Monday, October 24, 2005—8 a.m.-6 p.m.
Tuesday, October 25, 2005—7 a.m.-noon
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Go Red for Women Sabbath—Greater Kansas City
Metropolitan Area
Author
J. James, American Heart Association, Overland Park,
KS.
Background
• A 2003 American Heart Association study indicated that
only 13% of women believe that heart disease and stroke
are the greatest health threat to women. • Cardiovascular
Disease and stroke are the leading causes of death of
women with nearly 40% of all female deaths occurring from
CVD. The AHA launched the Go Red for Women campaign in
February 2004 to empower women to take charge of their
heart health. Through the success of our faith-based
cardiovascular education toolkit, "Search Your Heart", we
partnered with parish nurses to take the Go Red for Women
message to churches.
Methods
Participants received a Coordinator's toolkit that
provided sample activities, bulletin announcements, sample
messages from the pulpit, reproducible fact sheets and
American Heart Association guidelines and educational
brochures. Sample Educational Activities: -Participants
wore red to church services to draw attention to the
message -Participants signed a "Heart Healthy Pledge" -A
heart healthy meal coincided with services
Results
39 churches participated in the initial Go Red for Women
Sabbath, February 2005, of which 10 were new partnering
organizations, reaching over 5,800. The enthusiasm of the
February Go Red for Women Sabbath created a second event
in May centered on women's stroke health. In May 36
churches participated, of which 28 had neither
participated in the February program nor were "Search Your
Heart" outlets, the reach was approximately 5,400. The new
partnering organizations provided additional outlets for
possibly implementing a consistent curriculum of heart
health education throughout the year.
Discussion
Partnering with faith-based organizations facilitated
reaching over 10,000 Kansas Citians with awareness and
educational tools to improve women's heart health. This
easy-to-implement format provided 1) an opportunity to
reach populations at their place of worship and 2) led to
involvement with potential partners and 3) a secondary
event was created from the original allowing the reach to
double in numbers.
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Medicare Health Support and the American College of
Cardiology: An Innovative Effort To Prevent Complications
of Congestive Heart Failure in Chronically Ill Medicare
Beneficiaries
Authors
J.S. Wright1; M.E. Fitzgerald1; W.J.
Oetgen1; S.A. Thomas1.
1American College of Cardiology, Bethesda, MD.
Background
The mission of the American College of Cardiology (ACC) is
to advocate for quality cardiovascular care - through
education, research promotion, development and application
of standards and guidelines - and to influence health care
policy. Congestive heart failure (CHF) represents a
massive disease and cost burden in the United States. It
is present in approximately 14% of Medicare beneficiaries,
and its associated costs to the Medicare program represent
43% of expenditures. Clinical studies have shown that
routine care provided to CHF patients is generally
suboptimal when measured by compliance with published
practice guidelines. A separate body of medical literature
suggests that application of population disease management
principles (PDM) to patients with CHF can improve
adherence to practice guidelines, reduce costs, and
improve quality of life scores. Medicare Health Support (MHS)
is an innovative effort to determine if application of PDM
principles to large cohorts of Medicare beneficiaries can
improve guideline adherence and health and economic
outcomes for these patients.
Methods
The ACC is participating in MHS in two ways. We are
working with the Centers for Medicare & Medicaid Services
to develop processes by which the clinical expertise of
ACC can be useful in the analysis of data derived from the
MHS pilot programs. And we are working as partners with
three pilot program awardees, American Healthways, CIGNA,
and Health Dialogs to develop ways to achieve optimal
implementation of published guidelines for the treatment
of CHF patients.
Results
The ACC has developed and distributed to its MHS partners,
a Patient and Physician Agreement for Care and Treatment
(PACT), a two-page tool that will facilitate
implementation of published treatment guidelines.
Discussion
Participation in MHS has the potential to improve
measurably the care given to Medicare beneficiaries with
CHF and, in so doing, to help fulfill the mission of the
ACC.
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People With Diabetes Take Center Stage in Their Care:
Veracruz Initiative for Diabetes Awareness (VIDA) Project
Author
A. Barcelo, Pan American Health Organization, Washington,
DC.
Background
Chronic diseases are the leading causes of morbidity and
mortality in Mexico. Mortality due to diabetes has
increased over the years and is now the third leading
cause of death in Mexico. National data indicated that in
the year 2000, 66% of people diagnosed with diabetes had
inadequate glycemic control. The objective of the VIDA
project was to evaluate a comprehensive approach to
diabetes care.
Methods
The one-year intervention consisted of in-service training
of primary care personnel on diabetes management and foot
care and the implementation of a structured diabetes
education program. Ten health centers (five cases, five
controls) in Veracruz, Mexico participated. Primary care
personnel and hospital staff were trained to identify
problems that prevented them and their patients from
achieving good diabetes control and to develop solutions.
