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Elizabeth Knaster, MPH Project Coordinator Urban Indian Health Institute

Diabetes Care at Urban Indian Health Organizations: Results from the 2006-2010 Urban Diabetes Care and Outcomes Audit Report December 1, 2011. Elizabeth Knaster, MPH Project Coordinator Urban Indian Health Institute Seattle Indian Health Board. Webinar Agenda.

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Elizabeth Knaster, MPH Project Coordinator Urban Indian Health Institute

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  1. Diabetes Care at Urban Indian Health Organizations: Results from the 2006-2010 Urban Diabetes Care and Outcomes Audit ReportDecember 1, 2011 Elizabeth Knaster, MPHProject Coordinator Urban Indian Health Institute Seattle Indian Health Board

  2. Webinar Agenda • Describe background, methods and layout of report • Presentation of findings • Questions • Discussion

  3. Introduction Background: • Diabetes is a major cause of chronic disease among American Indians/Alaska Natives (AI/AN) • Indian health facilities conduct an annual medical chart review of their patients with diabetes • Audit data are reported by the facilities to the IHS Division of Diabetes Prevention and Treatment (DDTP) • Purpose of this report is to provide a description of the annual Diabetes Audit data collected by participating IHS-funded urban Indian health organizations

  4. Introduction Methods: • Annual Diabetes Audit performed at participating UIHOs • Audit data from 2006-2010 provided to UIHI by DDTP • Weighting of aggregate data Limitations: • Patient population may be different from year to year • Important indicators not captured in this data that may better represent the challenges and strengths of the UIHO programs • Missing data • Varying scope of health care services

  5. Introduction IHS Best Practices: • This report is framed around Diabetes Best Practice Guidelines, first developed in 2001 by a Workgroup coordinated by IHS • The Best Practices are based on the latest scientific research as well as diabetes success stories and experiences within AI/AN communities • Included are selected “key measures” from the Best Practice Guidelines • When possible, we also included comparisons to national standards (GPRA and Healthy People)

  6. Outline of Included Clinical Best Practices • Adult Weight Management • Cardiovascular Disease • Chronic Kidney Disease • Depression • Eye Care • Foot Care • Oral Health • Youth and Type 2 Diabetes

  7. UIHO Diabetes Registries *SUM OF ALL PATIENTS IN EACH REGISTRY ^SUM OF ALL PATIENTS IN AUDIT +NUMBER OF PATIENTS AUDITED/NUMBER OF PATIENTS IN REGISTRY #NUMBER OF URBAN INDIAN HEALTH ORGANIZATIONS PARTICIPATING. DATA FROM IHS DEMONSTRATION SITES ARE NOT INCLUDED

  8. BEST PRACTICE 1: Key Measure 1: Percentage of diabetes patients with documented nutrition education from a Registered Dietitian or other provider in the past 12 months. Key Measure 2: Percentage of diabetes patients with a documented assessment for overweight/obesity in past 12 months. Adult Weight Management

  9. Best Practice 1: Adult Weight Management Key Measure 1: Percentage of diabetes patients with documented nutrition education from a Registered Dietitian or other provider in the past 12 months.

  10. Best Practice 1: Adult Weight Management Key Measure 2: Percentage of diabetes patients with a documented assessment for overweight/obesity in past 12 months.

  11. BEST PRACTICE 2: Key Measure 1: Percentage of diabetes patients who have recent blood pressure measurements that are at goal in past 12 months. Alternative Measure 1: Percentage of patients who smoke that were referred for or provided with smoking cessation counseling. Alternative Measure 2: Tracking of mean blood lipid values among audited patients with diabetes. Cardiovascular Disease

  12. Best Practice 2: Cardiovascular Disease Key Measure 1: Percentage of diabetes patients who have recent blood pressure measurements that are at goal in past 12 months (mean<130/80).

  13. Best Practice 2: Cardiovascular Disease Alternative Key Measure 1: Percentage of patients who smoke that were referred for or provided with smoking cessation counseling.

  14. Best Practice 2: Cardiovascular Disease Alternative Key Measure 2: Tracking of mean blood lipid values among audited patients with diabetes.

  15. Best Practice 2: Cardiovascular Disease Alternative Key Measure 2: Tracking of mean blood lipid values among audited patients with diabetes.

  16. BEST PRACTICE 4: Key Measure 1: Percentage of diabetes patients who were screened for depression in the past 12 months. Depression

  17. Best Practice 4: Depression Key Measure 1: Percentage of diabetes patients who were screened for depression in the past 12 months.

  18. BEST PRACTICE 5: Key Measure 1: Percentage of diabetes patients with a documented qualifying eye exam in past 12 months. Eye Care

  19. Best Practice 5: Eye Care Key Measure 1: Percentage of diabetes patients with a documented qualifying eye exam in past 12 months.

  20. BEST PRACTICE 6: Key Measure1: Percentage of diabetes patients with a documented foot exam in the past 12 months. Foot Care

  21. Best Practice 6: Foot Care Key Measure 1: Percentage of diabetes patients with a documented foot exam in the past 12 months.

  22. BEST PRACTICE 7: Key Measure 1: Percentage of diabetes patients with a documented oral health exam in past 12 months. Oral Health

  23. Best Practice 7: Oral Health Key Measure 1: Percentage of diabetes patients with a documented oral health exam in past 12 months.

  24. Also available in the report is five-year trends for the years 2006-2010 Includes data on patient demographics, vital statistics, exams, diabetes education, immunizations, laboratory services and results, use of standard therapies, tobacco use and depression. Background information about GPRA and Healthy People 2010 targets related to diabetes Report Features

  25. This report summarizes the performance of UIHO diabetes programs using Diabetes Audit data to track select key measures Majority of clinical indicators have remained stable during the past five years Several improvements including nutrition instruction, blood pressure control, tobacco cessation counseling and depression screening Areas of growth and continued improvement Conclusion

  26. About the findings? About the report or its methodology? About the Diabetes Audit? Questions?

  27. More clients are receiving tobacco cessation counseling/referral each year, but the number of smokers remains steady. Why might that be? We are consistently well below the HP2010 and 2010 GPRA goals for Eye Care, Foot Care and Oral Health. Is this a data capture problem or is there limited access to these types of specialty care? What are some possible solutions to this problem? UIHO Discussion

  28. Urban Indian Health InstituteSeattle Indian Health BoardP.O. Box 3364Seattle, WA 98114Phone: (206) 812-3030Fax: (206) 812-3044Email: elizabethk@uihi.orgWebsite: www.uihi.org

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