S u m m i t G r a n t e e 2 0 1 3 2013 Together on Diabetes U.S. Grantee Summit February 25-27, 2013 Atlanta, Georgia TABLE OF CONTENTS About BMS Foundation and NNPHI 1 Acknowledgement 2 Map of Emory Conference Center Hotel 3 Together on Diabetes™ Background 4 Speaker Biographies 9 Workshop Descriptions 20 Participant List 23 Resources 30 Notes 50 CDC Diabetes Report Card About the Bristol-Myers Squibb Foundation The Bristol-Myers Squibb Foundation is an independent 501(c)(3) charitable organization whose mission is to promote health equity and improve health outcomes for people disproportionately affected by serious diseases around the world. For more information about the Bristol-Myers Squibb Foundation, please visit www.bms.com/foundation or follow us on Twitter at www.twitter.com/bmsnews About the National Network of Public Health Institute The National Network of Public Health Institutes (NNPHI) was formed in 2001 to recognize and enhance the work being done in public health by independent, nonprofit collaborative entities. Many states and local jurisdictions have formed these multi-sector organizations with their unique partnerships with government, the business community, academia, and other nonprofits. NNPHI members share certain characteristics of fostering innovation, creating efficient administrative structures, and reaching out to partners outside of the usual governmental arena. The leaders of the individual institutes recognize they share common goals and objectives, which can be enhanced through a formal collaborative network, working in partnership with national public health partners. NNPHI is a 501(c) 3 organization funded primarily by member dues, a cooperative agreement with the Centers for Disease Control and Prevention, and grants from the Robert Wood Johnson Foundation. NNPHI is a membership-driven organization that accomplishes its mission of fostering innovations that improve health through: educational teleconferences; training workshops; collaborative research and information exchange; support for emerging institutes; a bi-monthly newsletter; a website; and meetings such as this one. To learn more about NNPHI, including its members, programs and governance, please visit http://www.nnphi.org. 1 2013 Together on Diabetes Grantee Summit — ACKNOWLEDGEMENTS Planning Committee The National Network of Public Health Institutes and the Bristol-Myers Squibb Foundation would like to acknowledge the 2013 Together on Diabetes™ Grantee Summit Planning Committee. As part of this year’s planning for the Together on Diabetes™ Grantee Summit the following grantees provided valuable feedback to help shape the content of this year’s Summit. Nadia Ali, MPA Camden Coalition of Healthcare Providers Maggie Morgan, JD Harvard Law School Center for Health Law and Policy Innovation Alison Barlow, MPH, MA Johns Hopkins Center for American Indian Health Shelia Plogger Marshall University Center for Rural Health Ben Bluml, RPh American Pharmacists Association Foundation Kim Prendergast, RD, MPP Feeding America Jay Greenberg, ScD National Council on Aging Diana Urlaub, MPH Peers for Progress Program Development Center Jenna Hunter-Skidmore, MPH Kansas Universit Anna Lyn Whitt, LMSW, MPH Mississippi Public Health Institute Michelle Lyn, MBA, MHA Duke University Medical Center Continuing Education Providers The National Network of Public Health Institutes and the Bristol-Myers Squibb Foundation would also like to thank the Michigan Public Health Institute for providing continuing education credits for the 2013 Together on Diabetes™ Grantee Summit. 2 3 ELEV. ELEV. STARVINE FOYER WISTERIA LANES PUB WISTERIA LANES BOWLING ALLEY w w w . e m o r y c o n f e r e n c e c e n t e r. c o m S O U TH W IN G G A R D E N LE V E L DINING ROOM PATIO GARDEN COURTYARD FLOOR SPECIFICATIONS ME ET I N G S PA C E FACI LI T I ES 1615 CLIF TON RD • ATL A NTA , G A • 30329 • 404 712 6000 LOBBY PEACHTREE CREEK STARVINE 1 BALLROOM STARVINE 2 BALLROOM TRILLIUM BOARDROOM ELEVATOR LOBBY Together on Diabetes™ is a five-year, $115 million initiative launched in November 2010 by the Bristol-Myers Squibb Foundation to improve health outcomes of people living with type 2 diabetes in the United States, China and India by strengthening patient self-management education, community-based supportive services and broad-based community mobilization. Consistent with the Bristol-Myers Squibb Foundation’s mission to reduce health disparities, this initiative will target adult populations disproportionately affected by type 2 diabetes. Our Focus The initiative will target adults living with type 2 diabetes – both diagnosed and undiagnosed – who are disproportionately affected by type 2 diabetes. There are three focal points for funding and partnership: − Help adults living with type 2 diabetes to better self-manage their disease and navigate care with sustained and relevant support for the course of their disease journey − Help communities to build, integrate and coordinate medical, non-medical and policy efforts, and expand the base of