Project Title. Organization that received the grant. (include name, address, phone and )

Transcription

1 Project Title Wisconsin Office of Rural Health Rural Community Grants Final Report Reducing the Risk of Chronic Disease and Its Complications in Rusk County Indianhead Community Action Agency Organization that received the grant Project Contact Person Diane Winkler (include name, address, phone and ) Grant type (planning or Grant Type: Planning implementation) and amount Amount: $5000 I. Report Summary Based on the outcomes of the 2013 Health Needs Assessment of Rusk County conducted by Rusk County Memorial Hospital (RCMH), Rusk County Health and Human Services (RCHHS) and Indianhead Community Action Agency (ICAA), the top priority to promote healthy lifestyles and wellness activities in the county emerged with a goal of reducing the prevalence of chronic disease. In connection with this goal, the project, Reducing the Risk of Chronic Disease and Its Complications in Rusk County, focuses on (1) raising community awareness and increasing knowledge about the relationship between healthy lifestyles, i.e., exercise, obesity and diabetes prevention; (2) community participation in diabetes prevention programs and increased use of diabetes self-management; and (3) the feasibility of local dialysis services. After collaborating in the development and implementation of the health needs assessment, the tripartnership of RCMH, RCHHS and ICAA continued and became the impetus for the formation of the Rural Health Network of Rusk County (RHNRC). The RHNRC has established a culture of collaboration, achieved a sense of synergy in working effectively together and has spearheaded the WIORH Rural Community Grant project. New RHNRC partners have been recruited from Marshfield Clinic, Rusk County Economic Development, Rockwell Automation, Artisans Inc., Rusk County Community Foundation and other health care professionals to participate as members of the Network s steering committee. Each member organization has signed an MOU which defines the Network purpose, scope and the Network and member responsibilities. A major role of the Network is to assist the county in developing strategies and implementation plans to address issues emerging from the health needs assessment which focus on the promotion of healthy lifestyles including physical activity, healthy diet, and wellness with a goal to reduce chronic disease. Project Planning Year Activities: (1) The RHNRC actively recruited Network members to increase partnerships for the purpose of promoting the reduction of chronic disease and to examine the feasibility of prevention initiatives, given the vast numbers of individuals in RC who are either at-risk of developing diabetes or have been diagnosed with type 2 diabetes, and those already requiring dialysis services who currently travel outside of the county to receive this service; (2) three Community Forums were presented to raise awareness of the magnitude of an approaching crisis situation concerning the incidence of diabetes; (3) the Rusk County Dialysis Feasibility Study 2015 was completed which illustrates the need for dialysis services. II. Report Detail 1

