Upper Peninsula Diabetes Outreach Network UPDON (906) 228-9203 220 West Washington, Suite 340 (906) 228-4421 Fax Marquette, MI 49855 www.diabetesinmichigan.org The Upper Peninsula Diabetes Outreach Network Strengthening diabetes care & prevention in our communities since 1986 Our mission: To promote innovative partnerships to strengthen the prevention, detection and management of diabetes across the Upper Peninsula of Michigan. “Ontonagon had the highest amputation rate in the U.P. and no diabetes services, until UPDON intervened. They helped to get a diabetes self-management program established, and we also started a support group. Recently, one of my patients said, ‘Before you got here, there was no one in this county that people with diabetes could go to obtain information on how to take better care of their diabetes.’ ” - Winnie Huron, RN, CDE Diabetes Educator Aspirus Ontonagon Hospital UP Diabetes Outreach Network Quick Facts We Accomplish Our Mission By • Improving access to care, services and supplies. • Helping health care professionals stay up-to-date on diabetes care through educational and independent study programs. • Raising public awareness of diabetes through community programs and events. • Providing tools and expert assistance to measure outcomes, analyze data, and assess the quality of diabetes care. • Helping to develop and assist diabetes self-management programs, chronic care management in primary care and diabetes support groups. We Have a Proven Record of Success • Patients of Home Care agencies we worked with from 1986 to 1991 showed: 45% lower hospitalization rate 31% lower amputation rate 27% lower mortality rate Estimated $28 million saved in direct hospitalization care • All of Diabetes Outreach Networks (MDON) recognized as a Best Practice Initiative in 2002 by the U.S. Dept of Health and Human Services because: Blood glucose control of people with diabetes in MDON quality improvement project dropped by almost 2%. Rates of diabetes tests and exams improved. Strong regional networks, quality improvement project and aggressive collaboration with managed care, advocacy groups, state certified diabetes programs, health insurers and many others were noted as keys to MDON success. We Continue to Work • Between 1994 and 2000 data shows: The number of people with diabetes in Michigan increased by 32% (31% in the UP) Diabetes Death rate declined 15.7% statewide (17.8% in the UP) Diabetes-related hospitalizations increased by 36% in Michigan but only 15% in the UP. In the year 2000, the UP diabetes related hospitalization rate was 13% below state average. That saved the UP: 4261 hospital days and $4,687,482 in hospital costs. U. P. Diabetes Outreach Network Timeline 1985 Grant Awarded for the formation the U.P. Diabetes Outreach Network, to focus on the higher morbidity rates due to diabetes in the U.P., as compared to the rest of the state. 1986 UPDON begins 1989 - 1990 By 1989 the UP mortality rates due to diabetes have dropped and are lower than the rest of the state. UPDON participant hospitalization rate is 45% lower than for non-participants. 1991 Program Delivery Award presented by the Association of State and Territorial Chronic Disease Program Directors & the National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control. The award is for developing and implementing a program based on sound epidemiologic and evaluation data that shows significant impact in reducing the chronic disease burden. 1995 UPDON model is expanded throughout the state of Michigan, creating 5 more regional Diabetes Outreach Networks and the birth of the Michigan Diabetes Outreach Network (MDON) 2002 MDON is recognized by the U.S. Department of Health and Human Services as a Best Practice Initiative and specifically highlighted for helping to make improvements in diabetes care and outcomes in such a short time. 2003 MDON highlighted as a Promising Practice in Chronic Disease Prevention and Control. It is noted to be “an integral part of quality diabetes care throughout the state” of Michigan. 