Paper 3 – Community Health Improvement Paper
Develop intervention(s) to improve health outcomes.
- Review the health care topic and selected community of focus, addressed in the Community Health Profile paper.
- Perform a stakeholder analysis based on the health care topic.
- Conduct a minimum of three key informant interviews.
- Attend a minimum of one forum where the health care topic is addressed and/or the stakeholders convene.
- Access the Minnesota Department of Health website and familiarize yourself with the intervention model (http://www.health.state.mn.us/divs/opi/cd/phn/wheel.html).
- Access online resources for evidence based interventions that address the health care topic and the target population.
Guidelines for Paper
-Briefly discuss diabetes and pre-diabetes. What is the diagnostic criteria for diabetes and prediabetes.
- Analysis of the health care topic within the context of the community profile, stakeholder analysis, interviews, and forum participation
-Explore statics of diabetes in Buncombe county. Reference the CDC, NC state center of health statistics, and the buncombe county annual report. Links are listed below.
-Discuss the community based-based diabetes prevention & self-management programs in Buncombe County (PDF attached). Reference the PDF as being developed by the Community Health Improvement Project). The document was developed April of 2017 and has not been uploaded to the CHIP website. The document was given to me during an informant interview of L.F. Please discuss and reference CHIP. Please discuss and reference ABCCM.
-Interviews and forum participation is below. You may modify, embellish… Please cite and reference correctly. Transition to – based on informant interview and review the community based programs the community would benefit from an intervention that would increase the identification of pre-diabetes in primary care practice. Provide education to primary care providers regarding diagnostic criteria for pre-diabetes. Pre-diabetes should trigger a referral to a community based program. Evidence to support treatment of prediabetes with prevent the development of diabetes…(discussed more below)
- Evaluate applicable evidence based interventions
-what have other community done? How have they educated primary care providers? Was a system implements, such as an electronic medical record alert, when pre-diabetes was identified in a laboratory finding and subsequent referral triggered? Look for scholarly studies that speak to the interventions. Evidenced based interventions.
- Develop coordinated intervention(s) that improve health outcomes in the target population
-As discussed above.
- Analyze feasibility of successful implementation of selected intervention(s) in your community and with the target population
-What is the likelihood of the above discussed interventions could be adopted in Buncombe county. How would the intervention(s) be implemented?
- Paper length 8-10 pages, not including title and reference pages
- Minimum 10 references, current within 5 years
- APA format and style. Times New Roman, 12 Font
Minnesota Department of Health; (http://www.health.state.mn.us/divs/opi/cd/phn/wheel.html).
See the PDF attachment that lists the referral in the community.
Forum Participation: June 26, 2017; 4:00pm- Attending Research forum: Reviewed and discussed the results of participants in five ongoing research studies that are exploring the risks, benefits, side effects, and outcomes of mediations that in FDA phases 3 and 4 of the trial process. Each study had between 20-50 volunteers. The team included: two physicians; endocrinologists, one family nurse practitioner, a Clinical nurse specialist, a PhD in research coordinator, and 5 PhD research students that were acting as the lead analyst for each of the studies. Each of the PhD students present their resent research finds which consisted of are view of pre and current A1C laboratory findings, which served as the primary indicator of efficacy. Further, side effects, which were few were discussed and other routine laboratory findings, such as CBC, CMP, and UA. Several of the volunteer drop from the studies for a variety of reasons, but none due to side effects. Two of the participant were ill, which was discussed at length with hospital records to be requested and reviewed. The illness did not appear to be related to the research mediation, however thorough documentation was required. All of the participants demonstrated a decrease in A1C.
June 14, 2017; 1:00pm – Dr. S.W., MD.: The purpose of the interview with Dr. S.W. was to glean information about his volunteerism at Asheville Buncombe Christian Community Ministry (ABCCM). Dr. S.W. volunteer once a month at the clinic from 3pm to 9pm. He has been volunteering and the medical clinic for 13 years and describes the experience as “reward to give healthcare to those that have come into hard times, cannot afford insurance, or those that are underinsured.” Mr. S.W. assess a variety of alignments, but primarily sees patients that of diabetes or thyroid disease, as he is a Board-Certified Endocrinologist. He evaluates many of the same patients each month, orders and evaluates laboratory findings, and prescribes the appropriate medication. He admits to not having knowledge of the fee-for-service process except to say, “most do not pay anything or it’s a sliding scale based on their income.” I asked him if you get reimbursed and any tax advantages to which he said, “no, I don’t get any payment for service, except it makes me feel good to give back.” Further he said, “I need to ask my accountant if my time can be a tax write-off, thank you.” Writer: please briefly discuss ABCCM payment structure; link is attached.