2 1. Provide a description of the progress your collation made on the specific goals, objectives and activities you identified in your proposal including the project s impact and outcomes. Please address each activity separately. Use your original proposal work plan as a guide. Objective #1: Coalition Capacity Building The project planning year was an opportunity to develop partnerships among community organizations which had not yet collaborated or had very limited associations in the past. MOUs were signed by key partners and subcommittees were formed to address awareness and prevention programs and the dialysis feasibility study. Through the group efforts of ICAA, RCMH, Marshfield Clinic and the Aging and Disability Resource Center (ADRC), the project, Reducing the Risk of Chronic Disease and Its Complication in Rusk County, evolved into a mutually rewarding experience while promoting the reduction of chronic disease in Rusk County. The new coalition presented three diabetes awareness/prevention panel discussions during the planning year which are described in detail below. Members are continuing to work together on two future projects in an effort to increase community diabetes education after the 8/31/15 Rural Community Grant end date: (1) RCMH and ADRC are collaborating to present a second evidenced based Healthy Living with Diabetes Workshop to be conducted 9/22/15-10/27/15 at RCMH. This follows their successful partnership earlier this year when they combined efforts to present the first HLWD workshop 2/10/15-3/17/15. The workshop is designed to help adults with pre-diabetes or type 2 diabetes learn self-management skills and increase their confidence in managing their diabetes; (2) Marshfield Clinic is coordinating with coalition members in planning Breakfast with Brock featuring Lou Brock a major league baseball Hall of Fame legend who will bring his diabetes awareness message to Rusk County on November 18 th and share his experiences with managing type 2 diabetes. Objective #2: Increase Community Awareness and Knowledge About the Relationship Between Exercise, Obesity and Diabetes Prevention Three Community Forums were presented during the project planning year. Educational and informational diabetes resources were distributed at each forum. Promoting the forums and raising awareness of diabetes risk factors were carried out in many ways, i.e., newspaper ads, radio PSAs and the WLDY Talk Line Radio Show, Rusk County Chamber of Commerce weekly and monthly newsletters, flyers distributed by the Rusk County Transit Authority to area riders and at frequent destination pickup/drop-off points, by coalition members to colleagues and personal networks throughout the area, and through social media (ICAA website, Facebook). 3/24/15 Diabetes Awareness Panel Discussion As reported in the Rural Community Grant Interim Report, 6 panelists were invited and 31 individuals attended. Diabetes Knowledge Quiz pre- and post-tests were distributed. Evaluation indicated the participants increased their overall knowledge of diabetes. Copies of the evaluation, handouts and a photo of the event were included with the Interim Report. 8/20/15 Eating Healthy with Diabetes, It s Not Just About the Carbs Registered Dieticians, a Registered Nurse, and Certified Diabetes Educators from RCMH and Marshfield Clinic together with the Health Promotion Specialist from ADRC presented step-by-step cooking demonstrations to educate the community about healthy eating with diabetes. Five presenters/demonstrators and 23 community members attended. 2

3 Individuals learned tips and techniques to prepare healthy meals and were able to taste a variety of dishes prepared for the event. Attendees assisted with measuring ingredients for each dish while discussing the importance of portion control. Individuals were asked to compare portion sizes they are accustomed to use at home to the information presented. Samples of homemade hummus, spaghetti squash, lentil vegetable spaghetti sauce, roasted apples and Brussels sprouts, and pineapple angel food cake were available for everyone to taste. Recipes with Nutrition Information were provided as handouts. Marshfield Clinic provided microwavable portion control plates to the first 20 participants. WIORH grant funds were used to purchase the cooking demonstration food items and 10 Month of Meals Diabetes Meal Planner cook books which were given away as door prizes. Diabetes educational handouts, information regarding the upcoming Strong Bones program at RCMH and brochures for the upcoming Healthy Living with Diabetes 6-week workshop were distributed. Pre- and post- tests were distributed at the presentation and later analyzed by the grant evaluator, Dr. Jim Wheeler. A total of 22 individuals completed the 5 item pre-test and 19 completed the post-test. The Item Analysis in Table 1 below, indicates Items 3, 4 and 5 had a significant number of incorrect responses with about 25% missing the correct answer on the pre-test. Post-test results for two of these items did not significantly improve with nearly as many individuals identifying the incorrect answer(s) for Items 3 and 5. However, no participant missed Item 4 on the post-test. The complete evaluation provided by Dr. Wheeler is attached. Group 1 = 8/20 Item Analysis Question 1. Healthy eating for people with diabetes is: ALL OF THE ABOVE: a healthy diet for everyone, includes whole grains, fruits and vegetables, can be individualized to meet your needs, spacing meals and snacks evenly throughout the day 2. The only thing you need to be concerned within a diet for diabetes is the carbohydrate content.: FALSE 3. Which of the groups of foods are good sources of fiber?: BRUSSEL SPROUTS, LENTILES, NUTS. 4. For a healthy diet, at least half of your plate should be which of the following foods?: NON-STARCHY VEGETABLES. 5. A good way to help with portion control at home is to measure how much your cereal bowls and glasses hold.:true TABLE 1 Pre- Percent Incorrect Postpercent Incorrect 9% 0% 0% 9% 32% 27% 23% 0% 27% 27% 3

