2/29/2016. Special Diabetes Program for Indians (SDPI) Challenges Addressed by SDPI. Special Diabetes Program for Indians SDPI

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1 The Oneida Comprehensive Health Division-The Oneida Community Health Center, Oneida, Wisconsin Special Diabetes Program for Indians SDPI Presented by: Tim Moureau, APRN, BC, CDE and Sandra M. Schuyler, RN, BSN, SDPI Coordinator Special Diabetes Program for Indians (SDPI) The Special Diabetes Program for Indians (SDPI) is a $150 million per year grant program that is funded through Congressional legislation and administered by the Indian Health Service (IHS) Division of Diabetes Treatment and Prevention (DDTP). In the Balanced Budget Act of 1997, Congress passed legislation to create the SDPI to treat and prevent diabetes in American Indians and Alaska Natives (AI/AN). SDPI provides this funding to 404 IHS, Tribal, and Urban Indian health programs, serving nearly all Federally-recognized tribes. The SDPI grant programs use evidence-based and community-driven strategies to address diabetes treatment and prevention across the lifespan. Challenges Addressed by SDPI Diabetes is one of the most serious and devastating health problems in the United States, especially for AI/AN people, who suffer from among the highest rates of diabetes in the world. In some AI/AN communities, diabetes prevalence among adults is as high as 60%. The diabetes rate in AI/AN adults is 16.1%, which is almost twice the rate of the total U.S. adult population (8.3%). 1

2 Challenges addressed by SDPI cont., Once found mainly in older adults, diabetes increasingly affects younger AI/AN people, threatening the health, well-being, and quality of life of future generations. From 1994 to 2009, prevalence rates of diagnosed diabetes increased by 110% in AI/AN youth ages years and 161% in AI/AN young adults ages years. 13 Years of Successful Interventions Since 1998, Special Diabetes Program for Indians (SDPI) funding has enabled American Indian and Alaska Native (AI/AN) communities to develop, sustain, and dramatically increase access to quality diabetes programs that are associated with remarkable clinical outcomes. SDPI literally has changed the diabetes landscape across the Indian health system. Based on local needs and priorities, the SDPI grant programs implement proven interventions to address the diabetes epidemic, often where few resources existed before. Increased Access to Treatment and Prevention Services Diabetes Clinics 31% 71% Diabetes Clinical Teams 31% 94% Diabetes Patient Registries 34% 94% Nutrition Services for Adults 39% 89% Access to Registered Dietitians 37% 77% Culturally tailored diabetes education programs 36% 99% Access to Physical Activity Specialists 8% 74% Adult Weight Management Programs 19% 76% 2

3 U.S. American Indian and Alaska Native Population 2.9 million The umber of American Indians and Alaska Natives in Source: U.S. Census, 2010 Census Brief - The American Indian and Alaska Native Population: ( 566 The number of federally recognized American Indian and Alaskan Native Tribes. Source: Bureau of Indian Affairs ( accessed 5/4/2012) Diabetes in American Indians and Alaska Natives 2.3 times higher The likelihood of American Indian and Alaska Native adults to have diagnosed diabetes compared with non-hispanic whites (16.1% vs. 7.1%; 2009). Source: National Diabetes Fact Sheet, 2011 ( 9 times higher The likelihood of American Indian and Alaska Native youth aged diagnosed type 2 diabetes compared to non-hispanic whites ( vs per 1000; 2001). Source: SEARCH for Diabetes in Youth Study ( Diabetes in American Indians and Alaska Natives 110% Percent increase in diagnosed diabetes from 1990 to 2009 Indian and Alaska Native youth aged years (3.24 vs. in American 6.81 per 1000). Source: IHS Division of Diabetes Statistics (unpublished analysis) 1.6 times higher The death rate due to diabetes for American Indians and Alaska Natives compared with the general U.S. population (34.5 vs per 100,000; 2008). Source: Health, United States, 2011: With Special Feature on Socioeconomic Status and Health ( 3

4 Diabetes Complications 1.9 times higher - Incidence rate of kidney failure due to diabetes in American Indians and Alaska Natives compared with the general U.S. population (333.1 vs per million; 2008). Source: 2010 Atlas of End Stage Renal Disease in the United States [Reference Table A] ( 2-4 times higher - Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes. The risk for stroke is 2 to 4 times higher among people with diabetes. Source: National Diabetes Fact Sheet, 2011 ( Cost of Diabetes Results from the Strong Heart Study suggest that the risk for CVD in American Indian adults with diabetes may be 3-8 times higher than those without diabetes. Source: Diabetes Care 2003;26(12): ( 2-3 times higher - People with diagnosed diabetes, on average, have medical expenditures that are approximately 2-3 times higher than what expenditures would be in the absence of diabetes. Source: Diabetes Care 2008;31(3): ( 13 Years of Sustained Achievements in Diabetes Outcomes At the same time that access to these diabetes services increased dramatically, key outcome measures for AI/AN people with diabetes show achievement or maintenance at or near national targets. These results have been sustained throughout the SDPI era. Mean Blood Sugar Source: IHS Diabetes Care and Outcomes Audit 4

