Pamela Manning

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					                             Chronic Disease Control Branch
                        Epidemiology and Health Promotion Section
                               California Diabetes Program
                                 Monthly Activity Report
                                         July 2006

The California Diabetes Program is responsible for meeting Centers for Disease Control and
Prevention (CDC) national objectives that include: developing measurement procedures for
tracking program success, increasing rates of foot and eye exams, A1C testing and flu and
pneumococcal immunizations for people with diabetes. We are also responsible for reducing
health disparities, promoting linkages for wellness and physical activity, demonstrating success
in quality improvement efforts, and translating findings of diabetes prevention studies.

The following is progress made towards meeting our work plan objectives:

A. U.S./Mexico Border Diabetes Project.
    The AHPS-Los Angeles continues to serve on the Interventions committee for the
      U.S./Mexico Border Project; however, no conference calls were scheduled for the month
      of July. The Request For Application is in process.

B. Educate partners about the appropriate use of diabetes detection screening methods.
    The AHPS-North Central Valley met with and discussed appropriate screening methods
      with the Mutual Assistance Network who is providing health screenings during health
      fair events in the Del Paso area. Topics discussed included collaborating with a primary
      health care clinic in the area to help provide screenings and be able to support
      participants at risk for diabetes.
    The AHPSs-Greater San Diego and North Central Valley are compiling a diabetes
      detection toolkit to be posted on DIRC (Diabetes Information Resource Center). This
      toolkit is being developed for health care providers, health, and community
      organizations. It will include recommendations for selecting screening methods and
      populations as well as guidelines for referring patients for follow-up diagnostic testing
      and offering prevention and awareness education to those screened.

C. Collaborate with two partners to promote flu immunizations.
    The EL and AHPS-Greater Bay Area attended the California Adult Immunization
      Coalition quarterly steering committee meeting. Plans were discussed for 2007 Summit
      to be held on May 07 in Southern California. A connection was made from the California
      Pharmacists Association. During the meeting, collaborative practice agreements with
      physicians allowing pharmacists to administer immunizations were discussed. Program
      staff will follow-up with this group to see whether collaboration makes sense and can
      contribute to increases in the measure of flu immunization rates in people with diabetes.
    The AHPS-Greater Bay Area is participating in bi-monthly meetings with the National
      Adult Immunizations Awareness Week (NAIAW) Planning Committee for California. The
      goal of NAIAW is to promote as many local observances of NAIAW’06 as possible by
      providing educational tools, operational tools, and resources for stakeholders. In
      addition, the NAIAW Planning Committee will be organizing state-level actions/events
      that will support or enhance local efforts. These events will take place the week of
      September 24 through the 30th 2006.




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      The AHPS-Greater San Diego met with a Health Promotion Specialist for the San Diego
       Immunization Initiative to discuss flu and pneumococcal immunization activities and
       attended the San Diego Immunization Initiative quarterly meeting. The AHPS will
       participate in a Flu Summit planned for September 2006 and will exhibit information on
       the program and the importance of flu immunizations for people with diabetes.

D. Conduct three projects to increase use of the Basic Guidelines.

   Guidelines:
    The AHPS-Greater Los Angeles provided 100 Diabetes Health Records (DHRs) in
      English and Spanish to St. Vincent’s Medical Center Community Outreach program to
      be used in their community diabetes education program. Currently, St. Vincent’s
      Medical Center is providing diabetes management classes to approximately 150
      community members. Over one third of these persons are of Korean descent. St.
      Vincent’s was directed to DIRC to download the Korean DHRs for use in their programs.
    The AHPS-Greater Los Angeles presented information on the California Diabetes
      Program, DIRC, and the Be Proactive Campaign to members of the San Bernardino
      Department of Public Health. DHRs and Be Proactive materials were made available to
      the approximate 15 attendees.
    The AHPS-Greater Los Angeles promoted the Basic Guidelines to the following
      organizations and encouraged them to submit partner profiles if they had not already
      done so in the month of July: Healthy African American Families, LA CARE health plan,
      The Desert Sierra Health Network, Latino Community Diabetes Council, Tobacco Use
      Reduction Now Program, The American Diabetes Association (ADA), and Healthy
      Management Diabetes Education.
    The AHPS-North Central Valley met with Blue Cross’ Health Promotion Consultant from
      the Sacramento regional office and promoted the Basic Guidelines and DHR card and
      Diabetes Consumer Action Groups (Diabetes CAGS) training.
    The AHPS-North Central Valley provided and discussed the basic guidelines and DHR
      card with 10 clinic managers and Medical Assistants (MAs), and California Medical
      Association Foundation (CMAF) staff participating in the CMAF Advanced Practices for
      diabetes care meeting in San Joaquin County (100 English and Spanish DHRs were
      distributed to these clinics).
    The MMS and AHPS-Greater Bay Area updated the Guidelines Usefulness
      Questionnaire. The AHPS-Greater Bay Area conducted a short presentation to the
      Guidelines Steering Committee on the Guidelines Usefulness Questionnaire results and
      highlighted feedback obtained from those participating in the questionnaires in the areas
      Quality and Team Approach/Implementation.
    The AHPS-Greater Bay Area provided a presentation on the Basic Guidelines to Santa
      Cruz’s Community Chronic Care Network (CCCN) Implementation team meeting.
      CCCN is currently in the process of expanding a diabetes registry in offices/clinics with
      Santa Cruz County and are interested in finding out about other resources related to
      diabetes. The AHPS provided 250 English and 250 Spanish DHRs. The CCCN Project
      Manager requested 20 copies of the Basic Guidelines for Diabetes Care.
    The AHPS-Greater Bay Area conducted a presentation to members of the Chronic
      Disease Management Team at Clinica de la Raza on the Basic Guidelines for Diabetes
      Care and provided 10 packages of the Basic Guidelines and 200 English and 200
      Spanish DHRs.
    The AHPS-Greater Bay Area provided copies of the Take Charge! Presentation, both in
      English and in Spanish to the Medical Director of Natividad Medical Center. The AHPS