To evaluate the intervention, all centers implemented a
clinical information system and all people diagnosed with
diabetes were offered two (baseline and end of project)
glycated hemoglobin (A1c) tests.
Results
The intervention group significantly improved metabolic
control as measured by HbA1c. The number of people with
diabetes and good metabolic control increased from 28% to
40% (p= 0.01) in the intervention group, while among the
controls the proportion only increased from 21% to 28% (p
=0.22). Documented foot care education increased to 75%
among cases and only to 34% among controls.
Discussion
The VIDA project demonstrated that a comprehensive
approach can improve the quality of diabetes care in a
primary care setting. Some key elements of this
methodology are a well-functioning health care team and
the participation of people with diabetes, which is a
strategic element that could ensure sustainability. This
methodology utilizes a systematic approach based on a
combination of patient education, in-service training for
primary care teams and initiatives generated from within.
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Pathways to a Medical Home: Mini-registration from ER
to Public Health Clinic
Authors
M.S. Haupt1; K. Tiernan1.
1University of Texas Medical Branch at Galveston,
Galveston, TX.
Background
Access to a medical home is a priority health service
issue. At our medical center, over 1,000 unsponsored
clients from one county alone were accessing primary
health care at the emergency room. This created a burden
for both the ER to triage and treat the vast number of
patients and also for the clients who had long waits for
episodic care. This problem, along with other needs, was
the reason our community received HRSA funding to create a
CAP Community.
Methods
Through strategic planning, an agreement was created
between the ER and the local health department (FQHC) to
mini-register clients into a medical home directly from
the ER. Due to the volume of patients, this program was
limited to clients with diabetes, CVD, asthma, and those
who stated that they wanted to obtain a medical home. The
purpose of this presentation will be to explain the
process of developing an agreement, procedures used for
data sharing and reporting, the role of case management
and the results of the program to date.
Results
Results from over a year of the program demonstrate this
method as an effective way to communicate between
institutions and to follow patients.
Discussion
Most encouraging, 98% of those clients who mini-registered
with a correct phone number and who were later contacted
by the Health department to make an appointment kept their
appointment for follow up services at their new medical
home.
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Diabetes and Diabetic Retinopathy Demonstration
Project
Author
P.L. Hildebrand, University of Oklahoma, Oklahoma City,
OK.
Background
Diabetes is a leading cause of preventable vision loss.
Despite the availability of effective treatment and
broadly endorsed evidence-based guidelines for annual
dilated retinal evaluations (DRE), less than 50% of
diabetics receive annual DRE. Many underinsured
populations have a high prevalence of diabetes, more rapid
progression of retinopathy and difficulty accessing DRE.
Digital retinal imaging using "gold standard" protocols
developed by the National Eye Institute is a high quality,
convenient and cost effective method to provide DRE in the
primary care setting. This project introduced the iScan™
DRE service (Inoveon Corporation, Oklahoma City) into
three community family practice settings with a large
percentage of underinsured patients to determine its
impact on compliance with annual DRE.
Methods
A disease registry of patients with diabetes was created.
Chart abstractions were done to obtain compliance with DRE.
Diabetic patient rosters for each physician were created
by the registry and DRE compliance noted. Eligible
patients were referred for DRE evaluation with the iScan
as an alternative method to routine eye exams. Patients
referred for iScans received a letter advising the need
for DRE and availability of the iScan. Patients were asked
to call for an appointment. If the patient did not call,
outbound calls were made to help schedule patients. iScan
testing included visual acuity, 3D retinal imaging, eye
pressure tests, and standard results reports within 48
hours. Pre and post intervention compliance with DRE were
evaluated. Previously undetected vision threatening
disease was reported to the PCP.
Results
Three clinics participated in the project, enrolling 1776
patients with diabetes. Pre-intervention DRE compliance
was 10% (3-29%); post intervention DRE compliance was 39%
(45-57%).
Discussion
DRE is needed to detect vision threatening diabetic
retinopathy. The iScan coupled with a diabetes disease
registry is an effective and useful method that can
dramatically increase DRE, detect vision threatening
disease and prevent vision loss.
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Oral Health Care and Prevention Education in
Hyperglycemic Gestational Women
Authors
A. McElrath1; B.R. Saunkeah1; S.
McCage1.
1Chickasaw Nation Health System, Ada, OK.
Background
Periodontal disease as a complication of chronic
uncontrolled diabetes is well known. Research now suggests
other relationships as well, such as chronic gum disease
leading to diabetes and cardiovascular disease, and oral
bacteria transferring from mothers to their infants.
During pregnancy, chronic gum disease may cause lower
birth weights and increase the incidence of premature
births. This information may not be widely known beyond
oral health care specialists, and certainly not among the
general population.