June 20, 2017; 3:00pm – Dr. W.L., MD, Endocrinologist: The purpose of the interview with Dr. W.L. was explore what she does to provide care with in her practice for those that do not have insurance or are underinsured. Mr. W.L. is a World Renown Endocrinologist with a passion for diabetes. She is leader in her field and is active in clinical research. Additionally, she travels the world given lectures to other experts in her field. She had just returned from lectures in New York and Los Vegas when we sat down to talk. She explained that she often tries to identify patients that do not have insurance or are under insured for her research studies, as they are given medications for free and receive payment for participating in the study. Additionally, she always codes her encounters at the lowest possible level, which is frustrating to the office manager. For those that pay cash she charges half price for the visit. She also liberally gives medication sample to patients in need. Also, she is well versed in which pharmaceutical company provides prescription savings on mediations. Lastly, and most interestingly, the money she generates from research is funneled to the clinic. Therefore, since the clinic has a surplus of money the providers have elected to exam half the number of patients they would typically have to examine. So, instead of seeing 14 patients they see 7. This has had a profound impact on the quality of care provided, antidotally speaking. I observed the providers taking up to 1 hour examining, listening, collaborating, teaching, being taught, and caring for the patients. The provider report the patient outcomes as improved. Further, the providers have a sense of doing an excellent job caring for patients and not being rushed.
June 26, 2017; 11:00am – Meeting with A.J. a regional pharmaceutical representative with one of the largest pharmaceutical companies in the world. A.J. was excited to shares the many benefits and discount programs available to people in the community, especially those with low income. He gave an example of a current discount program for a medication that would typically cost about $1,400/month that costly $60/month with the discount card. I thought to myself, “that’s still a lot of money for someone that is poor.” Regarding sample, A.J. is not allowed to give them to patients and the allocations provided for the clinics have been decreasing over the last several years. I asked about his knowledge of donating medications to organizations such as ABCCM and was told they are not allow to give medications to charitable organizations. However, he did indicate that it’s common practice for the pharmaceutical reps to give samples to the providers that volunteer at charitable organizations and the providers then deliver the sample to the said organization.
June 28, 2017; 5:00pm – L.F., RN, MSN-Ed, CDE. L.F. is the director of a Diabetes Center at a hospital in Asheville, NC. She is s Certified Diabetes Educator and works closely with community agencies to assess the needs of the community as they relate to diabetes. She is an active member of CHIP, which is (writer please discuss CHIP; see attached link). During out meeting I presenting L.F. with a scenario and asked her to discuss how the scenario would play-out. Scenario: a 24-year-old, African-American, female, uninsured, and at the poverty line, presents to the Emergency Department with a new diagnosis of Type I diabetes, she is in ketoacidosis. L.F. said, “that’s a common and sad scenario.” She went on to explain that the women would be admitted to the hospital and her blood sugars would be stabilized. Once the young women is medicallystable a member of the inpatient diabetes education team would meet with her and assess her knowledge of diabetes and develop an education plan based on her literacy, interest, and preferred method of learning (i.e. audio, visual, face-to-face). L.F. expressed the immense amount of education the young women would need and the reality that it is going to take time to provide the education and the young women may not be ready to learn. The goal in the hospital is to stabilized her blood sugars, give her the basics of short-acting and long-acting insulin, how to use a glucose monitor, what is considered a high and low blood sugar and the associated risks and how to treat them, how and when to administered insulin via a syringe, basic education diet which is to essentially avoid sugar, and most importantly who she is being referred to for follow-up and continued education. In the above scenario, L.F. said that she would refer the young women to the Asheville Buncombe Institute of Parity Achievement (ABIPA). (Writer, please see the link for ABIPA and speak to what the organization does, specifically the diabetes nurse navigator role.)During the interview, I asked L.F. what the community was lacking or would it needed to have a more robust diabetes preventions and management program. L.F. simply stated, “we need to do a better job of identifying those with pre-diabetes and treated them prior to the disease advancing to diabetes.”
Writer: Regarding the development and coordination of interventions to improve outcomes in the target population. Please say something to the effect of after review of the many agencies available to those diagnosed with diabetes, it is this writer’s recommendation that the community would benefit from new and different approach to diabetes. A focus on prevention. A program that would educate primary care provider in the community to be more proactive in the access for pre-diabetes and make a referral to one of the many agencies. Find an article that speaks to the importance of identifying prediabetes. Also, propose writing and obtaining a grant that would provide education for primary care providers about the importance of diagnosing and treatment pre-diabetes. Additionally, grant money for one of the already existing programs to ramp up the pre-diabetes education department. (run with this section). This is the most important part of the paper. After review of the Buncombe community-based diabetes prevention and management programs (reference the referral tool) and after interview key informants, it is this writer recommendation that the community would benefit from improved identification of pre-diabetes in primary care practice and subsequent referral to one of the community programs. This section of the paper will require you to search for scholarly articles that speak to studies and interventions that were attempts in other communities. Explore who has attempts interventions as describe what they did. Evaluate the evidenced based intervention. Then talk about if the same could be replicated in Buncombe county. For example: is there a study that explored the utilization of unified electronic medical records that would alert the providers of a prediabetic laboratory result and would trigger a referral to a community base program? Education of the primary care providers as an intervention. Is the intervention feasible in Buncombe county? What is the likelihood this could be adopted.