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    will follow up with Natividad’s Medical Director to obtain information on how the Take
    Charge! Presentations were utilized.
   The AHPS-Greater San Diego distributed DHRs in English and Spanish to the chair of
    the South Orange County Diabetes Collaborative (SDCCC) for her to pass on to
    partners in the collaborative, particularly community clinics.

 Diabetes Care Coordinator Program:
  The AHPS-Greater Los Angeles participated in two planning meetings for the upcoming
    Diabetes Care Coordinator Training and Diabetes Update 2006 conference at St.
    Bernardine’s Medical Center in San Bernardino in September 2006. The Diabetes Care
    Coordinator Program (DCCP) training hopes to train approximately 20 Medical
    Assistant’s (MAs) who will be recruited from physicians in attendance at the conference.
  The AHPS-Greater Los Angeles met with the Associate Director of Latino Initiatives for
    the ADA in Los Angeles to discuss potential projects in which the ADA and California
    Diabetes Program could collaborate. Information was provided regarding the Basic
    Guidelines, DHRs, DCCP, and the Be Proactive Campaign. Plans were made to
    arrange for a conference call between regional ADA staff and staff from the California
    Diabetes Program to enhance collaboration and communication between the two
    organizations.
  The AHPS-Greater Los Angeles promoted the DCCP to the following organizations and
    encouraged them to submit partner profiles if they had not already done so in the month
    of July: Healthy African American Families, LA CARE health plan, The Desert Sierra
    Health Network, Latino Community Diabetes Council, Tobacco Use Reduction Now
    Program, The ADA, and Healthy Management Diabetes Education.
  The APHS-North Central Valley, EL, and MMS met to plan and implement the DCCP
    survey and to complete the evaluation of the project. The Program Assistant II will also
    assist with the project files. Evaluation surveys for the DCCP training program were sent
    out to all trainers, participants, and providers. This survey is provided via survey
    monkey. Results will be compiled in August and discussion with the California Health
    Care Foundation (CHCF) will begin for a possible funding opportunity.
  The AHPS-North Central Valley discussed the DCCP with 10 clinic managers, MAs, and
    CMAF staff participating in the CMAF Advanced Practices for diabetes care meeting.
    This meeting incorporated a diabetes 101 presentation to initialize the DCCP training for
    this group. Participants were provided with the provider agreement to take to their clinic
    physicians and return during the next training. The next training will be a direct DCCP
    training set for August 30, 2006.
  The AHPSs participated in a conference call to review the DCCP and provided input on
    areas to improve the DCCP curriculum and training.
   The AHPSs-Greater Los Angeles, Greater Bay Area, Greater San Diego, and North
    Central Valley collaborated on the redesign of the DCCP program. The redesign
    process aims to make the training more practical and clarify the role of the diabetes care
    coordinator, incorporate different forms of instructions (videos and practice role-plays, in
    addition to lectures), and more technical assistance follow-up, and include cultural
    competency items. The program’s evaluation plan is also being redesigned, with the
    objective of making the program eligible to be considered a “best practice” in diabetes
    care.
   The AHPS-Greater San Diego promoted the DCCP training to two Diabetes Educators
    (DEs) from Mission Hospital and St. Jude Hospital in Orange County. Mission Hospital
    is interested in having DCCP training for their affiliated physicians group, and St. Jude
    Hospital is interested in having the training for the MAs in endocrinologists’ offices.