Methods
In the Chickasaw Nation Health System (CNHS),
hyperglycemic pregnant women are followed closely in the
Diabetes Care Center (DCC). In 2004 the DCC followed 89
pregnant women diagnosed with hyperglycemia, gestational (GDM),
type 1 or 2 diabetes. The CNHS DCC is unique in that there
is a dental hygienist on site. Accordingly, the DCC
recently instituted a procedural change: all hyperglycemic
gestational women are now routinely referred to the dental
hygienist for preventive screening and education.
Results
The initial visit occurs during the first scheduled GDM
clinic appointment, and consists of a brief visual
screening, dental history and extensive education.
Educational focus is on oral health care of both the
mothers and their babies. Cleanings are scheduled to
coincide with subsequent clinic follow-up visits, with a
goal for GDM women of two prepartum cleanings. Type 1 or
type 2 diabetic women require more aggressive treatment,
with the initial screening and education visit occurring
at the earliest possible date and a goal of three
prepartum cleanings. Postpartum, a six-month recall
program is implemented for the mothers; a nine month baby
well-check appointment is scheduled in the dental clinic.
Discussion
The authors feel that this is an efficient use of
available services, a means of promoting good oral hygiene
behavior at an early age, and novel way to improve
awareness of the link between good oral health care and
chronic disease prevention.
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Diabetic Retinopathy: A Highly Technological and
Innovative Intervention To Improve Detection of Target
Organ Damage
Authors
S. Naidu1; P.L. Hildebrand2; K.D.
Smith1.
1Oklahoma Community Health Services, Oklahoma City,
OK;
2University of Oklahoma, Oklahoma City, OK.
Background
Diabetes is a highly prevalent disease with a rapidly
rising incidence. Retinal imaging (iScan) is a
high-quality, convenient, and cost-effective way of
detecting, staging and monitoring diabetic retinopathy.
IScan technology uses a retinal camera and software
package that captures 7 stereographic fields of each
retina. This technology offers a novel approach to develop
new policy for diabetic retinal screening within the
health-care setting. Oklahoma Community Health Services
has a diabetic population of 862 patients and is a
participant in the National Diabetic Collaborative. The
diabetic population is 64% uninsured, making the goal of
preventing target-organ disease is difficult to achieve.
Methods
A pre-intervention chart audit was conducted on all
diabetic patients. Data regarding baseline ophthalmologic
evaluations were collected. Every diabetic patient was
invited by letter and telephone to participate in retinal
imaging over 1 month; 365 patients were enrolled for free
iScan screening.
Results
The chart audit revealed baseline compliance of 4.5%. The
iScan intervention bolstered compliance to 42%. 302
patients (83%) had normal retinal scans; 60 (16%) received
recommendation for referral to ophthalmology. Of those 60
patients, 8 (13%) were referred for macular hard exudates,
18 (30%) for clinically significant macular exudates; and
34 (57%) for inadequate image quality often due to
cataracts.
Discussion
Clinics with restricted resources often do not have
affordable programs to screen for diabetic retinopathy.
The iScan retinal imaging program is innovative in
bringing affordable technology to provide an essential
service. The intervention revealed a large proportion of
diabetic patients with normal retinal scans, resulting in
enormous conservation of financial resources, as the cost
of the iScan represent 30% of the cost for ophthalmologic
referral. The study reveals that implementation of this
cost-effective technology has enhanced the detection of
retinal disease and significantly increased the referral
rate to ophthalmology for patients with advanced retinal
disease.
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Increasing the Prevalence of Colorectal Cancer
Screening Among Patients Seen at a Community Health Center
via Physician Prompts and Patient Mailers
Author
J.M. Skariah, Midwestern University Chicago College of
Osteopathic Medicine, Forest Park, IL.
Background
This presentation depicts an applied intervention aimed at
increasing the prevalence of colorectal cancer screening
at a community health center located on the south side of
Chicago, Illinois, whose primary mission is to provide
comprehensive primary and preventative healthcare
services.
Methods
A chart review was conducted of all physician encounters
with 280 clinic patients over the age of 50,between
January 1,2002, and January 28,2005.Patients without
documented screenings for colorectal cancer were noted.
First, a "flagged" colonoscopy referral was placed in the
chart . Next, a mailer that included a letter from the
clinic and Spanish/English versions of a CDC brochure from
the "Screen for Life" campaign was sent. It encouraged
patients to return to the clinic to both pick up their
referrals and talk to their doctor about colorectal cancer
screening.
Results
Initial Assessment: • 14.6% (28) have been referred to a
GI doctor for screening (with no record of the assessment
in the chart), have been screened, or have an appointment
to be screened in the near future for colorectal cancer. •
4.6% (13) had been screened, or have an appointment to be
screened in the near future. • 84.6% (237) have not been
referred for colorectal cancer screening. After
Intervention: • 95% (266) have referrals for colonoscopies
in their chart. • 95% (266) were mailed a mailer that
educates them about the importance of colorectal cancer
screening.