4 8/27/15 Diabetes Self-Management: Meds, Monitoring and Movement! Presenters were a pharmacist and a retired doctor from Ladysmith and a RCMH physical therapist. The panel was moderated by a Certified Diabetes Educator from Marshfield Clinic. Presenters discussed ways to effectively manage diabetes and pre-diabetes by educating the attendees to understand what various readings during the day can mean, how to manage medications and the benefits of healthy eating and exercise. The Physical Therapist demonstrated several simple low-impact exercises to do at home or at work and explained the purpose/benefits of each physical activity. He also asked the 20 attendees to join in a group exercise to demonstrate valuable stretching and bending routines and the proper use of exercise bands. WIORH grant funds were used to purchase the 20 exercise bands given to the attendees and the 10 pedometers given as door prizes. Pre- and post-tests were distributed at the presentation and later analyzed by the grant evaluator, Dr. Jim Wheeler. A total of 11 individuals completed the 5 item pre-test and 3 completed the post-test. The Item Analysis in Table 2 below indicates Item 4 was missed by all on the pre-test and 67% on the post-test. Individuals attending came into this workshop with a high level of knowledge and information as indicated by the fact that, with the exception of Item 4, only a couple missed any of the other pre-test items. Item 4 was clearly new information that the majority learned during the workshop 100% missed this item on the pretest and 67% missed it on the post-test. The complete evaluation provided by Dr. Wheeler is attached. Group 2-8/27 Item Analysis Question 1. A regular exercise program can: help control blood sugar and can lower blood pressure and cholesterol levels. 2. Food, exercise, diabetes medication and stress can affect the blood sugar level: TRUE 3. Losing weight may have which benefits for people with diabetes?: All of the above (help body use insulin more effectively, lower blood sugar levels, decrease risk of heart disease) 4. Everyone should have a Hemoglobin A1C under 7.0%; it does not matter if they are a child or elderly, healthy or ill.: FALSE 5. Metformin pills and Insulin injections are the only treatments available for a person with elevated blood sugar levels.: FALSE TABLE 2 Pre- Percent Incorrect Postpercent Incorrect 0% 0% 0% 0% 0% 0% 100% 67% 9% 0% 4

5 Objective #3: Examine the viability of providing dialysis services in Rusk County During the project planning year, the Rusk County Dialysis Feasibility Study 2015 was completed by the RCMH Chief Patient Care Officer. The community at large has historically been asking for local dialysis services for many years which supports the research showing patients prefer to receive healthcare close to home when it is available. Persons served in dialysis centers are often associated with diabetes and are elderly. The population of Rusk County is 21.9% over 65 and has limited transportation resources. Driving one hour each way, three days/week for care is a burden to patients and their family members who may also be elderly or need to work. There are currently 25 persons in the RCMH 40 mile service area that are receiving renal dialysis and 3 persons doing peritoneal dialysis at home. There are currently 5 persons in the 60 mile secondary service area receiving dialysis. In addition, there are seasonal residents on dialysis who spend the summer in Rusk County and require dialysis. This feasibility study illustrates the community need for local dialysis services that will most likely increase in the future due to aging of the community and the prevalence of diabetes. The feasibility study recommended next steps are: o Contact the Department of Health Services to determine regulations/standards. o Identify a willing partner for a sight visit. o Identify a location for dialysis center. o Identify a nephrologist. o Appoint a dialysis team. o Conduct a workforce assessment. A copy of the complete Rusk County Dialysis Feasibility Study 2015 is attached for review. 2. Describe modifications, if any, to the original project Work Plan and why you made them. The original project Work Plan was not modified. 3. Describe any data you gathered, how you gathered the data and, if appropriate, how you will use it. The data gathered from the 3/24 Diabetes Awareness Panel Discussion pre- and post-tests shows the participants increased their overall knowledge of diabetes. However, participant interaction with the panelists and attendees throughout the presentation and during the panel Q&A session indicated more community education was needed to address healthy eating, diabetes selfmanagement, patterns of inactivity, and the high prevalence of overweight/obesity. As a result, two additional diabetes awareness panel discussions were held in August 8/20 Eating with Diabetes: It s Not Just About the Carbs! and 8/27 Diabetes Self-Management: Meds, Monitoring and Movement! In review of the 8/20 evaluation, the data from the Item Analysis in Table 1 above suggests that the content for some questions was particularly troublesome, indicating that either the information was not covered in the presentation or that the explanations and examples were not clearly understood by the participants. Further, only 11 of the 20 participants completed the 8/27 pre-test with only 3 completing the post-test which could also 5