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      The AHPS-Greater San Diego promoted the August DCCP session I training in San
       Diego to MAs and others attending another session of the training sponsored by the
       SDCCC and the Whittier Institute.

   Team Care:
    The AHPS-North Central Valley discussed the team care concept with 10 clinic
      managers and MAs and CMAF staff participating in the CMAF Advanced Practices for
      diabetes care meeting as a part of the DCCP program that they will be trained on in
      August.
    The AHPS-North Central Valley met with the Central Valley Chronic Disease Partnership
      (CVCDP) to discuss the outcomes of the provider assessment that was implemented
      during the diabetes symposium in March 2006. Team care was one of the topics that
      the 130 health care providers responding to the assessment would like more training
      provided.
    The AHPSs-Greater Bay Area and North Central Valley are participating in monthly
      conference call with the Partnership Health Plan of California. The Partnership Health
      Plan of California through a grant from the CHCF is organizing a conference titled: Better
      Ideas for Chronic Disease Management which will be taking place in October. The
      following topics are being proposed: Advance Access/Group Medical Appointments,
      Promotores/Community Outreach Workers, Registries/Electronic Health Records,
      Comorbid Physical/mental Chronic Conditions, Chronic Pain Management, Engaging
      Patients in Self Management and Office Efficacy/Team Approach/Changing Clinical
      Office Practice Design. The AHPS suggested considering the DCCP, Diabetes CAGs,
      and the Team Care Tool Kit as part of the breakout sessions.
    The AHPS-Greater Bay Area conducted a presentation to members of the Chronic
      Disease Management Team at Clinica de la Raza. The Chronic Disease Team is
      working in creating a toolkit/curriculum for chronic disease management to train
      Promotoras. The Promotoras will be included as part of the team care chronic disease
      management and the AHPS shared with the group the idea of incorporating, as part of
      the Promotoras training, the DCCP, and the Diabetes CAG training.

E. Develop and promote DIRC.
    The AHPS-Greater Los Angeles promoted DIRC to the following organizations and
      encouraged them to submit partner profiles if they had not already done so in the month
      of July: Healthy African American Families (HAAF), LA CARE health plan, The Desert
      Sierra Health Network, Latino Community Diabetes Council, Tobacco Use Reduction
      Now Program, The ADA, and Healthy Management Diabetes Education.
    The AHPS-Greater Los Angeles finalized plans to use of the DIRC event calendar for
      registration at the upcoming Diabetes Update 2006 conference at St Bernardine’s
      Medical Center in San Bernardino in September 2006.
    The AHPSs participated in the DIRC Health Promotions Workgroup call to review the
      process for updating stale resources on the website
    The AHPS-North Central Valley discussed and promoted DIRC during meetings with
      Blue Cross’ Health Promotion Consultant from the Sacramento regional office; with 10
      clinic managers and MAs participating in the CMAF Advanced Practices for diabetes
      care meeting; with the CVCDP as a tool to share resources with health care providers in
      the region; at the ADA Northern region community forum planning committee as a tool to
      help register people for the upcoming event in November; with the California Partnership
      for Access to Treatment (CPAT) and Perry Communications to submit their partner




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    profile and review the prevalence report; and to 25 people attending the World
    Conference on Tobacco Or Health presentation on the smoking and diabetes project.
   The AHPS-Greater Bay Area provided a presentation on DIRC to Santa Cruz’s CCCN
    Implementation team meeting. CCCN is currently in the process of expanding a
    diabetes registry in offices/clinics with Santa Cruz County and are interested in finding
    out about other resources related to diabetes. The CCCN Project Manager requested
    information on DIRC. This information will be distributed to offices/clinics participating in
    the CCCN.
   The AHPS-Greater Bay Area conducted a presentation to members of the Chronic
    Disease Management Team at Clinica de la Raza on the Basic Guidelines for Diabetes
    Care and provided an extensive overview of DIRC.
   The AHPS-Greater San Diego met with the chair of the South Orange County Diabetes
    Collaborative and the president of the Orange Association of Diabetes Educators and
    provided an overview of California Diabetes Program activities, including the possibility
    of having the South Orange County Diabetes Collaboratives paper directory converted to
    an online resource on DIRC. Several copies of the DIRC “1-2-3” flyer were provided to
    them to pass on to their partners. They requested a flyer suitable for physicians that
    explained the resources available on DIRC; the flyer is under development. The Orange
    Association of Diabetes Educators added a link from their website to the California
    Diabetes Program and DIRC.
   The AHPS-Greater San Diego presented DIRC to the San Diego Diabetes Coalition
    Prevention and Education subcommittee, which agree to explore using DIRC as the
    repository for the diabetes resources for providers that they are gathering. The
    subcommittee is also considering creating an online service directory on DIRC. The
    AHPS also presented DIRC as a resource option for a pilot project the San Diego
    Diabetes Coalition is pursuing, in which it has proposed developing a web portal to
    facilitate communication among pilot project partners.
   The AHPS-Greater San Diego met with the Project Director of SALSA en la Comunidad
    (Spanish-language Approach for Lifestyle Adjustments in the Community), a diabetes
    screening and intervention project for Latinos at San Ysidro Health Center funded by the
    Office of Minority Health. The AHPS provided an overview of California Diabetes
    Program activities. The Project Director subsequently submitted a partner profile on
    DIRC.
   The AHPSs met as the DIRC Health Promotion Work Group to create a process for
    reviewing new submissions and updating stale resources.