Discussion
It is clear that there is a disparity that exists between
colorectal cancer screening in the state of Illinois and
Cook County, and the population that is served by the
health center. According to information provided by the
Illinois Department of Public Health, 58.7% in the state
of Illinois, and 58.4% of individuals in Cook County have
been screened for colorectal cancer in the past year (www.idph.state.il.us),
which is much higher than the rates prior to the
intervention. The intervention was aimed at addressing
this disparity. A 6 month follow-up is planned for further
evaluation.
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Evaluation of Fall Prevention Assessment and
Management of Older Home Health Care Patients
Authors
P.M. Trella1; R. Fortinsky1; D.
Baker2; M. Gottschalk3; M. King4;
M. Tinetti2.
1University of Connecticut Health Center,
Farmington, CT;
2Yale University School of Medicine, New Haven,
CT;
3Yale-New Haven Hospital, New Haven, CT;
4Hartford Hospital, Hartford, CT.
Background
Interventions aimed at evidence-based fall risk factors
are effective, and in-home education provides a distinct
opportunity to reach older patients who are typically at
risk for falls. The Connecticut Collaboration for Fall
Prevention (CCFP) uses evidence-based strategies to train
healthcare providers how to employ fall prevention
strategies. This study investigated fall prevention
strategies reportedly used by home health agency
clinicians whose agencies received CCFP training.
Methods
A self-administered questionnaire was completed by 183
nurses and rehabilitation therapists at 17 home health
agencies between October 2004 and May 2005. Measures
included assessment of fall risk factors, communication
with patients' families, referrals to rehabilitation
therapy or exercise classes at discharge, and barriers to
fall prevention strategies.
Results
Respondents reported "always" assessing the following
evidence-based risk factors: mobility/transfer impairments
(93%), balance disturbances (85%), environmental hazards
(82%), postural hypotension/dizziness (65%), multiple
medications (62%), sensory/perceptive deficits (62%), and
foot/footwear problems (57%). Nurses were most likely to
assess multiple medications, while rehabilitation
therapists were most likely to assess balance
disturbances. Most respondents (94%) reported reviewing
fall prevention educational materials with family members.
At home care discharge, 24% of respondents "often" or
"always" reportedly made referrals to outpatient therapy,
and 15% of respondents "often" or "always" reportedly made
referrals to exercise programs in the community. Patient
noncompliance was cited as the primary barrier to
implementation of fall prevention strategies.
Discussion
Home health agency providers reported incorporating most
evidence-based fall prevention strategies into everyday
clinical practice with older patients and their families.
At the time of discharge, however, more frequent referrals
to outpatient therapy and community-based exercise
programs could help ensure lasting effects of fall
prevention strategies implemented in the home setting.
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Is the Quality Promotion Model Valid?
Authors
L.J. McKibben1; J.C. Banaszak-Holl2;
R.A. Hirth2; A. Shefer3.
1Centers for Disease Control and Prevention
(CDC), Atlanta, GA;
2University of Michigan, Ann Arbor, MI;
3Centers for Disease Control and Prevention
(CDC), GA.
Background
An innovative model of organizational change, the Quality
Promotion Model (QPM), merges resource dependency and
organizational innovation perspectives to explain why
government promotion of standing orders programs (SOPs)
for influenza vaccination of nursing facility (NF)
residents is effective. The QPM posits that receipt of
government intervention to promote SOPs, greater
dependency on government for resources, and abundance of
general resources support change.
Methods
Evaluation data from a 1999-2002 Centers for Medicare &
Medicaid Services (CMS) and Centers for Disease Control
and Prevention (CDC) project in twelve states are used.
Quality Improvement Organizations (QIOs), state-based
private contractors of CMS, collected pre- and
post-intervention survey data in all states, and promoted
SOPs to Medicaid-/Medicare-licensed NFs in seven. The
survey collects information about vaccine programs and
staff perceptions of barriers to SOPs. Government
intervention consisted of QIO programs and relaxation of
CMS rules prohibiting SOP implementation. Characteristics
of NFs from CMS administrative data measure abundance of
general resources and resource dependency.
Results
Logistic regression models support the effectiveness of
government intervention and QIO programs to increase SOP
uptake. External policy disincentives, including legal
authority, were important barriers to implementation, but
less important in states that received high-intensity QIO
programs. Study limitations impeded full QPM validity
testing; however, evidence to support resource dependency
and diffusion of innovation perspectives is present in the
study population of NFs.
Discussion
Policy implications include the need for government to
remove policy barriers to innovations early; increase
intensity of QIO programs; focus on states and NFs that
accept the innovation; and conduct theory-based quality
promotion research. Alternative policies, e.g. stronger
regulation, public reporting and pay-for-performance
incentives, should supplement quality promotion to achieve
public health goals.