community organizations actively involved in and bringing their know-how, reach, influence and assets to the fight against type 2 diabetes − Foster a radical rethink and test new ideas about how diabetes control efforts are approached, designed, implemented and measured given the current and future scale of the epidemic and the long duration of the disease journey Together on Diabetes® Partners and Projects in the United States (visit the interactive map at www.togetherondiabetes.com) JANUARY 2013 4 • American Academy of Family Physicians Foundation, in partnership with Peers for Progress, National Council of La Raza and the University of North Carolina’s Gillings School of Global Public Health, received $5,234,876 for a fouryear effort to incorporate patient self-management education, peer support and community outreach for low-income Hispanics and African Americans into the patient-centered medical home model. • American Association of Diabetes Educators received $400,000 for a 12month pilot study of the effectiveness and sustainability of a flexible, multi-level diabetes education and support team that serves minority populations and utilizes professional and lay health workers. • American Pharmacists Association Foundation, working with government agencies, professional associations, pharmacy chains, health centers and others, received $4,384,210 for a four-year effort to adapt and expand the evidence-based Asheville Project model to patients covered by public and private health insurance in 25 communities heavily affected by diabetes. • Camden (N.J.) Coalition of Healthcare Providers and the Cooper Foundation received $3 million over five years to strengthen community-based components of its Camden Citywide Diabetes Collaborative care model by focusing on patient selfmanagement, education and support, care coordination, food access and physical activity programs, and behavioral health and community engagement activities in order to bend the curve on the diabetes burden and health care costs in the city. • Duke University Medical Center and the Durham County (N.C.) Department of Health and Human Services received $6.25 million over five years to create a data sharing system and geospatial map of the diabetes problem in the county and develop, pilot and implement a series of coordinated community-based interventions to improve diabetes self-management, health outcomes and quality of life. • Feeding America, in partnership with three member food banks in Texas, Ohio and California, received $3.1 million over three years to create and pilot bidirectional food bank-health center partnerships that will provide diabetes screening, care coordination, nutrition and disease management education, and healthy foods to adults who are living with type 2 diabetes and food insecure. • Harvard Law School Center for Health Law and Policy Innovation received $981,862 over four years to advise Together on Diabetes on policy and advocacy issues and develop comprehensive state-level policy recommendations for eliminating barriers to care, improving outcomes and enhancing health care policy for patients with type 2 diabetes as part of the Center’s Providing Access to Healthy Solutions (PATHS) initiative. • Marshall University Center for Rural Health, in partnership with the U.S. Centers for Disease Control and Prevention and the Appalachian Regional Commission, received $2.61 million over five years to build the capacity of 10 community diabetes coalitions to implement evidence-based programs that support long-term behavior change and improve the health of people living with type 2 diabetes. The 10 communities are: Louisa, Kentucky; Robbinsville, North Carolina; Georgetown, Ohio; Decatur, Tennessee; Williamson, West Virginia; Murray County, Georgia; Winona, Mississippi; Pomeroy, Ohio; Altamont, Tennessee; and Athens, Tennessee. • Mississippi Public Health Institute, in partnership with the Mississippi Department of Health, University of Mississippi Medical Center and the Mississippi Division of Medicaid, received $484,000 to develop a coordinated, evidence-based, community approach to systematically lower the incidence and severity of diabetes in JANUARY 2013 5 the Delta Region by integrating existing medical and non-medical systems of care, supporting the creation of patient-centered medical homes and developing policies that positively impact environmental and social determinants of health related to type 2 diabetes. • National Council on Aging received $4.87 million over three years to demonstrate a nationally scalable model for delivering the Stanford Diabetes SelfManagement Program on-line and in community settings in partnership with the YMCA-USA, OASIS Institute, WellPoint and Stanford University. • National Network of Public Health Institutes (NNPHI) received $197,027 to develop and host a two-day grantee summit in February 2013 and support an ongoing Learning Collaborative for grantees. NNPHI also will leverage its expertise and network to inform the annual summit and learning community activities, provide