Activities related to the management and administration of DIRC this month includes:

                                Item Tracked                        7/1/06-7/31/06
              Number of individuals who visited the Website                  2,367
              Total number of page views                                     9,838
              Total number of visits to Resources                            9,166
              Total number of documents downloaded                           2,852
              Total number of Resource hyperlinks clicked                      557
              Total number of visits to Partner Profiles                     3,028
              Total number of Partner Profiles hyperlinks clicked              413


 12 new Content Contributors
 2 new Partner Profiles
     - Office of Statewide Health Planning and Development


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          - SALSA en la Comunidad
    0 new Resources
    The EL met with diabetes educators working on the Diabetes and Smoking Cessation
     project and gave them an overview of DIRC and how it works. A focus group type
     discussion was also held to explore ways to position DIRC with diabetes educators as a
     useful tool.
    The DIRC Steering Committee met to discuss the budget, upcoming Stakeholders
     meeting and Usability Testing. A draft meeting agenda was created and the new yearly
     DIRC Award was discussed. Award criteria will be developed and the first annual award
     will be given out during the August meeting.

F. Develop four strategies to improve cultural competency among health care
   professionals.
    The AHPS-Greater Los Angeles participated in the HAAF diabetes workgroup in which
      strategies to improve culturally competent care for African Americans were discussed.
    The AHPS-Greater Los Angeles discussed new diabetes education and prevention
      curriculums for Latinos and African Americans which are being promoted by the ADA
      with the Associate Director of Latino Initiatives for the ADA in Los Angeles.
    The AHPS-North Central Valley continues to participate in the CMAF Network of Ethnic
      Provider Organization expert panel assessing health education materials for cultural and
      linguistically appropriateness.
    The AHPS-Greater Bay Area continues to participate in NDEP’s Hispanic/Latino Work
      Group monthly conference calls. The Work Group is working on updating the Strategic
      Plan 2005-2007 which focuses on three key NDEP campaigns and messages targeing
      the Hispanic/Latino community. These campaigns are: Control Your Diabetes. For Life,
      Be Smart About Your Heart. Control the ABCs of Diabetes, and Small Steps. Big
      Rewards. Precent type 2 Diabetes.
    The AHPS-Greater Bay Area is working in collaboration with the Binational Health Week
      Task Force of Santa Cruz County and Lumetra to organize a health forum titled:
      Cultivate the Care You Deliver: Improving patient/provider communication. The
      health forum will be an interactive workshop to learn and practive new communication
      skills and to increase awareness on culturally and linguistically appropriate health care
      services among health care providers working in diabetes prevention, care, and
      treatment. The event is scheduled for Friday, October 13, 2006 as part of the Binational
      Health Week activities.
    The AHPSs-Greater Los Angeles, Greater Bay Area, Greater San Diego, and North
      Central Valley collaborated on the redesign of the DCCP program. The redesign
      process aims to make the training more practical and clarify the role of the diabetes care
      coordinator, incorporate different forms of instructions (videos and practice role-plays, in
      addition to lectures) and more technical assistance follow-up, and include cultural
      competency items.
    The AHPS-Greater San Diego met with staff from the CMAF Ethnic Physicians
      Organization Network and gave them an overview and tour of the local area for their
      quality improvement project with solo and small group practices.

G. Gain access to Medicare beneficiaries’ flu immunization data.
    The program received the Immunization data report from Lumetra. Program Chief, ESL,
      and EL will meet in August to discuss report contents and how best to share this
      information with partners.