2006 UPDON receives the Good News Award, in recognition of work that affirms positive values and uplifts the human spirit from the Evangelical Lutheran, Presbyterian, United Methodist, Episcopal and Catholic Churches, for it’s work on the “Diabetes Hero” video. This video highlights 5 people in the UP who are living well with diabetes. “UPDON has been involved in the creation and management of MCAC’s programs. UPDON is interwoven into both the fabric of my agency, and into the healthcare community of the Upper Peninsula. Developing that connectedness over many years is a substantial investment.” ~ Melissa White, Executive Director, Medical Care Access Coalition, Marquette “In of all impressed the how creative they are at initiating new “I am mostorder to improve withhealth of employees and control health and innovative ways to accomplish their mission. UPDON is always open to suggestions related costs, Mead Westvaco has initiated numerous wellness programs that include activities, education, screening and history of success and quick to respond to whatever question is asked. They have athe the Upper Peninsula and have earned the UPDON able to continue here in development of personal fitness programs.right to be has been a great to be a very efficient and effective initiator of services that would not be available in this asset to our programs.” ~ remote area of Michigan.” expansive, highly rural and Anne Stein, Health Services Supervisor, MeadWestvaco ~ Michael Lovelace, Marquette County Sheriff “Thanks to UPDON, we have created effective working relationships across the entire UP which synergistically serve those impacted by diabetes.” ~Jim Brogan, President and CEO of Portage Health "UPDON has been THE DRIVING FORCE behind advancing the chronic disease UPDON has of the valuable partner in the work to support the model for the patientsbeen aUpper Peninsula. Without their support and needs of those have every reason those who are at risk for developing encouragement I with Diabetes andto believe that we would still be using a diabetes in the in the Peninsula.” model of care developed Upper 1950's. UPDON has been a catalyst for ~Beth Waitrovich, MSU Extension change and improved care for patients with diabetes in our region." Dr. Larry Skendzel, U.P. Physician “There are many other ways UPDON touches our programs on a daily basis that are too numerous to mention here.” ~Rick Hav “UPDON has been a valuable partner in the work to support the needs of those with Diabetes and those who are at risk for developing diabetes in the Upper Peninsula.” ~Beth Waitrovich, MSU Extension “In order to improve the health of employees and control health related costs, New Page has initiated numerous wellness programs that include activities, education, screening and the development of personal fitness programs. UPDON has been a great asset to our programs.” ~ Anne Stein, Health Services Supervisor, New Page “There are many ways UPDON touches our programs on a daily basis that are too numerous to mention here.” ~Rick Haverkate, Michigan Inter-Tribal Council “UPDON has been instrumental in helping us monitor and improve care that people with diabetes receive at Portage Health - first with scannable forms and now with the Chronic Disease Electronic Management System. These tools have been critical in helping us provide ongoing chronic care management to people with diabetes.” ~Carol Grafford, RD, CDE, former Diabetes Education Coordinator for Portage Health “UPDON has worked extensively with the U.P. Area Agency on Aging to ensure that seniors have the care and services they need. UPDON was also instrumental in getting the Personal Action Toward Health (PATH) program started in the UP, and we are working together to expand it across the UP ” ~Tonya LaFave, U.P. Area Agency on Aging “On a personal note, I have been getting my test strips free since turning 65, because of information I gained, and a contact I made at a Diabetes Expo, using Medicare and my other insurance. Because I test 6 to 8 times a day, this is a considerable savings for me.” ~ Karen Johnson, UPDON Advisory Council Member, person living with diabetes In both the medical and non-medical community, UPDON is a highly respected organization. UPDON was developed locally and is a highly successful and cost effective program that reaches out to all residents of Upper Michigan. UPDON is committed to the rural and remote regions of the Upper Peninsula in a manner unmatched by any other organization.” ~Elmer Moisio, PhD, RN, Professor Emeritus, NMU Key Recommendations From the UPDON Strategic Plan Consumer Empowerment/Education – helping people with diabetes take responsibility for their health and providing them with additional opportunities, which support them in making lifestyle changes. Health Care Delivery System – working to ensure that all persons with diabetes have equal access to the minimum clinical practice recommendations set by the American Diabetes