leadership and professional development opportunities for grantees, and enhance relationships between grantees and the broader public health practice community. • Sixteenth Street Community Health Center in Milwaukee, Wisconsin, received $163,907 over three years to help Hispanic patients with type 2 diabetes who have fallen out of a doctor’s care for their diabetes to reconnect to care, drawing lessons on linkage-to-care models used for people living with HIV/AIDS. • United Hospital Fund received $2,845,967 over three years to work with the New York City Department of Health and Mental Hygiene and the Department for the Aging to develop and test an integrated, community-based diabetes control strategy for seniors living in “naturally occurring retirement communities” (NORCs) and the surrounding neighborhoods. • University of Kansas received $2,885,944 over five years to develop and implement an online documentation and support system that will help the Foundation evaluate and understand what is being accomplished by Together on Diabetes at the individual project and overall initiative levels, while also helping to improve the individual and collective performance of Together on Diabetes grantees and their projects. 2011 Special Focus Population: African American Women African American women represent one of the highest-risk groups of type 2 diabetes in terms of prevalence and disease burden. In November 2010, Together on Diabetes issued a special request for proposals to encourage, identify and promote new and evidence-based approaches to empowering African American women to control their diabetes while taking into account the opportunity they have to impact the health of their families and communities. Each of the following organizations received two-year, $300,000 grants: • • • University of Virginia received a grant to undertake a comparative study to evaluate the effectiveness of the Call to Health model, which includes supportive text messaging, “buddies,” group visits in clinic and community-based settings and community resource referral and mobilization in partnership with the Charlottesville-Albemarle Community Obesity Task Force. East Carolina University received a grant to implement a behaviorally centered "small changes" approach and care navigation delivered by lay health worker teams in four rural communities in eastern North Carolina. Whittier Street Health Center working with the Boston Housing Authority and Boston YMCA, received a grant to connect African-American women living in public housing with comprehensive diabetes management, including health education and JANUARY 2013 6 • • support by a certified diabetes educator and peer supporter, nutritional counseling by a dietitian, social service navigation, and a tailored program for physical activity in Roxbury. Black Women's Health Imperative working with clinical and faith-based partners received a grant to implement a comprehensive self-management, social support and empowerment program for African American women age 40 and older and their families living in three wards in the District of Columbia. United Neighborhood Health Services received a grant to implement a comprehensive diabetes self-management program in Nashville, Tennessee, that includes clinical care, case management, nutrition counseling, fitness instruction and counseling, structured physical activity, social supports, and stress and behavioral counseling. 2012 Special Focus Population: American Indians in the Southwest American Indians and Alaska Natives suffer the highest rates of diabetes in the nation. Rates are as high as 33.5% in areas of the southwest – Arizona and New Mexico. In November 2011, Together on Diabetes announced a partnership with Johns Hopkins Center for American Indian Health (JHCAIH), 3 Navajo communities and 1 White Mountain Apache community to adapt and implement community evidence-based diabetes practices and a Family Coach model to improve the health outcomes of 250 families in the Southwest. JHCAIH received a grant of $2,173,360 for this two-year demonstration project that will also draw on Native American traditions and identity that support a healthy diet and physical activity. Working with Hispanic Communities According to the U.S. Centers for Disease Control and Prevention, 11.8 percent of Hispanics are diagnosed with type 2 diabetes, compared to the national rate of 8.3%. Lifetime risk estimates for developing diabetes are higher for both Hispanic men and women than for other ethnic groups. Diabetes is also the fifth-leading cause of death among Hispanics in the U.S. Since the start of Together on Diabetes in 2010, the initiative has been supporting projects to develop comprehensive and effective solutions that leverage the strengths of Hispanic communities, culture and health traditions such a promotoras de salud to improve health outcomes and reduce the burden of diabetes in 12 U.S. communities with significant Hispanic populations. 