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H. Expand efforts in the area of primary prevention of diabetes.
    The AHPS-Greater Los Angeles discussed new diabetes education and prevention
      curriculums for Latinos and African Americans which are being promoted by the ADA
      with the Director of Latino Initiatives for the ADA in Los Angeles.
    The AHPS-Greater Los Angeles participated in the HAAF diabetes workgroup in which
      strategies to increase awareness of the importance of diabetes prevention among
      African Americans were discussed.
    The AHPS-North Central Valley provided basic diabetes 101 presentation to 10 clinic
      managers and MAs and CMAF staff participating in the CMAF Advanced Practices for
      diabetes care meeting in San Joaquin County.
    The Program Chief, ESL, and AHPS-Greater Bay Area are working in collaboration with
      the Binational Health Week Task Force of Santa Cruz County and the University of
      California Santa Cruz to conduct an assessment to better understand the immigrant
      community in Santa Cruz County. The purpose of this assessment is to provide a profile
      of the immigrant community in the county their socioeconomic status and housing
      conditions, their communities of origin, and risk factor for diabetes through the use of
      ADA’s Diabetes Risk Test.

I.   Promote Peer to Peer Education Models.
      The MMS participated in the Tobacco Tax Initiative planning meeting for Chronic
        Diseases and recommended the Diabetes CAGs and DCCP programs be funded if the
        Initiative is passed.
      The AHPS-North Central Valley met with Blue Cross’ Health Promotion Consultant from
        the Sacramento regional office and promoted Diabetes CAGs training as an opportunity
        for the Blue Cross patient education program.
      The AHPS-Greater Bay Area conducted a presentation to members of the Chronic
        Disease Management Team at Clinica de la Raza. The Chronic Disease Team is
        working in creating a toolkit/curriculum for chronic disease management to train
        Promotoras. The Promotoras will be included as part of the team care chronic disease
        management. The AHPS shared with the group the idea of incorporating in to the
        Promotoras training the DCCP and the Diabetes CAG trainings.
      The AHPS-Greater Bay Area and North Central Valley are participating in monthly
        conference calls with the Partnership Health Plan of California. The Partnership Health
        Plan of California, through a grant from the CHCF, is organizing a conference titled:
        Better Ideas for Chronic Disease Management for October 2006. The following topics
        are being proposed; Advance Access/Group Medical Appointments,
        Promotores/Community Outreach Workers, Registries/Electronic Health Records,
        Comorbid Physical/mental Chronic Conditions, Chronic Pain Management, Engaging
        Patients in Self Management and Office Efficacy/Team Approach/Changing Clinical
        Office Practice Design.

J. Participate in activities with organizations representing high-risk populations.
    The AHPS-Greater Los Angeles participated in the HAAF diabetes workgroup.
    The AHPS-Greater Los Angeles met with the director of Latino Initiatives for the ADA in
      Los Angeles.
    The MMS responded on behalf of the program to a survey on the use of the Women’s’
      Monograph and specific California programs targeting women.
    The AHPS-North Central Valley met with 10 clinic managers and MAs and CMAF staff
      participating in the CMAF Advanced Practices for diabetes care meeting in San Joaquin
      County.


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      The Program Chief, ESL, and AHPS-Greater Bay Area is working in collaboration with
       the Binational Health Week Task Force of Santa Cruz County and the University of
       California Santa Cruz to conduct an assessment to better understand the immigrant
       community in Santa Cruz County. The purpose of this assessment is to provide a profile
       of the immigrant community in the county their socioeconomic status and housing
       conditions, their communities of origin, and risk factor for diabetes.
      The AHPS-Greater San Diego met with the Project Director of SALSA en la Comunidad,
       a diabetes screening and intervention project for Latinos at San Ysidro Health Center
       funded by the Office of Minority Health. The AHPS provided an overview of California
       Diabetes Program activities and DIRC. The Project Director subsequently submitted a
       partner profile on DIRC.

K. Participate in national and state diabetes collaboratives to increase A1C testing rates.

L. Work with the Breakthroughs in Chronic Care Program (BCCP) to increase A1C
   testing rates.

M. Expand Cal NDEP Partnership Network.
    The MMS contacted Dr. Pam Allweiss to gain insights into workplace wellness programs
      and the latest tools available from the NDEP.
    The MMS gathered information to include in the next issue of Cal Diabetes News.

N. Collaborate with one partner to promote pneumococcal immunizations.
    The AHPS-Greater San Diego met with a Health Promotion Specialist for the San Diego
      Immunization Initiative and attended the San Diego Immunization Initiative quarterly
      meeting to learn about flu and pneumococcal immunization activities in the county.