Association. Also included are the financial concerns people experience in paying for health care, which prevent them from accessing care. Funding Issues – making certain that cost-effective diabetes prevention, detection, and treatment strategies will be funded and health care costs in the U.P. will be reduced. This includes keeping legislators informed about and involved with setting policies to reduce the burden of diabetes. Lifestyle and culture – striving to help Upper Peninsula residents eat a more healthful diet and move more to achieve and/or maintain a desirable weight and reduce their risk of developing diabetes and its related complications. Diabetes detection, treatment, and prevention strategies, which are evidence-based, exist. However, they have not been universally implemented. In addition, physical and financial barriers prohibit some from receiving appropriate care. To stop this epidemic, which is costing billions of dollars and causing untold human suffering, we have to act now, and we have to engage multiple levels of intervention. Not taking prompt and broad-sweeping action will lead to an even larger financial and physical burden which will further cripple our health care system and society. The Upper Peninsula Diabetes Outreach Network Projects and Partnerships I know of no more encouraging fact than the unquestioned ability of a man to elevate his life by conscious endeavor. - Henry David Thoreau UP Diabetes Outreach Network Projects and Partnerships Help for YOUTH & YOUNG ADULTS with Diabetes Sharing With Insulin-using Mentors (SWIM) • Purpose: Match youth with type 1 diabetes to adults with type 1 diabetes; enhance health behaviors and health outcomes for youth. • Partners: Big Brothers/Big Sisters of Marquette and Alger Counties, Marquette General Health System and Bell Memorial Hospital. • Four youth with type 1 diabetes have been matched with adults with type 1 diabetes. • “I knew that my Little Sister was not really taking care of herself and kind of rebelling against the diabetes. I have been there. Since our time together she seems to have a much better attitude about the diabetes & even told me that she was glad she had diabetes instead of some other disease because ‘with diabetes you can actually have control over it & not the other way around.’ ” Kelly Z, Big Sister Camp for Youth with Diabetes (Camp UPeninsulin) • The American Diabetes Association discontinued the U.P. camp in 1993. After nearly a decade of no camp for kids with diabetes in the Upper Peninsula of Michigan and many complaints from parents, school nurses and diabetes educators, UPDON initiated a 2-day family camp in 2002. Health care professionals from across the U.P. helped make it happen. • Supported by fundraisers and private donations, camp is now overseen by a committee and has evolved into a five-day, youth only camp. • “Since we live in a small community, it gives our son a chance to be with other children who have diabetes. He doesn’t feel so alone having this condition.” ~Michelle, mother of a camper Help for U.P. College Students • This program was developed in coordination with some U.P. hospitals to assist U.P. college students with diabetes who are under or uninsured. • “I appreciated all the help with getting the supplies for my pump and for testing. It definitely helped financially. I could concentrate on school and not have to worry about getting diabetes supplies.” Samantha, LSSU student 7-09 Youth and Young Adult Programs 2006 - 2008 Keweenaw + Houghton + * * Ontonagon + Alger + Baraga * * Luce + * Gogebic Marquette + * Chippewa Iron Mackinac Delta + Dickinson + Schoolcraft + * Menominee Diabetes Assistance Program for * U.P. College Students offered Diabetes Assistance Program for U.P. * College Students- enrolled students Kids Camp Attendees +Volunteer medical support staff SWIM (Sharing With Insulin-Using Mentors) 7-09 UP Diabetes Outreach Network Projects and Partnerships Help for Adults with Diabetes Personal Action Toward Health (PATH) • A Chronic Disease Self-management Program developed by Stanford University and designed to be facilitated by 2 trained lay leaders. The project has been shown to help people with chronic conditions feel better and use hospital services less often. • UPDON has offered four leader trainings, one each in Marquette, Escanaba, Houghton and Sault Ste. Marie. The Sault Ste. Marie class trained leaders from tribes across the state of Michigan. • Four people in the UP are trained as “Master