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The National Registry of Effective Prevention Programs
(NREPP): Facilitating Effective Identification and
Dissemination of Prevention Programs
Authors
L.C. Patton1; D. Snipes1.
1Westat, Rockville, MD.
Background
U.S. demographic projections indicate that by 2030, people
over the age of 65 are expected to account for 20 percent
of the population, up from 13 percent today. Current
research indicates that as many as 17 percent of older
adults misuse and abuse alcohol and prescription
medications. Nearly 20 percent of those misusing alcohol
and prescription medications age fifty-five and older
experience mental health problems not considered part of
the normal aging process. The Substance Abuse and Mental
Health Services Administration (SAMHSA) developed the
National Registry of Effective Prevention Programs (NREPP)
in 1998 to better facilitate effective identification and
dissemination of prevention programs targeting substance
abuse. The newly revamped system, the National Registry of
Evidence-based Programs and Practices, has expanded to
include all programs and practices for preventing and/or
treating mental health and substance use disorders.
NREPP's evaluation process determines if the program is
appropriate for dissemination to the field and is rated by
three qualified independent reviewers who base their
scores on scientific merit and utility. Programs receive a
NREPP rating in one of four categories: (4) Effective, (3)
Conditionally Effective, (2) Emerging and (1) Program or
Practice of Interest. A recent revision of NREPP offers
many opportunities for expanded inclusion of older adult
programs into the new registry. NREPP seeks to bridge the
science to service gap by providing easily accessible
information on best practices and programs. Delivery of
effective and reliable services to older adults can
decrease the disabilities and impairments associated with
mental health problems and substance abuse in late life,
while increasing the quality of life for this rapidly
growing population.
Methods
N/A
Results
N/A
Discussion
N/A
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Building a Bridge From Youth to Older Adulthood
Authors
E. Brown1; B. Canada2.
1University of Tennessee, Knoxville, TN;
2Family-Security, Incorporated, Knoxville, TN.
Background
Gorman-Smith & Tolan (1998) found that inner city youth
are exposed to high levels of community violence. Babies
born in the United States are expected to live, barring
any geographical locations, family demographics,
socio-economic status, race/ethnicity, or violence, to
greater than 70 years of age. However, once the risk
factors are taken into consideration babies may not
survive to adulthood and especially older adulthood.
Race/ethnicity, geographical locations, such as the inner
city or urban areas have been studied as being significant
factors affecting youth development. Family-Security,
Incorporated, a 501 [c] 3 organization, whose mission is
to strengthen the family, implemented a healthy kids camp,
this Summer 2005. Family-Security, Incorporated is
attempting to reach the youth with the goal of providing a
bridge to older adulthood.
Methods
Inner-city youth, located in Knoxville, Tennessee, were
the participants of the four-week healthy kids camp.
Topics covered included nutrition, resiliency skills,
conflict resolution, physical activity, healthier living
through creative expression, stress management, and
writing skills.
Results
The initial program was successful and has been a catalyst
for future programs, such as an afterschool/tutoring
program. The afterschool program will provide a structured
environment where youth can be nurtured to grow and
develop in a positive and safe learning environment.
Discussion
More programs and initiatives need to be developed in the
inner city for youth to help curtail those vulnerable
hours afterschool and during the summer when they might be
unsupervised. More research needs to be conducted and
policies written to contribute to the body of knowledge on
reducing risks for youth.
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Harvest Health: A Chronic Disease Self-Management
Program for Older African Americans
Authors
N.L. Chernett1; L.N. Gitlin1.
1Thomas Jefferson University, Philadelphia, PA.
Background
Chronic health conditions are the major cause of illness,
disability and death in the United States, with African
Americans bearing a greater burden compared to Whites. The
Chronic Disease Self Management Program (CDSMP), a 6 week
education program developed by Dr. Kate Lorig at Stanford
University, has been found to improve health status and
self efficacy, and reduce health care utilization in white
middle class elders using randomized trials. The Harvest
Health Program extends the applicability of the CDSMP to
low income African American elders in an urban community
and seeks to evaluate its impact for this population.
Methods
Four community aging service organizations including the
Area Agency on Aging, a multi-purpose senior center, a
health care network and an academic institution have
collaborated to implement and evaluate the impact of the
CDSMP evidence-based program with 500 African American
elders over a three year period with funding from the US
Administration on Aging. Participants are interviewed at
baseline and at 4 months to evaluate program outcomes.
Results
To date 322 persons have participated in the program with
a retention rate of 87%. Year one outcomes for 94
participants indicate significant increases (p=.000) in
stretching and strengthening, with a trend towards
increases in aerobic activity (p=.076) and a significant
reduction in health distress (p = .000). Ninety-five
percent report continuing to use strategies developed
during the program to increase physical activity; improve
their diet and increase use of symptom management
techniques.