2012 Expansion to China and India In May 2012, Together on Diabetes® announced a $15 million, five-year expansion to China and India, developing nations with rapidly growing numbers of type 2 diabetes patients. The International Diabetes Foundation (IDF) reports that more than 90 million people in China – 9.3 percent of the population – had type 2 diabetes in 2011, the most of any country. That figure is projected to grow to 129.7 million, or 12.1 percent of the population, by 2030. India, which has 61.26 million people diagnosed with type 2 diabetes (8.3 percent of the population), ranks second only to China in total cases and third behind the United States (10.9 percent) and China in terms of prevalence. By 2030, India will have 101.2 million people with type 2 diabetes, IDF projects. JANUARY 2013 7 The initial partners of Together on Diabetes in China are: • Chinese Center for Disease Control and Prevention received US $709,016 over three years to enhance the capacity of rural health care providers to manage and prevent type 2 diabetes at the village level in Western China, where diabetes is growing faster than in China’s cities and where rising medical costs are an important factor leading to poverty. • Shanghai Charity Foundation received US $522,797 over three years to create an efficient and effective community-based, block-by-block approach for managing type 2 diabetes in Shanghai, a mega-city of 23 million people. The initial partners of Together on Diabetes in India are: • Mamta Health Institute for Mother and Child received US $706,995 over three years to pilot a study to determine the feasibility of involving India’s lay community health workers (Accredited Social Health Activists) and integrating various systems of medicine, including modern and AYUSH, to prevent and control non-communicable diseases, especially type 2 diabetes. • All India Institute of Diabetes and Research and Swasthya Diabetes Hospital received US $465,685 over two years to provide medical education about the diagnosis and management of uncomplicated type 2 diabetes to medical officers working in public and community health clinics. • Sanjivani Health and Relief Committee received US $426,374 over four years to conduct a household-by-household study in 348 villages to identify type 2 diabetes and ensure early diagnosis of undetected diabetes among those with prediabetes or at high risk of developing diabetes. The study also will determine the prevalence of type 2 diabetes and related complications among the rural poor. Grant and Partnership Development Funding for US, China and India grantees is being awarded to non–profit organizations through proactive partnership development and invited requests for proposals. The Bristol-Myers Squibb Foundation and Together on Diabetes® welcome and seek opportunities to join forces and resources with other foundations and charities, corporate social responsibility and philanthropy initiatives from diverse industries, and government programs and agencies. For U.S. program and grant inquiries, please contact Patricia M. Doykos via email at patricia.doykos@bms.com. For China and India program and grant inquiries, please contact Phangisile Mtshali at phangisile.mtshali@bms.com. For comprehensive program information, visit our web site www.togetherondiabetes.com. For media inquiries, please contact Fred Egenolf via email at frederick.egenolf@bms.com JANUARY 2013 8 2013 Together on Diabetes Grantee Summit — Speaker Biographies Featured Speakers Ann Albright, PhD, RD Director, Division of Diabetes Translation Center for Disease Control and Prevention Ann Albright, PhD, RD, has served as director of the Division of Diabetes Translation since January 2007. As director, Dr. Albright leads a team of professionals who strive to eliminate the preventable burden of diabetes. Dr. Albright received her doctoral degree in exercise physiology from Ohio State University. She completed an NIH postdoctoral fellowship in nutrition at the University of California, Davis and a clinical internship in nutrition at University of California, San Francisco (UCSF). Before joining CDC, Dr. Albright served as Chief of the California Diabetes Program for the California Department of Health Services and held an academic appointment in the Institute for Health and Aging at UCSF, a position she held since 1995. From 2003-2004, Dr. Albright served as the Senior Health Policy Advisor in the Office of the United States Surgeon General and led the Secretary of Health’s Diabetes Detection Initiative. Dr. Albright lectures and is published in several areas, including exercise, nutrition, and public health practice in diabetes prevention and control. Dr. Albright has served as the American Diabetes Association President for Health Care and Education and has held other leadership roles with the American Association of Diabetes Educators, the American Dietetic Association and the American College of Sports Medicine. 