Trainers”, people who will train more lay leaders. • Since the beginning in February 2007, 20 classes serving 231 people in Alger, Marquette, Houghton and Delta counties have been offered by UPDON and our partners. • “Having been diagnosed with Type 2 diabetes fairly recently, I have found the PATH classes invaluable in helping me learn to deal with the daily ups and downs of a chronic illness. From simple relaxation techniques to the value of exercise and good eating to end-of-life planning, I have learned a great deal about a great many things. There’s a great therapeutic value to PATH classes as well, in that all attending have similar conditions and share common problems and solutions with the group. I am deeply grateful to the Diabetes Outreach Network for providing this type of program.” ~Linda, Munising PATH graduate 06/08 Other Programs for Adults • UPDON has also helped pilot other programs like Move More Yoopers, which matched adults who wanted to be more active with mentors. • UPDON has helped train diabetes support group leaders and has acted as a resource for these groups. • UPDON facilitated an annual Diabetes Expo with free health screenings in collaboration with a Senior Health & Leisure Expo for 10 years. Approximately 2000 people attended the event each year. Volunteer diabetes educators and other healthcare professionals helped make the event successful. 7-09 Personal Action Towards Health 2006-2009 Keweenaw*- Houghton*- Alger*+- Ontonagon Marquette*+- Baraga Luce Chippewa*+- Gogebic+* Iron* Mackinac Dickinson* Schoolcraft Menominee*- Delta*+- + PATH classes held - PATH class scheduled *Trained leaders Leader training held Classes in coordination with Wisconsin agencies Tribal PATH Leaders 7-09 UP Diabetes Outreach Network Projects and Partnerships Professional Education Professional Continuing Education • We have helped develop and update 8 on-line continuing education programs for nurses and dietitians. These programs include: Basic Nutrition and Diabetes Diabetes, Genetics & Genomics Diabetes and Kidney Disease Diabetes and Tobacco Use Foot Care and Diabetes Gestational Diabetes Mellitus Type 1 Diabetes Type 2 Diabetes in Adults • In coordination with the UP Telehealth Network, we provide monthly video-teleconferencing of Continuing Education programs for health care professionals on various aspects of diabetes management. • In 2000, the first year of video-teleconferencing, 14 programs with an average of 24 participants occurred. • In 2002, a revised schedule offered only 9 total programs but saw an average of 31 attendees per program. • In January of 2006, a videotape program was introduced as an alternative for those unable to attend the scheduled video-teleconference. This addition resulted in an average of 47 people receiving continuing education credits through the video-teleconference program. • UPDON is working with Marquette General Health System and the Midwest Alliance for Health Education to offer web-based educational programs. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ “The educational opportunities that UPDON provides to all educators in the UP and the State of Michigan are tremendous. They have developed a network of monthly continuing education opportunities on a videoconference system that allows us, as educators, to keep on top of the latest changes and care that directly impact our patient care while not losing many hours of travel time that can be spent with our clients.” ~ Lynn Kihm, Diabetes Educator, Helen Newberry Joy Hospital 7-09 Professional Education 2000 - 2009 Keweenaw Houghton ●● ● ● ● Ontonagon ● Baraga ● ● Luce ● ● Gogebic Marquette ● ● Iron Alger Chippewa ● Mackinac Delta ● ● ●● Dickinson ● Schoolcraft ● Menominee ● Video-teleconference sites On-Site Professional Education Video-teleconference video tape viewers UP Diabetes Outreach Network Projects and Partnerships Professional Collaborations for Health Care System Change Monitoring & Improving Diabetes Care • Until 2006 UPDON had a scannable form used with a variety of agencies to help them monitor and improve diabetes care. Individually and collectively we saw improvements in care and outcomes for people with diabetes. Of special note, UPDON has been nationally recognized for helping to improve diabetes care and outcomes. Chronic Disease Electronic Management System (CDEMS) • We brought in the managers of this system, which was designed for the state of Washington, to do an informational meeting. • With technical assistance from UPDON, Marquette General Health System started using this tool in their largest family care practice. • MGHS has expanded use of CDEMS to 5 other clinics. • Over 1200 patients with diabetes are in the system. • The use of CDEMS helped FamilyCare Doctors achieve NCQA (National Committee for Quality Assurance) Diabetes Recognition status. • Several other health systems have instituted CDEMS. Strengthening Diabetes Care • In UPDON continues to explore how we can help healthcare systems strengthen diabetes care and outcomes. 