Discussion
Harvest Health thus far demonstrates the utility of the
evidence-based CDSMP to positively impact health behaviors
and enhance the health of a traditionally underserved
population. The collaborative approach linking community
service organizations with healthcare organizations to
offer accessible, high quality disease prevention
programming to underserved populations with chronic
conditions is an important replicable model that can be
used to implement other evidence-based programs.
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"Small Steps. Big Rewards." Primary Prevention of Type
2 Diabetes
Author
J.M. Gallivan, National Institutes of Health (NIH),
Bethesda, MD.
Background
Over 41 million Americans are estimated to have
pre-diabetes, putting them at risk for type 2 diabetes.
The majority of these potential cases of diabetes can be
prevented if people at risk lose 5 to 7 percent of their
weight by getting 30 minutes of physical activity 5 days a
week and following a low-fat diet. The U.S. DHHS' National
Diabetes Education Program has translated the key findings
from the Diabetes Prevention Program clinical trial into a
national public awareness campaign, called "Small Steps.
Big Rewards. Prevent type 2 Diabetes" (SSBR).
Methods
In addition to general audience PSAs, SSBR includes
tailored PSAs and educational materials for high risk
audiences – i.e., African Americans, Hispanic/Latino
Americans, Asian Americans and Pacific Islanders, American
Indians and Alaska Natives, and Older Adults. SSBR has
introductory tip sheets for each high risk audience and a
comprehensive toolkit for consumers who want to become
actively engaged. SSBR also has a teaching tool in place
for lay leaders conducting programs for older adults and a
comprehensive guide for health care professionals.
Attendees will learn: 1) Techniques for promoting and
disseminating the campaign messages to the media and
through nontraditional channels. 2) How to use the
teaching curriculums to develop effective primary
prevention for older adults. 3) How to use tools for
health care professionals to identify and treat
pre-diabetes.
Results
Since SSBR was launched in 2004 more than 512 million
people have been reach through PSAs and news stories. In
addition, more than 200,000 copies of high risk audience
tip sheets have been distributed, more than 50,000 patient
toolkits have reached those at highest risk for developing
diabetes and more than 15,000 health care professional
toolkits are in use across the country.
Discussion
SSBR educational tools and new curriculums allows lay
leaders/educators in many settings and health care
professionals to become actively engaged in promoting
healthy lifestyles for older adults and populations at
higher risk for developing diabetes.
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Chronic Disease Prevention for Older Adults of Color:
Making Community Physical Activity and Nutrition Programs
Accessible
Authors
C. Gordon1; L.J. Cieslik2; D.
Garrett3; J. Marble4.
1American Society on Aging, San Francisco, CA;
2Milwaukee County Department on Aging,
Milwaukee, WI;
3Health Promotion Consultant, Baltimore, MD;
4Massachusetts Department of Public Health,
Boston, MA.
Background
The U.S. population is aging and becoming more culturally
diverse. By 2050 older adults of color will be 35 percent
(30,000,000) of those 65 and older. Chronic diseases
affect 88 percent of older adults, but disproportionately
affect racial groups: African Americans and Latinos are
more likely to have diabetes, heart disease and cancer,
and African Americans and American Indians/Alaska Natives
are more likely to have limited activities of daily
living. Physical activity and nutrition can prevent or
manage negative health effects, but elders of color are
especially inactive and lack access to healthy foods. How
do you create culturally appropriate programs that provide
access and improve lifestyle choices?
Methods
Many health promotion programs designed for white
populations have not been effectively replicated in
culturally diverse communities. Key practices from
evidence-based studies include behavior change,
engagement, culturally-adapted strategies, health literacy
techniques, access/solutions to barriers, and
multidimensional programming. Examples of how these key
practices can be implemented will be presented from Keep
Moving (Boston), W.O.L.F. - Wellness Works (Milwaukee),
and Project Joy (Baltimore).
Results
Keep Moving community walking clubs: Surveyed its 3,000
participants to improve outreach and training; trained 750
leaders in 5 years; establishes 12 new walking clubs each
year, including Latino, Chinese and African American
communities. Work Out Low Fat (WOLF) for urban Indian
elders: First year data found 75 percent of participants
lost weight; the program was successful in motivating
elders to maintain increased physical activity and better
eating habits. Project Joy for urban African American
middle-aged and older women, church-based: After one year
(n=529) the intervention group achieved clinically
important improvements in cardiovascular disease risk
profiles.
Discussion
Lessons learned from the programs discussed may provide
strategies for engaging elders of color, finding solutions
to barriers, and improving access to evidence-based health
promotion in your community.