9 Dr. Ann Bullock, M.D. Chief Clinical Consultant for Family Medicine Indian Health Service Ann Bullock, MD is a board-certified Family Physician who has worked with the Indian Health Service and the Eastern Band of Cherokee Indians since 1990. From 2000-2009, she was the Medical Director for the tribe's Health and Medical Division and now serves as its Medical Consultant. She is also the Clinical Consultant for the IHS Division of Diabetes Treatment and Prevention. Her main interests are related to diabetes prevention and treatment, including the role of prenatal and early life risk factors in the development of chronic disease. She has been an author on a number of IHS Diabetes Best Practices, Standards of Care, and Clinical Guidelines. Dr. Bullock is interested in the development of interdisciplinary programs, including complementary approaches and integrating services which address stress, trauma and depression. She is the course director for Indian Health’s annual primary care conference, “Advances in Indian Health”, which occurs each spring in Albuquerque. All Indian Health System clinicians are invited to attend—check the IHS calendar or the University of New Mexico Office of CME website for information on the current year’s conference. Dr. Bullock is an enrolled member of the Minnesota Chippewa Tribe and a member of the Association of American Indian Physicians. She is a Fellow of the American Academy of Family Physicians. Pedro Greer, Jr., MD Assistant Dean of Academic Affairs Florida International University Dr. Pedro J. Greer has an unwavering commitment to and is an advocate for those without access to health care. Throughout his career, Dr. Greer has received numerous awards and Honorary Doctoral degrees. Most recently, he was recognized as a 2009 Presidential Medal of Freedom honoree, and in 1993, he was honored as a MacArthur Foundation "Genius Grant" Fellow. Dr. Greer is board certified in Medicine and Gastroenterology and has been practicing in Miami, Florida since 1991. He established Camillus Health Concern and Saint John Bosco in Miami, Florida, health care centers for persons who are homeless, undocumented, uninsured, and low income. Better known as "Joe," Dr. Greer wrote Waking up in America, an autobiographical account of caring for persons who are homeless. In July 2007, Dr. Greer joined the newly established Florida International University Herbert Wertheim College of Medicine as Assistant Dean for Academic Affairs. He led the creation of the Department of Humanities, Health, and Society, and in January 2009 became its Founding Chair. Dr. Greer and the department faculty have spearheaded a unique undergraduate medical education program to prepare physicians to assess and address the social determinants that affect health care access and health outcomes. The goals are to educate highly skilled, ethical, and culturally competent physicians attuned to the complex health and social needs of South Florida’s diverse populations. Dr. Greer currently serves in various capacities for a multitude of national, state, and local organizations. He is a Trustee at the RAND Corporation (America’s oldest and largest think tank) and is the current Chair of the Pardee RAND Graduate School Board of Governors. Additionally, Dr. Greer served as Chair for the Hispanic Heritage Awards Foundation from 2002 to 2012. He is a member of Alpha Omega Alpha National Medical Honor Society and a fellow in the American College of Physicians and the American College of Gastroenterology. 10 Harrison Jim Sr. Traditional Healer– Navajo Blessing Harrison Jim, Sr. is Dine’. His clans are: Maternal clan - Haltsooi, ei nilii Paternal clan – Kinyaa’aani, ei yashchiin Maternal grandfather’s clan - Tsi’naajinii, ei da’bi cheii. Paternal grandfather’s clan - Tsi’naajinii, ei da’bi nali Harrison is a lifetime resident of the community of Red Rock, New Mexico located near Gallup, New Mexico with exception of the years 1974 through 1977, during which time he completed a tour of duty with the United States Navy. He is certified as a CADC-II and ICADC with the Southwest Certification Board; certified with the Dine’ Hat’aali Association of Window Rock, Arizona as a Traditional Counselor and Consultant; and a certified Peacemaker with the Navajo Nation. He is the Co-founder of the renowned Traditional Program - Hinaa’h Bits’os Society (HBS) of the Na’nizhoozhi Center, incorporated in Gallup, New Mexico. He was employed as a Traditional Practitioner, Counselor and Cultural Teacher with the Navajo Area Indian Health Service Unit - Fort Defiance Indian Hospital Adolescence Care Unit in Ft. Defiance, Arizona. Ft. Defiance SU-ACU is the first hospital based residential program of its kind for the Indian Health Service, and seeks to integrate traditional and western approaches to healing. He is currently employed as a traditional Practitioner, Traditional Counselor, and Cultural Teacher with Northern Navajo Medical Center. He is a strong advocate for integration of cultural teachings and healing, Ceremonies into the delivery of patient services of Residential Treatment, Outpatient Treatment Centers, Educational, and Counseling Programs. Honors received by Harrison: Becoming a recipient of the fellowship award with the Robert Wood Johnson’s Developing Leadership in Reducing Substance Abuse in 2002, Harrison is the only full blooded Native American to receive the distinguished award through out the nation. Being assigned by the Mayor of the City of Gallup, as chair person of the Blue ribbon Task Force in addressing alcoholism within City of Gallup in 2004. Serving as a consultant to Behavioral Health Organizations throughout the country, including schools and Communities located within the Navajo Nation; past to present date. Receiving recognition as a Native Scholar from the University of New Mexico in year 2000. 