7-09 Professional Collaborations For Healthcare System Change 2006 - 2009 Keweenaw Houghton Ontonagon Baraga Luce Marquette Chippewa Gogebic Iron Alger Delta Mackinac Dickinson Schoolcraft Menominee Strengthening Diabetes Care Advisory Council Members 7-09 UP Diabetes Outreach Network Projects and Partnerships Sample Community Initiatives Lifestyle Change Initiatives • Convenience Store Project – UPDON facilitated a campaign to improve offerings of healthy foods in convenience stores including identification of healthy items, addition of healthy items and promotion. Project was funded through a grant from the Active Living Task Force of Marquette County. • Get Moving UP – Since 2003, UPDON has helped the Wellness Council of the U.P. promote and recruit participants for the annual Get Moving UP, a team-based incentive program designed to get people active 30 minutes most days of the week. • Eat 5 – a month-long promotion of the Eat 5 program was promoted to U.P. diabetes support groups and diabetes educators by UPDON. School Initiatives • Helping schools form Wellness Teams. • Assisting U.P. schools with the completion of the Healthy School Assessment Tool (HSAT) and identifying action plans to provide healthful environments for youth. • Providing assistance to secure grants to facilitate changes needed as identified by the Wellness Team. 7-09 Sample Community Initiatives 2003 - 2009 Keweenaw Houghton * * Ontonagon Alger Baraga Luce Gogebic Marquette * Iron Schoolcraft * Chippewa * ** Delta Mackinac * Dickinson * Menominee Convenience Store Project Get Moving UP (all 15 counties were involved) * Eat 5 7-09 Diabetes Resource Guide & Assistance By County Sheets Do people with diabetes that you know or work with need extra help with their diabetes? The U.P. Diabetes Outreach Network has a resource guide and a listing of assistance available by counties on-line to help! For information about diabetes education, support groups, pharmaceutical help, & a host of other helpful resources go to www.diabetesinmichigan.org. Click on the map of the U.P. and then choose “U.P Wide Resource Directory” or “Assistance Available in U.P. Counties.” UPDON Phone: 906 228-9203 220 W. Washington, Suite 340 Fax: 906 228-4421 Marquette, MI 49855 Email: email@example.com Diabetes is always serious! The Upper Peninsula Diabetes Outreach Network Awards and Publications With regard to excellence, it is not enough to know but we must try to have and use it. - Aristotle “First of the Best” Best Practices Initiative Fact Sheet • Michigan’s Diabetes Outreach Network has been cited by the United States Department of Health and Human Services as a national “Best Practices Initiative” for its community collaboration efforts. • Department of Health and Human Services Assistant Secretary of Health recognizes the impact of the statewide Diabetes Outreach Network in spreading information, establishing cooperative programs, and strengthening the management of diabetes in Michigan residents. • Upper Peninsula Diabetes Outreach Network was the first program of its kind in the state. After ten years, the initial success of UPDON’s efforts in the reduction of diabetes related amputations, hospitalizations, and mortality resulted in the establishment of 5 additional Diabetes Outreach Networks in Michigan. • Michigan Diabetes Outreach Network’s practices and collaborations are being disseminated by the federal department to other health agencies across the nation. • Ann Constance, UPDON Director, gives credit to the many health care providers in health departments, home health agencies, state certified diabetes self-management programs, Veteran’s Administration health system, clinics, hospitals, and tribal health centers for their patient care and collaboration with the network program. Publications Diabetes & Exercise Safety; By Lisa Flood, MSN, RN, CS and Ann Constance, MA, RD, CDE. AJN, June 2002, Vol. 102, No. 6. Changes in glucose levels and the risk of foot injuries are two