6 indicate the explanations and examples were not adequately presented and/or clearly understood by the participants. The validity/reliability of the 8/27 Item Analysis in Table 2 above is questionable given the fact that so few of the participants completed either the pre- or post-tests. In an effort to provide continuing diabetic education, RCMH and the ADRC will be conducting the second HLWD 6-week workshop 9/22/15-10/27/15 and Marshfield Clinic will host Breakfast with Brock on 11/18/15. The HLWD curriculum includes participant questionnaires to be completed at the first workshop session and follow up questionnaires after six months. Preand post-tests will be developed for the 11/18/15 Breakfast with Brock. The data gathered for the 2015 Rusk County Dialysis Feasibility Study 2015 was conducted by the RCMH Chief Patient Care Officer and in consultation with Gundersen Lutheran Medical Center, home of the Peritoneal Dialysis program to hospital inpatients 24/7 and outpatients with acute renal failure. Patients with end stage renal disease receive services as near to home as possible in Gundersen facilities located in La Crosse, Onalaska, Tomah, Viroqua, Prairie du Chien, Richland Center or Black River Falls. The final feasibility study was presented on 6/15/15 to the Reducing the Risk of Chronic Disease and It s Complications in Rusk County project members and on 8/9/15 to the RCMH Board of Directors. A focus group is being assembled to address the next steps. Other findings: a dialysis center in Rusk County is feasible if funding is secured; project meets the minimum critical mass of 25 potential patients; research shows patients are likely to switch to a new facility from other, more distant dialysis locations; Gunderson recommends services be available Mon-Wed-Fridays; Saturdays are possible but transportation could be an issue; Rusk County Transit Commission is being considered as a partner to provide patient transportation; dialysis services could be provided off-site RCMH due to hospital space limitations; dialysis is not a money-making service but it is possible to get a Medicare reimbursement increase if the facility is losing money after three years. 4. Explain other relevant information on the project as appropriate, such as staffing changes, new funding sources and new partnerships/collaborations formed that resulted from the grant. The Project Director and Project Assistant remained constant throughout the project planning year and no staffing changes were made. The UW Population Health Institute annual County Health Rankings for Rusk County have declined since the Rural Community Grant Program application was submitted. Health Outcomes went from 53 rd of 72 counties in 2013 to 68 th in New funding sources are constantly being sought after to continue improving population health and reducing risks associated with chronic disease such as diabetes. Security Health has been identified as a potential funding source to assist with implementing the Centers for Disease Control National Diabetes Prevention Program in Rusk County. The CDC program would be another educational opportunity to complement the work already accomplished during the planning year. The yearlong CDC program helps participants make real lifestyle changes such as eating healthier and increasing physical activity. This proven program can help people with prediabetes and those at risk for type 2 diabetes make achievable and realistic lifestyle changes and cut their risk of developing type 2 diabetes by 50 percent. Another possible funding source is the Medical College of Wisconsin/Healthier Partnership Program which supports Be Well Barron County in the Cumberland School District. The program provides tools and resources to empower 6

