A Newsletter for the HHQI Underserved Populations (UP) Network | September 2016

Welcome to the Underserved Populations (UP) Network e-newsletter, the UPDate.

This quarterly newsletter provides several summaries of news and/or research

that affects underserved populations which may include: Health disparities,

underserved regions, dual-eligible, or small home health agencies.

Underserved Population (UP) Network Announcements

Underserved Populations (UP) Network Quarterly Webinar

October 20, 2016 | 2-3pm ET

Guest Speaker:

All About You! Home Care Services

Read the Success Story, "A Patient-Centered Approach to Home Care" by All About You! The organization's leadership uses innovative interventions to address the needs of patients with behavior and poor health status using a Life Maps Model. During the October UP Webinar their leadership will share more interventions about their approach, interventions, lessons learned, and tips to for improving outcomes of complex patients.

Click here for registration details.

Did you miss the June 2016 UP Network Webinar?

The Delivering Culturally Confident Care: A 365 Approach webinar (60 minutes) provided information and data related to delivering culturally competent care, understanding the changing demographics of the United States and defining culture, diversity, health disparities within the context of changing demographics, beliefs, biases and assumptions and how they impact our patient care delivery and effective cross-cultural communication strategies. Free Nursing (ANCC) CEs available.

Guest Speaker:

Emeobong "Eme" Martin, MPH, Project Manager, Cultural Competence, Adventist Healthcare

UP Network Webinar Schedule:

2016	2017
October 20*	January 19
	April 20
	July 20
	October 19

All webinars will be held from 2-3pm ET.

Unless specified in the table, topics for UP Network webinars are to-be-determined. As soon as more details are available, they will be accessible via the UP page on the HHQI website and emailed directly to those who are subscribed to our Educational & Networking Opportunities mailing list.

* Registration now open

UP News & Highlights

Diabetes is currently the 7th leading cause of death in the U.S. (CDC, 2016). The prevalence of diabetes continues to expand nationally as evidenced by Figure 1 with the changes over a 20 year period. The dark red indicates > 9.0% prevalence in the state. The CDC (2014) reports 1 in 3 adults (86 million) have prediabetes, and unfortunately 90% of those 86 million are unaware of it. The data also shows that without intervention, 15-30% will develop type 2 diabetes within 5 years.

Figure 1: Age-Adjusted Prevalence of Diagnosed Diabetes Among U.S. Adults 1994 to 2014

Source: Click here for the full trending report (CDC, 2015)

Diabetes & Race/Ethnicity

The burden of diabetes is higher for certain racial/ethnic groups than for the white population as evidenced in Figure 2. There are multifactorial reasons for disparities in diabetes prevalence and health outcomes that affect the incidence and management of diabetes. For example, foods may differ among ethnic populations including the types, preparation methods, and seasonings used when cooking. One must consider how tradition and culture play a role in the timing and frequency of meals as well. Geographic location and socioeconomic status may affect availability of healthy food options. Sensitivity to cultural values and other health disparity issues is essential for healthcare clinicians when individualizing education for various ethnic groups. The National Diabetes Education Program (NDEP) offers educational materials for specific racial/ethnic groups.

Figure 2: Diabetes and Race/Ethnicity - Adults 20 years of age and older with diabetes

Source: 2010-2012 National Health Interview Survey and 2012 Indian Health Service's National Patient Information Reporting System (CDC, 2014)

Stroke and Diabetes Connection

Stroke is currently the 5th leading cause of death in the U.S. (CDC, 2015). There is higher stroke mortality in southern regions commonly called the "stroke belt" which is circled in Figure 3.
Research indicates that diabetes and hypertension imparts similar relative risk for stroke (American Stroke Association, 2008). Look at the highest prevalence regions for diabetes in 2014 in Figure 1 (above) and compare with the regions for Stroke Death in Figure 3. This indicates a great opportunity for improvement of diabetes in the stroke belt and associated states to assist in preventing stroke deaths.

Figure 3: Stroke Death, 2011-2013 Adults, Ages 35+, by County

Source: Click here to access the Stroke Fact Sheet (CDC, 2015)

Diabetes Complications

Complications from diabetes adds a great burden to patients, families, and our health systems. Diabetes is the leading cause of:

Kidney failure
Non-traumatic lower-limb amputations
New cases of blindness in adults

Socioeconomic status and other underserved population factors can greatly affect the management of diabetes and preventing complications. Lack of fresh foods (food deserts) in both urban and rural areas, lack or inadequate transportation assistance for medical appointments, and health literacy issues are a few factors that affect the patient's ability to self-manage.

Home health agencies (HHA) are a great setting to teach patient diabetes self-management to prevent incidence, exacerbations, complications, and deaths. There are plenty of evidence-based tools and resources to assist HHAs and their clinicians to assist with develop culturally appropriate plans of actions with patients.

When creating a quality improvement plan you need data for monitoring and evaluation the effectiveness of progress. Unfortunately, the Home Health OASIS Data Set includes only two outcome measures that related to diabetes. Data is available in both Home Health Compare
and CASPER reports.

M2250 Plan of Care Synopsis (SOC/ROC)

(b) Diabetic foot care ...

M2400 Intervention Synopsis (Transfer/Discharge)

(a) Diabetes foot care ...

There are many evidence-based foot care resources below that may assist you with a quality improvement project, including short videos.

Free Tools & Resources

HHQI Disease Management: Diabetes 2016 Update Best Practice Intervention Package

Clinician Tools

Clinical Evidence-Based Strategies for Diabetes
Clinical Diabetic Medication Reference
Diabetes Self-Management Checklist
Multimedia Modules

Diabetes Self-Management Education Programs & Benefits (13 minutes) provides information overview and differences of various evidence-based Diabetes Self-Management Education programs for Medicare Beneficiaries
Evidence-Based Foot Care (11 minutes) provides information related to teaching foot care to patients

Patient Tools

Many of HHQI's patient tools are written at appropriate health literacy levels and available in Chinese, Russian Spanish, and Vietnamese
Multimedia Modules

Diabetes Self-Care (8-minutes) includes information on Hemoglobin A1C , foot care, and more
Healthy Eating (13 minutes) focuses on better food choices and reading labels
Prediabetes and Signs & Symptoms of Diabetes (10 minutes) includes risk factors, what can be done to prevent or delay diabetes, signs & symptoms of hyper/hypoglycemia, and more

Diabetes & Your Heart video (5 minutes) provides patients/caregivers information on how diabetes increases the risk of heart attack or stroke

For more information or to suggest future UP topics or speakers,

please contact us at HHQI@wvmi.org.

Click here for more information about the HHQI National Campaign.

Stay Connected with HHQI

This material was prepared by Quality Insights, the Medicare Quality Innovation Network-Quality Improvement Organization supporting the Home Health Quality Improvement National Campaign, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The views presented do not necessarily reflect CMS policy. Publication number 11SOW-WV-HH-ADL-091516