of the many concerns of people with diabetes as they embark upon an exercise program. But with proper assessment and instruction, they can exercise safely. MPA and MDON – Partnering for Diabetes Outreach; By Karl Widak, R.Ph. and Sandra Parker, RD, CDE. Michigan Pharmacist, November/December 2002, Vol.40, No. 6. November is National Diabetes Month and the Michigan Pharmacists Association and the Michigan Diabetes Outreach Network have partnered to bring important diabetes information to the MPA membership. The Role of Michigan Schools in Promoting Healthy Weight, A Consensus Paper. Michigan Department of Education, Office of School Excellence, September 2001. Ann Constance, UPDON, was a member of the Healthy Weight Advisory Group The purpose of the paper is to provide practical guidelines and policy recommendations to school districts for promoting healthy weight for all students. Community Based Screening for Diabetes in Michigan; Bahman Tabael, MPH, Ray Burke, MA, Ann Constance, MA, RD, CDE et. al. Diabetes Care, March 2003, Volume 26, Number 3. Community screening for diabetes conducted according to ADA recommendations was extremely inefficient at identifying individuals with undiagnosed diabetes. The ADA diabetes- screening questionnaire resulted in many false positive tests, and the ADA criteria for positive plasma glucose tests likely missed a substantial portion of individuals with undiagnosed diabetes. Relying on biochemical tests such as random plasma glucose, changing the criteria for a positive plasma glucose test, targeting racial and ethnic minority groups, and targeting medically underserved individuals might improve the yield of community-based diabetes screening. MDON: A Network of Community Partnerships; Ann Constance, RD, MA, CDE et. al. Family & Community Health, Vol. 25, #3, October 2002. This model for strengthening diabetes care in communities teams the public health system with the professional lay community to address prevention, early detection, and treatment of diabetes. This article describes how the Michigan Diabetes Outreach Network (MDON) develops local, regional, and statewide partnerships to increase professional and public knowledge and to improve care delivery for this chronic and complex disease. The Upper Peninsula Diabetes Outreach Network Staff Use what talents you possess: the woods would be very silent if no birds sang there except those that sang best. - Henry Van Dyke U.P. Diabetes Outreach Network Staff Ann Constance, MA, RD, CDE UPDON Director Ann holds a bachelor degree in Nutrition and a master degree in Exercise Physiology from Michigan State University. She is also a Registered Dietitian and a Certified Diabetes Educator. Ann started with UPDON in 1992, first as a Special Projects Coordinator and since 1997, the director. Ann has also worked in a variety of settings from clinical dietetics to therapeutic recreation and cardiac rehab. She has also worked as a seminar leader and has conducted workshops across the country. Ann is also a trained PATH leader as well as a Master Trainer. Paula Ackerman, MS, RD, CDE UPDON Diabetes Educator Paula is a master degree prepared Registered dietitian and Certified Diabetes Educator. Paula received her bachelor degree from Central Michi- gan University and her master degree was earned at Rush University in Chicago. Paula has also worked as a clinical dietitian and has been a health department based health educator. In addition to working for UPDON Paula coordinates a diabetes self-management program in Munising. Paula volunteers many hours to the local school system and is a trained PATH leader. U.P. Diabetes Outreach Network Staff Kay Bammert, BS UPDON Office Manager Kay comes to UPDON with personal business experience. Prior to joining UPDON, Kay was the owner and operator of Little Steps Daycare. She holds a bachelor of science degree in Health Education with a minor in social welfare from Northern Michigan University. Kay also has worked as a substitute teacher, day camp director and secretary. An active volunteer with the local school system, Kay is also a trained PATH leader. Janet Harry, BS UPDON Community Programs Janet brings to UPDON years of experience and expertise working with a variety of groups and individuals from her many years employed in the Marquette County Friend of the Court office. Janet’s gentle yet encouraging attitude are a tremendous asset to UPDON. Janet is active in the commu- nity through yoga, a knitting club, cycling and a book club.