donna rice, mba, rn, cde, faade
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Donna Rice, MBA, RN, CDE, FAADE Healthy Communities: The Intersection of Community Development and Health Federal Reserve Bank of Dallas, Houston Branch Houston, Texas September 28, 2011. Mission Statement. - PowerPoint PPT PresentationTRANSCRIPT
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Donna Rice, MBA, RN, CDE, FAADEHealthy Communities:
The Intersection of Community Development and Health Federal Reserve Bank of Dallas, Houston Branch
Houston, TexasSeptember 28, 2011
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Mission Statement
To improve the care and save lives of people with diabetes by creating a new care model focused on health care, education, and research in
South Dallas.
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Key Factors:– Public and private partnership between the City of
Dallas and Baylor Health Care System
– Integration of social, cultural, medical, and economic initiatives
– Innovative approaches to care of diabetes and other related conditions
– Incorporation of community-based, multi-disciplinary research to understand the needs of the community
Fundamental Principles
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Health Equity Improvement ModelD I A B E T E S
Existing Evidence Health Disparity Research
Primary PreventionPrevent/Delay Onset of
Disease
Secondary Prevention Identify/Treat Undiagnosed Conditions Without Symptoms
Tertiary PreventionTreatment of Established
Diseases
Health Promotion & Barrier I.D.
Disease Prevention &
Early Detection
Disease Treatment
1 2 3
Holistic HealthEquity Model
Collective Mission & Collaborative Financial Support
Integration of Social, Cultural Political & Economic Barriers
Multidisciplinary & Community Based Participatory Research
Innovative Approaches toDiabetes & Other Conditions
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SSHI Market: Demographics
• Frazier Community Demographics (2005)– Population – 33,607 (46% M; 54% F)– Race – 84% AA; 14% H; 1% W; 1% O– Avg. Per Capita Income - $9,000
• (Dallas Avg. - $24,444)– Efforts will target South Dallas
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Measuring OutcomesOutcome Measure
Glycemic Control Hemoglobin A1CHealth Indicators − Blood Pressure
− Body Mass Index (BMI)− Urine Microalbumin− Lipid Levels− Flu/pneumonia
Achievement of ADA/Medicare Standards of CareAADE 7 Self care Behaviors
Clinical, process measures, Eye and foot exam Behavior change -Interventions/barriers
Quality of LifeSatisfaction
Diabetes QOL SurveyPatient Centeredness
Patient Participation Rates Enrolled, % participation, drop-outs /no show rates
Health care cost BHCS/BUMC inpatient/ED direct cost analysis/health outcomes
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DemographicsRace/Ethnicity (n=2081) Gender (n=2099)African American 1424 Male 578
Non-white Hispanic 412 Female 1521
White/Hispanic 123 AgeWhite 84 Mean (std) 50 (14.7) yr
Black/Hispanic 36 Min 18 yr
Other 20 Max 95 yr
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DemographicsInsurance
Uninsured 54.4% Medicare 5.5% Medicaid 1.4%
Insured 29.3% Refused 3.9%
Diabetes Type (for those who reported having diabetes n=1002)Type 1 2.3% Type 2 95.2% Pre-diabetes or gestational 2.5%
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Enrollment by Month
Janu
ary
Februa
ryMarc
hApri
lMay
June Ju
ly
Augus
t
Septem
ber
Octobe
r
Novem
ber
Decem
ber
0
50
100
150
200
250
300
20102011
μ2010 = 162 per month
μ2011 = 135 per month
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Program Visits by Month
Janu
ary
Februa
ryMarc
hApri
lMay
June Ju
ly
Augus
t
Septem
ber
Octobe
r
Novem
ber
Decem
ber
0100200300400500600700800900
1000
20102011
μ2010 = 677 per month
μ2011 = 758 per month
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Quality of LifeEQ-5D
No Problems Some Problems Many Problems
Mobility 56.8% 36.5% 6.7%
Self-care 91.0% 8.1% 0.9%
Usual Activities 71.2% 25.4% 3.4%
Pain/Discomfort 34.1% 55.4% 10.5%
Anxiety/Depression
56.8% 36.5% 6.7%Visual Analog ScaleOn a scale from 0 (worst imaginable health state) to 100 (best imaginable health state) , indicate how good or bad your health is today.
Mean Std Median Mode
66.4 21 70 80
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Standards of Medical Care in DMA1c <7.0% n=199
Meets Does Not MeetBaseline 47.2% 52.8%
Follow-Up 63.3% 36.7%
Blood Pressure <130/80 mmHg n= 307
Meets Does Not MeetBaseline 32.6% 67.4%
Follow-Up 39.4% 60.6%
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Standards of Medical Care in DMTotal Cholesterol <200 mg/dL n=1421 at baseline; n=184 at F/U
Meets Does Not Meet
Baseline 70.0% 30.0%Follow-Up 60.9% 39.1%
Triglycerides <150 mg/dL n=1400 at baseline; n=181 at F/U
Meets Does Not Meet
Baseline 49.9% 50.1%Follow-Up 44.2% 55.8%
HDL-C >40 mg/dLn= 1384 at baseline; n=182 at F/U
Meets Does Not Meet
Baseline 62.3% 37.6%Follow-Up 60.4% 39.6%
LDL-C <100 mg/dLn=1275 at baseline; n=163 at F/U
Meets Does Not Meet
Baseline 50.6% 49.4%Follow-Up 46.0% 54.0%
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Participant AttendanceNo-show rates for biometric screenings and health partner visits
and cumulative totals of participants by fiscal quarter
FY11 (July 2010 – June 2011) FY12 (July 2011 – June 2012)†BiometricScreening
Health Partner n
BiometricScreening
Health Partner n
Q1 - - 501 Q1 6% 18% 1696Q2 0% 35% 870 Q2 - - -Q3 10% 29% 1094 Q3 - - -Q4 30% 22% 1499 Q4 - - -
†FY12 only contains data through July and not the entire 1st quarter
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Quality
of S
ervice
Kind of
servi
ce w
anted
Program
met
need
s
Recom
mend p
rogram
Amount
of he
lp
Deal e
ffecti
vely
with pr
oblem
s
Overal
l sati
sfacti
on
Wou
ld co
me bac
k80.0%
84.0%
88.0%
92.0%
96.0%
Client Satisfaction Percentiles
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Diabetes Health & Wellness Institute at the Juanita J. Craft Center
Parks & RecreationPrimary Prevention
ClinicSecondary & Tertiary Prevention
Wellness CenterPrimary & Secondary Tertiary
Prevention
Health Risk Appraisals
Health & Wellness Programs –Nutrition, Exercise, Stress Management
Behavior ModificationHealth Screenings
Health coaches
Individual Enrichment ClassesAdult/Youth Education
Tutoring
Comprehensive EducationAADE Education recognized
Diabetes Self-Management Training (DSMT)Medical Nutrition Therapy (MNT)
Care Coordination:Referrals to education or social services and other
services
Disease State Management/ NCQA Recognized/employee health
Train the Trainer ProgramsDisease state management
Speakers’ Bureau
Health Screenings – Prevention/Fairs(Identifying People at Risk)
Peer Led Self-Management SupportFor People With Diabetes
Recreation/Lifestyle Programs w Health Messaging
Physician directed, teamled, empowerment model
Community Based Research Agenda
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Weekly Farm Stand
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Questions?