11 Robert E. Ratner, MD, FACP, FACE, Chief Scientific & Medical Officer Chief Scientific & Medical Officer American Diabetes Association Dr. Ratner provides leadership and oversight of scientific and medical activities including research, clinical affairs, program recognition and certification, medical information and professional education. In this capacity, he oversees the Association's support of a broad range of professional education activities and the development of the American Diabetes Association Clinical Practice Recommendations, clinical consensus reports and expert opinions. Prior to joining the American Diabetes Association, Dr. Ratner was a Professor of Medicine at Georgetown University Medical School and Senior Research Scientist at the MedStar Health Research Institute in metropolitan Washington, DC. He recently completed a sabbatical as a Robert Wood Johnson Foundation Health Policy Fellow, having served as the study director for the Institute of Medicine Comparative Effectiveness Research Priorities Committee, and a program examiner for health reform in the Health Division of the U.S. Office of Management and Budget. He received his MD from Baylor College of Medicine in Houston, Texas where he also completed his Internal Medicine training. He underwent fellowship training in Endocrinology and Metabolism at Harvard Medical School and the Joslin Diabetes Center in Boston. He recently completed six years of service on the Steering Committee of the National Diabetes Education Program (NDEP), representing the American Diabetes Association. He has served on the Board of Directors of the National Certification Board for Diabetes Education and the American Association of Diabetes Educators, and is Past-President of the Washington Area Affiliate of the American Diabetes Association. He has served as the Chair of the Government Relations Committee and the Pregnancy Council of the American Diabetes Association. He is a Principal Investigator for the Diabetes Prevention Program (DPP) and DPP Outcomes Study of the National Institutes of Health (NIH) and serves on the Steering Committee for the project nationwide. At Georgetown University, he served on the University Research Committee, and co-chaired the Joint Oversight Committee for Clinical Research. He is currently an Associate Editor of the Journal of Clinical Endocrinology and Metabolism. His research interests include diabetes therapeutics and complications, with an emphasis on translational efforts from controlled trials into community-based practice. He is the author of more than 120 original scientific articles and 20 book chapters. 12 Expert Faculty of Panel Sessions Leonard Jack, Jr., PhD, MSc, CHES Director, Division of Community Health Centers for Disease Control and Prevention Dr. Leonard Jack, Jr., currently serves as the Director of the Division of Community Health at the Centers for Disease Control and Prevention. Prior to his employment at the Centers for Disease Control and Prevention, he served as the Director, Center for Health Minority Health & Health Disparities Research and Education; Endowed Chair of Minority Health; and Professor in the Division of Clinical and Administrative Services in the College of Pharmacy at Xavier University of Louisiana. Dr. Jack also held the Jim Finks Endowed Chair of Health Promotion and was Professor of Behavioral and Community Health Sciences at the Louisiana State University Health Sciences Center’s School of Public Health. Dr. Jack also served as Associate Dean (the Dean) of the School of Health Sciences and Interim Chair, Department of Behavioral and Environmental Sciences at Jackson State University. He worked for 14 years at the Centers for Disease Control and Prevention in Atlanta, Georgia where he served as Team Leader of Applied Behavioral Research, Epidemiology, and Evaluation; and Chief of Community Intervention in the Division of Diabetes Translation. Dr. Jack’s areas of research and public health practice include: psychosocial aspects of disease management, health disparities, men’s health, family, and community-based research. Dr. Jack has several years of teaching experience and has held numerous research/professional positions. He has delivered over 95 professional presentations and published over 80 peer reviewed publications and/or book chapters. He serves on several editorial boards of peer reviewed journals and is Editor-in-Chief of the Health Promotion Practice Journal. Dr. Jack is Editor and contributing author of his recently published book, “Diabetes in Black America: Public Health and Clinical Solutions to a National Crisis”. He also served as Editor of the National Commission for Health Education Credentialing seven chapter study guide, The Health Education Specialists: A Companion Guide for Professional Excellence, 6th Edition. Dr. Jack is the recipient of the Society for Public Health Education’s 2011 Distinguish Fellow Award, the society’s highest award given in recognition of an individual’s national contributions to the profession of public health and public health education. 