5 Mean LDL Cholesterol Goal: LDL ( bad ) cholesterol < 100 mg/dl Outcome: Average LDL cholesterol declined from 118 mg/dl in 1998 to 94 mg/dl in Importance: Improved control of LDL cholesterol can reduce cardiovascular complications by 20%-50%. Source: IHS Diabetes Care and Outcomes Audit Department Mean Blood Pressure Goal: Blood pressure <130/80 mmhg Outcome: Blood pressure has been well-controlled throughout the SDPI era. The average blood pressure in 2011 was 131/75 mmhg. Importance: Blood pressure control reduces the risk of cardiovascular disease among people with diabetes by 33%-50% and reduces the risk of eye, kidney, and nerve complications by about 33%. Lowering blood pressure in patients with early diabetic kidney disease can reduce the decline in their kidney function by 30%-70%. Source: IHS Diabetes Care and Outcomes Audit Use of ACE Inhibitors and ARBs for Blood Pressure Control Treatment with angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) is more effective in reducing the decline in kidney function than is treatment with other blood pressure-lowering medications. Use of these blood pressurelowering medications increased from 42% in 1997 to 72% in Source: IHS Diabetes Care and Outcomes Audit 5

6 Adjusted Incident Rates of ESRD Due to Diabetes, By Race and Ethnicity Between 1995 and 2006, the incident rate of ESRD in AI/AN people with diabetes fell by 27.7% a greater decline than for any other racial or ethnic group. Given that Medicare costs per year for one patient on hemodialysis were $82,285 in 2009, this reduction in new cases of ESRD means a decrease in the number of patients requiring dialysis translating into millions of dollars in cost savings for Medicare, IHS, and other third party payers. Source: U.S. Renal Data System, 2011 SDPI is Fulfilling Congress Vision The SDPI grant programs, now with more than 13 years of experience, implement diabetes interventions that have significantly improved clinical outcomes for AI/AN people. As Congress envisioned, SDPI funding has enabled the Indian health system to make tremendous changes in the diabetes landscape in AI/AN communities. Internal Staff Positions Dental Hygienist 66% devotion This position will help to improve access to dental services. The hygienist will provide dental exams and cleaning for the treatment and prevention of periodontal disease in patients with diabetes. Diabetes Program Supervisor 100% devotion This position will be responsible for the supervision of the Special Diabetes Program for Indians Grant. Registered Nurse, Certified Diabetes Educator 100% devotion This position will provide comprehensive diabetes education for adult and pediatric patients within the Medical Clinic. RN with CDE. 6

7 Internal staff positions continued Fitness Specialist Contracted collaboration between Oneida Community Health Center and Oneida Family Fitness (OFF) Center. Wellness coaching and exercise program for 12 weeks one on one where patients are assigned a wellness coach and fitness specialist. PATIENT CARE SUPPLIES Podiatry Supplies To provide custom made shoes, orthotic inserts, and steel toed work boots to protect and prevent amputations in patients with diabetes. Patient Care Supplies Continued Dental Supplies To provide dentures, crowns, bridges, partials and prosthetics to patients with diabetes. To allow for more uninsured patients to acquire the necessary dental appliances. Optical Supplies To provide low vision equipment to patients with diabetes who are losing or have lost their vision. To allow for more uninsured patients to acquire the necessary optical equipment. We will also assist the Optical Department with the purchase and installation of an anti-theft monitor. Last year we purchased a Humphrey Visual Field Analyzer. Patient Care Supplies Continued Pharmacy Supplies To provide patients with diabetes insulin pump and other related diabetic supplies. Our Insulin Pump budget line significantly increased over the past year to over $121K Medical Supplies (clinic) To provide the Diabetes Program and medical clinic with medical supplies. Medical Alert Bracelets or Necklaces To provide medic alert bracelets or necklaces to indicate specific health care needs if a patient with diabetes and other chronic conditions is unable to communicate. 7

8 EVENTS & ACTIVITY NEEDS Children s recreational supplies Children s activity equipment Healthy Snacks To provide healthy snacks at the following community activity events: Children s Annual Event 450+ participants Diabetes Support Group $250 per month x 12 months, #vary. Annual Golf Outing, 16 teams of 4=64 Participants CONTRACTUAL Podiatrist who will be working four (4) days per week. Estimated cost for Podiatrist, ($80 hourly X 32 hours X 52 wks) 12 hours a $40/hr for additional screening and recreation activities. (costs varies weekly with activity type) x 52 weeks. Diabetes Walk: Oneida Tribe of Indians of Wisconsin Security staff, portable toilets, and music system for dance and stretching exercises. Diabetes annual Event/Taking Responsibility In Addressing Diabetes (TRIAD) Awards Ceremony, educational/motivational speaker. CONTRACTUAL ( cont.) Children s Annual March Event: Activity games, Music system for dance exercises, inflatables for bouncing, and related activities Incentives 10 K Summer Walk/Run $10.00 gas only card for 200 participants for travel to the event and exercise garments appropriate for the activity. Event gas only cards intended to assist participants to get to the event. 8

9 Health Maintenance Incentives-Personal Diabetes Care Record TRIAD program August Diabetes Event Children s Annual March Event Annual Fall Diabetes Awareness Walk Golf Outing Incentives cont., Lifestyle Balance Program Initiatives OTHER Community Event Registration Association Memberships Oneida Printing Room Rentals/Service Charge 9

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