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Peninsula Institute for Community Health's Commitment
to Patient Education: Pharmacy Care of Hampton Roads
Presents Helpful Hints to Staying Healthy
Authors
D. Hudson1; J. Goodman1; I. Esinou2;
J. Ambrose1; F. Angela1; E. Gary1.
1Peninsula Institute for Community Health,
Newport News, VA;
2Hampton University, VA.
Background
Community-based healthcare facilities provide health
information and preventive, maintenance and full-service
medical care to medically underserved populations,
reaching individuals with limited access to healthcare
services on a reduced-fee scale. These facilities serve as
a bridge between underserved populations and health
services. The Peninsula Institute for Community Health (PICH)
has been responsive to the healthcare and health education
needs of Newport News and Peninsula area residents in
Virginia since 1978, placing an emphasis on acute and
preventive care and education to patients, both insured
and uninsured.
Methods
In an attempt to increase knowledge levels, promote
healthy lifestyle modifications, and provide educational
literature to its patients, PICH developed an
informational handout to accompany each prescription
monograph filled by the Pharmacy Care of Hampton Roads (PCHR)
discussing diabetes, asthma, elevated cholesterol,
elevated blood pressure, and heart disease to accompany
the prescription monograph as prescriptions are filled by
the central-fill pharmacy, Pharmacy Care of Hampton Roads.
Patients will receive a pharmacy patient satisfaction
survey to measure knowledge, particularly perceptions of
disease state and treatment / prescription regimen
understanding.
Results
This project demonstrates PICH's commitment to promoting
on-going patient education of these five disease states
and overall improved health status. The handout includes a
description of the disease, symptoms associated with the
disease, and suggested lifestyle modifications. Data has
not been collected.
Discussion
One of the two overarching Healthy People 2010 goals is to
eliminate health disparities among minority segments of
the population, such as the poorer health status of racial
and ethnic minority sub-group populations and the
inadequate access to healthcare services. Although
research shows that the interfacing of genetics, physical
and social environment, and lifestyle impact health
disparities, other contributory factors include income,
education, and health insurance status.
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Multiple Strategies for Promoting Appropriate
Antibiotic Use in the Community: CDC's National Campaign,
Get Smart: Know When Antibiotics Work
Author
D.D. Johnson, Centers for Disease Control and Prevention
(CDC), Atlanta, GA.
Background
CDC is engaged in a process to improve collaboration to
improve service to our customers, and increase the
agency's impact through improved marketing and program
evaluation. Presently three distinct programs are
collaborating to combat antimicrobial resistance, each
previously addressing this problem in isolation. There are
several reasons why integrating efforts has proven
beneficial. These reasons include a better coordination of
services provided to CDC funded community-based
collaboratives.
Methods
Development of treatment guidelines, educational
materials, and strategies to promote appropriate
antibiotic use are key. A social ecological framework is
used to describe individual and social environmental
factors that determine antibiotic use and prescribing.
Campaign activities include a national media campaign,
developing and distributing educational materials, funding
sites/ providing technical assistance, developing and
testing Health Plan Employer Data and Information Set
performance measures, and developing curricula for medical
professionals.
Results
Integrating efforts has helped focus prevention resources
and activities. Specifically, we have joined forces with
CDCs AR in healthcare settings and agriculture programs.
100 external partners disseminate campaign messages and
develop programs, generating over $15 million in in-kind
support.
Discussion
Integrated strategies, both within CDC and with our
partners, serve to strengthen campaign efforts, maximize
resources, and extend the campaign's reach. We are
establishing new partnerships within diverse audiences,
addressing disparities in access to health information,
insuring that all segments of the population have access
to this pressing public health message.
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Bridging Multicultural Gaps for Health Promotion and
Disease Prevention
Authors
M. Amaya1; P. Juarez1; A. Pena2;
G. Melendez3.
1University of Texas at El Paso-College of
Health Sciences, El Paso, TX;
2FEMAP, Cd Juarez, Chihuahua;
3AYUDA, San Elizario, TX.
Background
The study was designed as a partnership between
researchers and the community to implement a
community-based geo-epidemiologic assessment of exposure
and sources of lead in the border region of El Paso, Texas
and Juarez, Mexico. The objectives were to map the
geographic distribution of lead in soil, assess
indoor/outdoor sources of lead in a GIS-based
representative sample of households and measure blood lead
levels in children. The aim is to transfer and deliver
environmental exposure information and prevent risks to a
diverse community.
Methods
Lead exposure data included maps of the geo-distribution
of ambient lead in soil, household dust wipes, drinking
water and yard soil, and children's blood lead levels.
Community partners interpreted the results based upon
their knowledge of the neighborhoods and extracted
interpretations accordingly, taking into account language,
cultural, and socioeconomic diversity. Four community
partners in El Paso and Juarez worked as equal partners.
The partnership was evaluated. The process included
background review, written questionnaires, and one-to-one
interviews.