O. Develop and implement DPCP/CDPHS Communications Plan.
    The MMS continues to work with three contractors to design and produce promotional
      items to promote the program and DIRC.
    The MMS notified the CDHS Office of Public Affairs that we will not participate in a public
      awareness effort around the issue of Diabetes and West Nile Virus, as it is not as critical
      as other issues.
    The AHPS-Greater Bay Area is participating in bi-monthly meeting with the NAIAW
      Planning Committee. The goal of NAIAW is to promote local observances of NAIAW’06
      by providing educational tools, operational tools, and resources for stakeholders at all
      levels. In addition, NAIAW will be organizing state-level actions or events that will
      support or enhance local efforts. Such events will take place the week of September 24
      through the 30th, 2006.

P. Develop and support new and existing local diabetes coalitions.
    The AHPS-Greater Los Angeles promoted DIRC as a resource to the HAAF diabetes
      work group to find resources and tools for their activities. HAAF was encouraged to
      submit a partner profile of their organization on DIRC and provided with the DIRC
      instructional flyer for submitting partner profiles.
    The AHPS-Los Angeles participated in the ASC conference call with members of the
      Executive Committee of the DCC to update them on current events with the California
      Diabetes Program, such as, staffing changes and the upcoming DIRC reception in
      August.




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      The AHPS-North Central Valley convened a meeting with the CVCDP in Fresno to
       discuss provider assessment results, begin planning for the next provider outreach effort
       and to share updates from all organizations attending. A report on the March
       symposium and assessment has been drafted and will be written into an article that will
       be distributed to the medical societies and community organizations involved in the
       partnership – as well as posted on DIRC. The next meeting will be held in September.
      The AHPS-North Central Valley participated in the ADA Northern California region
       Community outreach committee. This committee is currently planning a community
       forum for people with diabetes during Diabetes Awareness Month in November 2006.
      The MMS participated in the Tobacco Tax Initiative planning meeting for Chronic
       Diseases and recommended that local coalitions be funded if the Initiative is passed.
      The AHPS-Greater Bay Area was invited by the Monterey, San Bento, and Santa Cruz
       Counties Regional Diabetes Collaborative (RDC) to present on the System Dynamics
       Model (SDM) to the Executive Committee. The RDC’s Executive Committee has
       demonstrated interest to have to pilot test the SDM in the Santa Cruz area and have
       sent a letter of interest to the California Diabetes Program’s Chief.
      The AHPS-Greater San Diego attended the San Diego Diabetes Coalition steering
       committee, prevention and education subcommittee, and general meeting. At the
       steering committee and prevention and education subcommittee, the AHPS offered
       DIRC as a resource for the Coalition and explained its capabilities for encouraging
       communication and the sharing of resources.
      The AHPS-Greater San Diego met with the chair of the South Orange County Diabetes
       Collaborative and the president of the Orange Association of Diabetes Educators and
       provided an overview of California Diabetes Program activities including DIRC, DCCP
       training, the basic guidelines, and DHRs.
      The AHPS-Greater San Diego discussed collaboration opportunities with a Health
       Promotion Specialist from San Diego County’s East Region. The East Region has
       identified diabetes as an area of concern. The AHPS provided the Specialist with a copy
       of California’s Plan for Diabetes and Performance Improvement Plan to help the region
       plan its diabetes activities.

Q. Tobacco Cessation Helpline- Expand educational activities to healthcare providers.

   1. Collaboration:
       The AHPSs, MMS, and EL participated in a conference call with members of the
         California Smoker’s Helpline (CSH) to discuss current and planned outreach
         activities to Indian Health Services (IHS) clinics throughout the state to promote the
         Be Proactive Campaign. Plans were made to outreach to 10 IHS clinics in the 2006-
         2007 work year for this project.
       The AHPS project lead met with Tobacco Control Section (TCS) staff to discuss the
         changes in the work plan (Activity 1 and 3). The main conclusion of the discussion is
         that the work plan objectives don’t need to be rewritten – but that we need to discuss
         how the focus, measurement and or numbers have changed in the progress reports
         and the final project report.

   2. Educational Materials Development :
       The AHPS-Greater Los Angeles promoted the Be Proactive Campaign to members
         of the San Bernardino Department of Public Health, the Tobacco Use Reduction
         Now (TURN) program, the Associate Director of Latino Initiatives for the ADA in Los




                                               9
       Angeles, members of the Desert Sierra Health Network, and the manager of the
       Health Education Department for LA CARE health plan.
      Be Proactive project materials are currently being updated.
      The AHPSs and partners from the CSH met to discuss the development of materials
       for training the IHS Health Centers to implement the Be Proactive smoking cessation
       for patients with diabetes project.

