Since completing my dietetic intern-             the chance to bring together my
                                     ship in 1994, I have worked in a vari-             knowledge of diabetes care and liv-
                                     ety of Indian health care settings.                ing and working in Indian communi-
                                       Being a member of the Hoopa Valley               ties.
                 Glenna Starritt
                                     Tribe in Northern California, and                          gstarritt@npaihb.org
               Central Specialist


Page 2                                                            C A L I F O R N I A A R E A D I A BE T E S S U R V E I L L A N C E P R O J E C T
Why Diabetes Data?
  CADSP has chosen to track specific    The importance of the Onset and                    Why Diabetes Data?
data elements to describe the bur-                  Diagnosis Date                 There are four questions you could
den of diabetes in California. The        This information is important to es-     ask yourself about the information
data elements are grouped into          tablish baseline data in order to de-      currently available to describe diabe-
three categories and include: (1)       termine future rates for diabetes and      tes within your community and
diagnosis and onset date, (2) diabe-    associated complications. This infor-      throughout other California AI/AN
tes complications and diagnosis         mation helps identify both the cur-        communities.
date, and (3) standards of care.        rent health status and the future
  These items were selected because     trend in diabetes of the communities.      1.) Do you know the current rate of
they overlap with either the data       In a sense, this information helps us           diabetes within your community or
elements collected for the GPRA         to understand better the need for re-           is this information available?
health indicators, the Annual IHS       sources, funding, and diabetes pre-        2.) If yes, does this rate describe the
Diabetes Audit, or the requirements     vention projects for California AI/AN           true picture of diabetes within your
for reporting on the Special Diabetes   communities.                                    community?
Grants that were allocated by IHS.             Limitations in AI/AN                3.) If no, why do you not know the true
                                                   Health Data                          rate of diabetes within your
                                        1) Misclassification                            community?
Before CADSP, this information          2) Unrepresentative Sample
                                                                                   4.) If no, is this acceptable and what
was not available.                      3) No Central Location of Data
                                                                                        impact does this have on your
                                        4) Documentation Errors
                                                                                        community?

Data Tracking Elements
 Diagnoses (and onset date)
                                           Complications (and date of               Health Factors And Procedures
 •   Type 1 diabetes
                                           diagnosis )                              •   Comprehensive foot exam
 •   Type 2 diabetes
                                           •   End Stage Renal Disease              •   Comprehensive dental exam
 •   Impaired Glucose (IGT)
                                           •   Minor and Major Amputations          •   Comprehensive eye exam
 •   Gestational Diabetes
                                           •   Retinopathy                          •   Smoking status
                                           •   Neuropathy                           •   Obesity
                                           •   Hypertension                         •   Body Mass Index for Youth
                                                                                    •   Laser Treatment for Retinopathy


                                                                                            CADSP offers technical assistance
      Hoopa Valley Tribe
      Northern California                                                                   and skill building to achieve sustain-
            2000                                                                            able data tracking systems that are
                                                                                            flexible and realistic.


Trainings
 CADSP will conduct on site trainings at                  SUMMARIZED GOALS
your request for your convenience.               • To improve the
                                                      Quality of data
Trainings are always FREE OF CHARGE.                   Quantity of accurate data
                                                 • To achieve Sustainability
 Upcoming Off-Site Trainings: October 10-        • To Optimize community health
12, RPMS Case Management System, Diabe-                                                       Community
tes Register, at Sacramento, CA, IHS. Call                                                       Group
                                                                                               Redding
CADSP for details.                                                                           Indian Health
                                                                                                  Site



CALIFORNIA AREA DATA IMPROVEMENT                                                                                         Page 3
    T H E N O R T H W E S T P O R T L A ND AREA
           INDIAN HEALTH BOARD


California Area Diabetes Surveillance Project
     527 SW Harrison Street, Suite 300
             Phone: 503-228-4185
              Fax: 503-228-8182




            We’re on the Web!
            www.npaihb.org




Year 1 Data from CADSP
The primary goal is to assist California        case management system is important                offered to provide better access to the
Indian health programs improve the              to initial clean up and periodic update            CADSP program and to accommodate
collection and analysis of diabetes spe-        of the register and crucial to long-term           the needs of the California Indian
cific information for their service popu-       sustainability of the diabetes surveil-            health programs. For those programs
lations. CADSP will assist with deter-          lance system.                                      needing assistance, CADSP also offers
mining the prevalence and incidence               Off-site as well as on-site training is          technical assistance with development
rates of diabetes and specific com-                                                                of a diabetes team for comprehensive
plications for Indian health pro-                                                                  diabetes care. During the first year of
grams in California. CADSP utilizes                                                                CADSP, there were improvements in
strategies developed by the Nort h-         100%                                                   many areas including:
west Diabetes Data Project to pro-           90%
                                                                                                   1) 84% of the sites are beginning to
vide a framework to achieve these            80%
                                                                                                   actively use an electronic diabetes re g-
goals. More specifically, CADSP              70%
                                                                                                   ister
provides training and technical as-          60%
sistance on the use of the Re-               50%                                     Other         2) 41% of the sites have an active dia-
source Patient Management Sys-               40%                                     RPMS          betes team
tem (RPMS) 2.0 Diabetes Case                 30%                                     Hand-kept
Management System. This includes                                                                   3) 18% are beginning to electronically
                                             20%
use of a Diabetes Register that                                                                    track complications
                                             10%
allows for proper identification and          0%                                                   4) 86% are beginning to electronically
consistent documentation of diabe-                Pre-            One                              track diabetes and onset date
tes and related complications.                   Project          Year
CADSP also assists with establish-                                                                 CADSP is looking forward to working
ing a case management system for                                                                   with the tribes for the Year 2000-2001.
maintenance of the register. A           The number of sites using an electronic (RPMS) diabetes
                                                      register increased after one year.