Proyecto Vida Saludable: An Innovative Program for Latino Patients with Type 2 Diabetes

Dawn Heffernan RN, MS Jon Liebman MSN, MSPH Holyoke Health Center

Funded by the Robert Wood Johnson Foundation

Holyoke Health Center � JCAHO accredited

� Federally Qualified CHC

� Western Massachusetts

� 17,277 medical patients

� 6,722 dental patients

� 162 employees

ü 25 medical providers

ü 3 dentists

ü On-site retail pharmacy n One of the highest diabetes

mortality rates in Massachusetts n Nearly 100% of our patients live at

or below the poverty level

Proyecto Vida Saludable: Race, Type of Diabetes

98.4% 97.9% 97.9% 98.3% Type 2 1.8% 2.9% 2.3% 1.8% Type 1 

Diabetes 

2.5% 2.5% 2.6% 2.3% Other/Unspecified 1.6% 1.2% 1.5% 1.4% African­American 9.8% 8.7% 8.% 7.9% Caucasian 85.6% 87.6% 87.9% 88.4% Latino 

Race 

1/26/2006 1/26/2005 1/1/2004 1/1/2003 Year

Proyecto Vida Saludable: Patients with Diabetes :Age of Population

20.3% 19.0% 16.3% 16.6% ≥ 65 42.8% 43.4% 44.6% 45% 50­64 33.5% 33.5% 34.5% 34.5% 30­49 3.5% 4.2% 4.6% 4.3% <30 

Age 

1180 1054 877 773 Total Patients 1/26/2006 1/26/2005 1/1/2004 1/1/2003 Year 

Demographics

Type of Insurance for Patients with Diabetes at Holyoke Health Center

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

100%

Private Uninsured Public

2003 2004 2005 2006

N= 750 853 1016 1122

90.5% 87.9% 86.3% 83.7%

Body Mass Index 2003-2006 2003 8.2%

28.2%

49.5%

14.2%

<25 25-29.9 30.30.9 >40

2004 8.0%

25.6%

48.9%

17.5%

2005 9.8%

25.4%

48.1%

16.6% 2006

8.6%

26.6%

47.9%

16.9%

Holyoke Health Centers Patients with Diabetes

Increase in the Number of Patients with Diabetes at the Holyoke Health Center

0 200 400 600 800

1000 1200

Number of Patients

2003 2004 2005 2006

499

675

873 1061

Program Interventions

n  Initial Focus Groups n  Breakfast Club n  Chronic Disease Self­Management Classes n  Community Health Workers n  Diabetes Education Classes n  Exercise Classes n  Individual Appointments with the diabetes educator and the nutritionist 

n  Snack Club

Breakfast Club n Eleven Sessions n Nutritious Breakfast n Correct Portion Sizes n Balanced Meals n Variety of Foods n New food products

introduced n Label reading n Hands on learning

opportunities n Incentives and raffles

Supermarket Tour

n Practice skills learned in class

n Patients with low literacy levels benefit

n Assess patient knowledge of products and food selection

n Hands on learning

Chronic Disease Self-Management Program n Six, two hour sessions n Intervention Focus

q Goal Setting q Problem Solving q Cognitive Techniques q Breathing Techniques

Community Health Workers

n Bridge between the community and the health center

n Co-lead Programs n Outreach n Telephone Follow-Up n Joint Visits with Providers n Teaching n Social Support n Goal Setting/Problem Solving

Diabetes Education Classes

Exercise Class

Individual Appointments with Diabetes Educator and Nutritionist n Medication Management n Nutrition Therapy n Self-Monitoring Blood

Glucose n Prevention of Complications n Exercise n Preventative Health Care n Diabetes Self-Management

Programs n Goal Setting/Problem

Solving

Drop In Snack Club

n  Informal gatherings n  Meet Program Staff n  Diabetes Bingo n  Raffles with healthy prizes 

n  Goal Setting n  Problem Solving n  Referral to other programs

Significant HA1c Improvements

7.0%

7.5%

8.0%

8.5%

02-03 03-04 04-05 05-06

8.4%

8.1%

7.7% 7.5%

N= 499 675 873 1061

Patients with HA1c less than 7

02-03 03-04 04-05 05-06 0% 5%

10% 15% 20% 25% 30% 35% 40% 45% 50%

29.7% 34.4%

41.8% 46.7%

N= 499 675 873 1061

Patients with HA1c Greater than or Equal to 9

0%

10%

20%

30%

02-03 03-04 04-05 05-06

29.1% 26.1%

23.4% 21.2%

N= 499 675 873 1061

Significant Improvements in LDL

0% 10% 20% 30% 40% 50% 60%

0%

20%

40%

60%

80%

% With LDL Tested

2003  2004  2005  2006  2003  2004  2005  2006

% of Those < 100

N= 351          473       659        749  N=     351       473        659         749

45.4% 53.9% 

62.5%  63.5% 

33.9% 

46.9% 62.5%  49.9%

Percentage of Patients with Controlled Blood Pressure

0.0% 10.0% 20.0% 30.0% 40.0%

02-03 03-04 04-05 05-06

% BP< 130/80

N = 561 692 1033 1136

33.7% 26.6%

34% 33%

0% 10% 20%

30% 40% 50% 60%

70% 80% 90%

# of Visits in Last Year 

02­03  03­04  04­05  05­06

0 1-2 >3

Impact of Outreach

26.1%

54.5%

19.6%

61.7%

1.1%

81.9%

3.3%

71.8%

Conclusions:

n Patients Benefit from a Wide Range of Interventions n Community Health Workers: Integral Role in DSMP n Sustainability of Program

n Utilization of Data to MCO’s n Additional Grant Funding

n Linkage with Other Programs n Healthy Weight in Women n Childhood Obesity Project n Cardiovascular and Diabetes