3. Provider Outreach:
    The AHPS-Northern Central Valley attended the World Conference on Tobacco Or
      Health during the week of July 11, 2006. The AHPS provided a presentation on the
      Be Proactive Project during this conference with the CDC Office of Smoking and
      Health program consultant. The Presentation was attended by about 20 people from
      through out the world.
    The AHPS-San Diego and CSH staff presented to the San Diego Council of
      Community Clinics (SDCCC) Medical Directors to finalize the fax referral pilot
      project. Results from the follow up calls from the patients participating in the fax
      referral program were shared, an evaluation survey was implemented and a
      newsletter was presented to the Medical Directors thanking the SDCCC for their
      participation in the project. Continued support will be provided to the SDCCC as
      needed. More details on this project will be discussed in the evaluation progress
      report on the entire tobacco and diabetes project.
    The AHPSs-North Central Valley and San Diego participated in the Diabetes
      Educators (DE’s) Taskforce meetings this month. A work plan for the project has
      been developed as well as subcommittees to work on the toolkit and AADE
      accredited CEU program. The DE’s, the Helpline, and the Diabetes program will be
      exhibiting at the AADE Conference in LA in August and will preview the “Do You
      CAARD?” campaign, toolkit, and encourage other DE’s to join the project.
    AHPS project lead and DE from Kaweah Health Care District were interviewed about
      the project by Nurses Week Magazine. This issue will be available in the upcoming
      months.
    The AHPS and CSH staff met to discuss the expansion of the Be Proactive program
      in to the HIS health centers. The project will focus on developing ideas for
      integration of the Be Proactive program and intervention in the a clinic setting, work
      with clinics to develop program protocol and training program, then implement the
      training with the point person at each clinic. Develop follow-up questions. Three
      months after the training, follow-up with the clinic point person to assess the
      programs implementation. The group will meet on a monthly basis and is currently
      reviewing the results of the assessment of the IHS survey and focus group from the
      June 2006 event, will connect with contacts from this event, the workgroup will
      review and make suggestions for the update of the fax referral and fax referral
      protocol, and will find a point person to collaborate with at one or two IHS clinics in
      their region by September 29th, 2006.
    The AHPS-Greater Bay Area provided a presentation on the Be Proactive Project to
      Santa Cruz’s CCCN Implementation team meeting. The CCCN Project Manager
      requested copies of the Be Proactive Toolkit. This information will be distributed to
      offices/clinics participating in the CCCN.
    The AHPS-Greater San Diego and CSH staff presented an overview of the California
      Diabetes Program and the results of the fax referral pilot project to the SDCCC
      Medical Directors and conducted a follow-up survey on the project. The AHPS and




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           CSH also conducted a follow-up survey on the project with the SDCCC Healthy
           Communities Access Program (HCAP) Diabetes Care Coordinators.
          The Smoking and Diabetes Task Force developed and sent an email to all members
           of local ADE chapters to publicize the task force’s activities at the AADEs meeting in
           August, including a presentation by the Program Chief, an exhibit by the CSH, and
           an invitation to participate in the Task Force.
          The EL met with DEs working on the Diabetes and Smoking Cessation project and
           gave them an overview of DIRC and how it works. A focus group type discussion
           was also held to explore ways to position DIRC with DEs a useful tool to promote the
           Do You CAARD? Campaign.
          The AHPS-Greater San Diego provided “Take Charge” Gold Cards with the CSH
           phone number to the chair of the South Orange County Diabetes Collaborative,
           along with a materials order form.
          The AHPS-Greater San Diego met with the Program Manager of Project Dulce, an
           educational and clinical management program for people with diabetes offered in
           medical and community settings, and offered the CSH and materials about smoking
           cessation as a resource for the Project’s patients with diabetes.

   4. Evaluation/Reporting
       Discussion of the 2006-2007 work plan update and general discussion of evaluation
         activities was shared during the Evaluation workgroup meeting.
              Action items for the workgroup include: discussing the feasibility with IHS
                  Clinics to share data about their patients. CSH currently collects information
                  from its callers about race/ethnicity, if they were referred by a health care
                  provider, zip code of caller, and whether they have diabetes. If needed, we
                  can use this information to determine if the caller is from a zip code served by
                  one of the clinics.
              CSH has decided to keep the fax referral as an option
       Update on the publication. The main set of interviews for the publication is
         completed. Discussion regarding the value of a publication without outcome data
         entailed: should we do two publications, one about the unique collaboration and
         another focused on outcomes? The group decided to move forward with the
         collaboration publication and then consider a second publication after data has been
         collected on the IHS Intervention and the diabetes educators "Do you cAARd?"
         campaign
       Discussed 05-06 evaluation report. Data is due to Evaluation Consultant by 8/7.
         The TCS has currently not provided detailed information or guidance on the 2005-
         2006 progress report for this project.