7 individuals and families to make lasting positive lifestyle choices and create environments that support healthy lifestyle behaviors. Implementing a similar program in Rusk County schools is being considered to address diabetes/obesity prevention. As the Federal Office of Rural Health Policy is redesigning the Rural Community Program and directing future funds to rural critical care access hospitals, Rusk County Memorial Hospital is a potential candidate to be invited to apply for the next project period. This funding opportunity will be pursued in an effort to continue addressing the needs identified by the 2013 comprehensive assessment of the health needs of Rusk County, i.e., promoting healthy lifestyles, physical activity, healthy diets and decreasing obesity with a goal of reducing chronic disease. As shared earlier in this report, Objective #1: Coalition Capacity Building, was achieved during the project planning year. Members of the Reducing the Risk of Chronic Disease and Its Complications coalition included representatives from RCMH, Marshfield Clinic and ADRC collaborating as a group for the first time. They are maintaining their partnership after the 8/31/15 project end date by presenting the Healthy Living with Diabetes Workshop 9/22/15-10/27/15 and Breakfast with Brock on 11/18/ Describe any funds you received or are pursuing to continue your project after the Office of Rural Health funding ends and whether your coalition will continue working on this or a similar project. No additional funds have been received at this time to continue the project. Future funding opportunities to be pursued are: Security Health to assist with the implementation of the Centers for Disease Control and Prevention National Diabetes Prevention Program in Rusk County; the Medical College of Wisconsin/Healthier Partnership Program which supports Be Well Barron County in the Cumberland School District to assist with the implementation of a similar program in Rusk County schools to address diabetes/obesity prevention; and funds directed to rural critical care access hospitals such as RCMH by the redesigned Rural Community Program will be pursued. III. INFORMATION AND MATERIALS DEVELOPED 1. Describe and submit and reports, documents or materials that you developed through the grant. This could include educational brochures, surveys, photos, etc. Attached please find the following reports, materials and photos: Rusk County Dialysis Feasibility Study 2015 Diabetes Awareness Panel Discussions 8/20/15 and 8/27/15 Flyer and Advertisements Photos (2) of the 8/20/15 panel, Eating with Diabetes: It s not just about the Carbs! Evaluation Reports of the Pre- and Post-Tests taken by participants at the 8/20/15 and 8/27/15 diabetes awareness panel discussions. 2. Submit copies of any public recognition, awards or acknowledgement of your program in local media. 7

8 2014 RCMH Annual Report Acknowledgement of RHNRC and reducing risks associated with diabetes by Charisse Oland, RCMH CEO. Ladysmith News articles: 7/2/15 Partnership Hopes to Improve on County Health Rankings 9/17/15 New Chapter Starts for Rural Health Network IV. FINANCIAL REPORT Amended Budget A modification to the Travel budget item was requested and approved in May The budget revision was due to the panelists for the 3/24/15, 8/20/15 and 8/27/15 presentations being local residents of Rusk County and therefore, travel and related expenses were not incurred. The $477 Travel item was moved to Supplies ($77) and Advertising ($400) in support of the 8/20 and 8/27 diabetes awareness panel discussions. A column titled, Approved Revised Budget (5/2015) has been inserted into the table below to reflect the budget modification. Category Original Grant Budget Financial Status Report Approved Revised Budget (5/2015) Actual Grant Expenditures (through 8/31) Matching/In Kind Contributions (through 8/31) Total Expenditures (Actual + Matching) Salaries *18, , Fringe Benefits Travel Equipment Supplies Consultants/ Contracts Other (Advertisement) TOTAL *18, , *364 in-kind $50/hour = $18,200 Project Director 62 hours Ad Hoc Committee 109 hours Executive Committee 80 hours Steering Committee 113 hours 8

9 Budget Narrative Salaries and Fringe Supported the Project Assistant and Project Evaluator wages and fringe benefits. Matching/In Kind Contributions All Project Director and Committee members time was provided in-kind. Travel As noted above, an amended budget was requested and approved in May 2015 allowing the $477 in Travel to be moved to Supplies ($77) and Other ($400). Supplies Project supplies include items for the 8/20 and 8/27 diabetes awareness panel discussions, i.e., pedometers, xertubes, meal planners, and cooking demonstration items. Consultants/Contracts Stipend to Dr. Ron M. Charipar, MD for his participation in the 3/24/15 diabetes awareness panel discussion. Other Ladysmith News ads for 3/24, 8/20 and 8/27 diabetes awareness panel discussions. 9