WELCOME• Host: Dr. David Bang Public Health Advisor, CDC• Lead: Dr. Carolyn Jenkins Latonya Fisher

REACH U.S. SEA-CEED• Topic: Diabetes self-management and other

related clinical practices and delivery care systems.

Session Plan

• Welcome and Ground Rules

• Brief REACH SEA-CEED overview

• Opportunity to hear from you (efforts, successes and challenges)

Do YOU have a STORY?

• What aspect of your work would be best served through a storytelling format? 

• What audience would react best to the storytelling format?

• What storytelling formats are successfully being used by REACH awardees?

REACH U.S. SEA-CEED

Racial/ethnic groups include:• African Americans• American Indians &

Alaska natives• Asian Americans• Hispanics/Latinos• Native Hawaiians/Pacific

Islanders

Health Disparities are focused on:

• CVD• Diabetes• Infant Mortality• Breast & Cervical Cancer• AIDs/HIV• Adult Immunizations

Disparities for African Americans with Diabetes in Charleston and Georgetown

• Lower levels of:– Per capita income– Access to health care– Funding and insurance– Care and education– Satisfaction with care*– Medications and

continuing care– Treatment– Trust in health systems*

• Higher levels of:– Prevalence of diabetes– Complications including:

• Amputations• Renal failure (dialysis)• CVD

– EMS and ED use– Hospitalizations– Costs of care paid by client*– Deaths, especially CVD

*All disparities were first identified through focus groups and validated with epidemiological or quantitative data except those with asterisk. For those with asterisk, quantitative data showed difference in outcome.

Action Team for Change • 4 Coalitions

• Diabetes Initiative of South Carolina• REACH Partners Coalition• 2 County Coalitions

• 85 partner organizations (SC DHEC, Statewide and Community Organizations, Neighborhood Groups, Health Care Systems, Greek Organizations, Faith-Based Groups, Public Libraries, Academic Institutions)

REACH Charleston and Georgetown

Diabetes CoalitionTennessee

South Carolina

SC DHECRegion 6

GeorgetownDiabetes

CORE Group

St. James Santee Health

Center

Enterprise HealthCenter

Enterprise CommunityTri County

BlackNurses

MUSC, MUHAVA Medical CenterDiabetes InitiativeCollege of Nursing

Alpha KappaAlpha Sorority

Franklin C. FetterFamily

Health Center

Trident United Way

GeorgetownGeorgetown

North Carolina

Georgia

CharlestonCharleston

County Library

Statewide REACH home-basedin Columbia: Welvista SC DHEC SC DPCP

American Diabetes AssociationCarolina Center for Medical Excellence

TriCounty FamilyMinisteries

SC DHECRegion 7

County Library

East Cooper Community

OutreachS. SanteeSt. James

Senior Center

Our Coalition Goals• Improve diabetes care and education in 5 health

systems for >13,000 African Americans with diabetes.

• Improve access to diabetes care and self-management education, diabetes supplies and social services for people with diagnosed diabetes.

• Decrease health disparities for African Americans at risk and with diabetes.

• Increase community ownership and sustainability of program.

Community Actions Community-driven educational activities and

healthy learning environments where people live, worship, work, play, and seek health care.

Evidence-based health systems change using continuous quality improvement teams (CQI).

Coalition power built through collaboration, trust, and sound business planning and focused on systems, community, and policy change.

Methods for Collaboration• The health professionals/scientists determine

“science” or “evidence-base” for diabetes care.

• Community leaders/members determine “what, when, where, and how” to apply “science” or “evidence” in their community while generating evidence for community empowerment.

• Together we translate into skills for individual, organizational, systems, and community behavior change, advocacy, and policy change and we evaluate/report our results.

E.T. Anderson and J.M. McFarlane (2006)

Our Community Systems Wheel

External InfluencesExternal Influences

Evaluation Logic Model

CoalitionCoalition

Understanding Context, Causes, & Solutions for Health Disparity

CommunityAction Plan

Planning & Capacity Building

Targeted REACH Action

Existing Activities

Change Agents Change

Widespread Change in Risk/Protective

Behaviors

Reduced HealthDisparity

Community & Systems Change

OtherOtherOutcomesOutcomes

Changes within Organizations• Partners working together developed database to

collect health information (in their programs)• Wellness programs (exercise/physical activity,

cooking classes, screenings for glucose, A1C, BP, lipids, kidney function, foot problems) based in and sustained by the community

• Community gardens (four community in GT, 2 Chas., master gardener classes, and 4 in LPs)

• Media Awareness (Television, Radio, Billboards, bus placards, Banners)

Changes within County• Organizations have come into the community

(FQHC, Public Library, MH, Youth Org., Park & Rec.)

• Park & Rec. adding several activities sites in GT (workout, court, pool, tennis, daycare)

• GT county schools removal junk food & sodas from vending machines

• Local churches have changed foods served

Changes within Health Systems• DSME classes and group visits• Weight management classes• CQI Teams• Community Health Workers for community

education and linkage to health systems• Diabetes “PECS” (now EHRs)• Continuous Quality Improvement Teams

Changes within Health Systems• 2 AADE certified sites• Mandatory attendance at DSME classes• Foot, shoe and wound clinics at sites• New transportation systems• New benefits bank to determine eligible services• Influenza vaccines regardless of ability to pay• Reduced payment for uninsured (some systems)• Expansion of clinic hours• Clinic based physical activity intervention

Changes in Health Professionals

• 10 new African American CDEs who trained with REACH (compared to 1 when REACH started)

Statewide change•Diabetes Advisory Council established the Guidelines for Diabetes Care

•Adopted in 9/2011 and updated in 3/2012

•Presented at the Diabetes Symposium September 2011, by MUSC President Dr. Greenburg •“Diabetes Under the Dome”

Policy Change

• Statewide Guidelines• Law requiring DSME coverage (ERISA)• PCMH and Care Coordination• Foot Care Training for Nurses

Change across States

• PCMH– Care Coordination training for provider

offices integrating SDOH.– Potential National Certification for Care

Coordination.

The Community Chronic Care Conceptual Model REACH Charleston and Georgetown Diabetes Coalition

(Jenkins, Pope, Magwood et al., PCHP 4 (1): 73)

Community Resource Systems

Community Information System

Community & Service System

Design

Community Decision Support

Self-Management Support

Clinical Information System

Delivery System Design

Clinical Decision Support

Patient Self-Management

Support

Prepared, Proactive HealthSystems

Policies & Actions Social,

Health, &Economic

Informed, Activated Persons

External Environment, Resources, and Dissemination influences:

Prepared, Proactive Community

Systems

Improved Community-Wide Health Outcomes and Elimination of Health Disparities

Influences Influences

Health Care Provider Systems

Limitations

• Challenges– Health System in state of change– Time, funds and personnel changes– Contributions of external influences,

community by-in– Legislative support

For additional information

Carolyn Jenkins, DrPHe-mail: jenkinsc@musc.edu

Phone: 843-792-4625