R. Sustain and increase BRFSS and CHIS questions related to National Objectives.
     ESL worked with CA BRFSS on the 2007 BRFSS diabetes module skip-pattern and
      notes to address the issue on data gap between California and Centers for Disease
      Control and Prevention (CDC).
     ESL continues work with CDC Genomics and California Health Interview Survey (CHIS)
      on family history questions on 2007 CHIS. An estimate on the cost for different versions
      of the module was given by the CHIS.




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S. Diabetes Surveillance Reports.
     ESL and MMS joined a branch meeting on ideas of improving chronic disease
      surveillance sources with the help from the Tobacco Tax Initiatives. Ideas included buy
      back the CHIS and develop a CA NHANES-like survey.
     Lumetra report on flu immunization was received. The ESL, EL, and Program Chief
      planned to meeting to discuss the report.
    The AHPS-Greater San Diego provided the Orange County and California sections of
      the diabetes prevalence report to the chair of the South Orange County Diabetes
      Collaborative and incoming president of the Orange Association of Diabetes Educators,
      and the San Diego and California sections to the medical directors of the SDCCC and
      representatives from the CMAF Network of Ethnic Physician Organizations.

Additional Program Updates

   DPPI: The Diabetes Primary Prevention Initiative Project:
    The Program Chief and AHPS-Greater Los Angeles continue to participate in the
     Interventions Focus Area. Partners are currently being recruited and interviewed as
     potential partners for Phase II of the DPPI project.
    The AHPS-Greater Los Angeles participated in conference calls with Sutter Hospitals,
     Project Dulce, and Healthy Silicon Valley to provide information on the DPPI project and
     guidelines for those organizations interested in participating in the Phase II intervention.
    The AHPS-Northern Central Valley discussed the DPPI intervention opportunity with
     Sutter health System in Sacramento. Sutter is interested in developing a pre-diabetes/
     diabetes prevention program. This organization will consider applying for the DPPI
     intervention pilot. A meeting with the diabetes program staff and the Sutter Chronic
     Disease Management staff will take place on August 14, 2006 to decide about the
     intervention opportunity.
    The AHPSs-Greater San Diego and Greater Los Angeles, project lead, met with the
     Program Manager of Project Dulce, an educational and clinical management program for
     people with diabetes offered in medical and community settings, to explore Project
     Dulce’s interest in participating in DPPI as an intervention site. The AHPS-Greater San
     Diego met with the Director of the Border Area Health Education Center, who expressed
     interest in providing her affiliated clinic, Chula Vista Family Health Center, as a clinical
     intervention site for the DPPI project, with Project Dulce providing the education.
    Report on California Learning Lab was completed and distributed to DPPI Executive
     Committee, System Dynamic Modeling focus area, and learning lab participants.

       California Engagement (January 2007):
      First planning meeting was held. Planning committee includes Program Chief, ESL, EL,
       California consultant, CDC, and CDC consultants. Discussed the purpose of this
       engagement, the California Diabetes Program’s role as a coordinating leader in
       California, and draft site selection criteria. Next step is it to draft a scope of work and
       instructions for interested organizations.
      SDM Focus Area: (see Karen’s report).
      Surveillance Focus Area: The ESL and a CA surveillance contractor continue to work
       with the members of FA on NHANES analysis, attended CA workgroup meetings and FA
       teleconference meetings.
      DPPI Executive Committee: ESL, EL, and Program Chief attended the Executive
       Committee meetings. (see Karen’s report)




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Other:

   The team met with CDC’s West Team to review progress of activities in the templates.
    Four templates were reviewed leaving the Surveillance and PIP templates to review and
    respond via email. The MMS responded on behalf of the program to the request by the
    Workplan Workgroup for input on the template format.
   The Program Chief and MMS completed a matrix of recommendations for funding
    diabetes and chronic disease projects in the event the Tobacco Tax Initiative is passed.
    Included in the recommendations was broader implementation of the Basic Guidelines
    for Diabetes Care, DCCP, and Diabetes CAGs to improve quality of healthcare delivery,
    as well as, expanding DIRC to be utilized as a communications and reporting too. We
    also supported the idea for a California NHANES, increased project evaluation data, and
    targeted media/public awareness campaigns. We also described our recommendations
    for key elements to build core capacity at the local level which included chronic disease
    coalitions, use of state health department programs and tools, use of DIRC to find and
    share information and data. The diabetes specific request was $20,200,000, though no
    specific line item for diabetes exists in the proposed initiative.
   Maria Elena Avila-Toledo was hired as the AHPS-South Central Valley.
   Tami MacAller was promoted to Senior AHPS.




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