Results
Strengths and weaknesses were identified and
recommendations for sustaining the partnership are given.
Political obstacles to collect data were encountered in
Mexico and represented one major stressor to researchers
and community partners alike. Results hold implications
for addressing disparities in risk of environmental
exposures arising from differences in language, culture,
and socioeconomic status unique to the border milieu.
Discussion
We will present partnership evaluation and advocacy
activities including input in public hearings,
newsletters, community forums, presentations, and TV
interviews. The outstanding result is a more accurate
understanding of the interactions between research and
ethical issues and political that has some bearing on
community-based environmental health research on the
U.S.-Mexico border. An informational strategy was designed
aimed to encourage border residents for risk reduction and
maintain a healthy environment at the household and
community level.
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Making Evidence-Based Lifestyle Programs for Older
Adults Ready for Prime Time in Communities: Role of the
CDC’s Healthy Aging Research Network (HAN)
Authors
J.R. Sharkey1; B. Belza2; M.A.
Altpeter3.
1Texas A&M University, College Station, TX;
2University of Washington, WA;
3University of North Carolina at Chapel Hill,
Chapel Hill, NC.
Background
Achieving an improved understanding of the factors that
influence the process of translation into diverse
community settings requires increased collaboration
between researchers and community program leaders. To that
end, the HAN is participating in site visits to
evidence-based community prevention programs specifically
to identify critical barriers and facilitators to
successful translation and to develop recommendations for
both researchers and community leaders.
Methods
Academic researchers from HAN sites at Texas A&M, UNC-CH,
and U. Washington conducted site visits (2004-2005) of 9
AoA-funded evidence-based disease prevention programs in
TX, OR, CA, PA, and NY. These programs focused on
nutrition, physical activity, disease-self management,
medication management, or depression. During each of the
site visits, we observed intervention activities and
partnership meetings, interacted with program
participants, and provided technical assistance. Of
particular interest was assessing the suitably of the
original interventions (typically developed and tested on
middle class white populations in clinical settings) for
multi-cultural community agencies.
Results
The targeted populations represent older African
Americans, Hispanics, Native Americans, Asians, and
non-Hispanic Whites. Population diversity issues
identified during the site visits included: 1) greater
heterogeneity of setting and target population than in the
original research; 2) ensuring cultural appropriateness of
intervention ingredients; 3) fidelity to original
research; 4) influence of organization and partnership
changes; 5) recruitment and retention; 6) staffing; and 7)
meaning of adherence.
Discussion
Successful spread of evidence-based health promotion,
especially in diverse populations, requires new knowledge
to community leaders and for researchers. The work of the
HAN is to enhance community collaborations to deliver and
sustain evidence-based programs without changing the core
evidence-based features. This experience will influence
HAN research and dissemination as well as helping
communities to extend outreach.
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Understanding and Enhancing Adolescent Health Through
Community-Based Collaborative Action Research (CBCAR)
Authors
J.K. Brandt1; M. Johnson2; A.
Skrypec Finn1; L. Moore3; T. White1;
D. Xiong1; M. Dexheimer Pharris1; P.
Cosby3; C. Wilson3.
1The College of St. Catherine, St. Paul, MN;
2The College of St. Catherine, Minneapolis, MN;
3NorthPoint Health and Wellness Center,
Minneapolis, MN.
Background
This presentation describes a research methodology
designed to engage adolescents and the community around
them in a dialogue about the meaningful patterns of health
for youth. For this study, the identified community is
North Minneapolis, a richly diverse neighborhood on the
northern edge of Minneapolis, Minnesota, which is
predominantly African American, Southeast Asian,
Caucasian, Latino, and American Indian. Health disparities
within this community are some of the greatest in the
United States.
Methods
Community-based Collaborative Action Research (CBCAR)
engaged adolescents within North Minneapolis in a dialogue
about the meaning of health experiences for youth within
their community. Interviews and focus groups were held
with individuals between the ages of 15-24 who
demographically represented this multiethnic community
where health disparities are some of the greatest in the
nation. Once identifiers were stripped from transcripts,
this data was taken to the larger community where the
researchers and community members engaged in a dialogue to
identify patterns and interpret the meaning of the
findings.
Results
Seventy-eight youth who demographically represent North
Minneapolis participated in this process. Data analysis
was done by the research team and forty community members.
Significant findings were woven into several hip-hop
songs, which creatively focus on the role of adults in
teens' lives, environmental factors contributing to poor
nutrition and the lack of exercise, sexual decision
making, and healthy teen relationships.
Discussion
The next step in the process is the action planning, in
order to determine how to best facilitate the needed
discussion between adults and teen to discern how the
community could be better organized to support teen
health. It is through this transformative dialogue that
communities can move closer to understanding how to best
answer the questions that remain and begin to identify
effective actions that will truly make a difference for
youth in their community.