13 Dominic H. Mack, MD Assistant Professor, Deputy Director, National Center for Primary Care, Morehouse School of Medicine Dominic Mack, a native of Augusta, Georgia, earned his Bachelor of Science degree from Paine College in Augusta, GA and his Medical Doctorate from Meharry Medical College in Nashville, TN. He completed his residency in Family Medicine at Morehouse School of Medicine in Atlanta GA. Dr. Mack practiced at Southside Community Health Center in Atlanta for 11 years where he served as Chief Medical Officer during his tenure, then returned to Morehouse School of Medicine in 2001 as an Assistant Professor in the Department of Family Medicine. While at Morehouse he served as the Medical Director for the Family Medicine Department and later became the Associate Chair of Clinical Affairs. In 2003, he graduated from Kennesaw State University with a Master of Business Administration degree. In 2006, Dr. Mack served as the Associate Director for the National Center for Primary Care and Project Director for the Regional Coordinating Center for Hurricane Response at Morehouse School of Medicine. He later took the position of Chief Medical Officer for AmeriCorp Holdings/The AeroClinic which has opened airport clinics in Hartsfield Jackson Atlanta Airport and the Philadelphia International Airport. He is also the founder and past president of Mack Medical Consultants, a company dedicated to the improvement of business practices in medical organizations. Dr. Mack currently serves as the Deputy Director of the National Center for Primary Care at Morehouse School of Medicine, and as the Executive Medical Director, Principal Investigator of the Georgia Health Information Technology Regional Extension Center (GAHITREC). Phangisile Mtshali-Manciya Director of Corporate Philanthropy Bristol-Myers Squibb Phangisile Mtshali-Manciya is the Director of the Bristol-Myers Squibb Foundation, responsible for Secure the Future™, Delivering Hope™ and Together on Diabetes ™ initiatives in southern Africa and Asia respectively. In this role, she supervises community outreach and education programs funded by Bristol-Myers Squibb Foundation to support HIV and Aids in Africa, Hepatitis B & C in China, Taiwan, India and Japan and Diabetes in China and India. She is based in Johannesburg, South Africa. Prior to joining the Bristol-Myers Squibb Foundation initiative in 1999, she was a managing director of SIMEKA TWS Communications in Johannesburg. She previously operated her own communications consulting firm and held a position as a corporate public relations officer. Earlier in her career, Ms. Mtshali Manciya served as a television news editor and a newspaper feature writer and editor. Mtshali-Manciya’s academic background includes studies in journalism, public relations and project management. She holds a Post graduate Diploma in Project Management from Cranefield College of Programme and Project Management. 14 Jerry Schultz, Ph.D. Co-Director of Work Group for Community Health and Development University of Kansas Dr. Schultz holds a Ph.D. in cultural anthropology from the University of Kansas. His work is focused on building the capacity of communities to solve local problems, understanding community and systems change, evaluating community health and development initiatives, and developing methodologies for community improvement. He is part of the Community Tool Box (CTB) development team, a global online resource for community building. His responsibility includes both content and design development for the CTB. Dr. Schultz has authored numerous articles on evaluation, empowerment, and community development. He has been a consultant to several foundations, community coalitions, and state agencies. Dr. Schultz was given the Society for Community Research and Action Award for Distinguished Contribution to the Practice of Community Psychology in 2007. He is a Fellow of the Society for Applied Anthropology. 15 Evaluation Workshop Leads Kaston Anderson-Carpenter, MA, MPH Graduate Research Assistant, Applied Behavioral Science University of Kansas Kaston Anderson-Carpenter is graduate research assistant and doctoral student in applied behavioral science. He holds graduate degrees in experimental psychology/applied behavior analysis and public health. His previous research focused on behavioral interventions in increasing adherence to medical regimens, particularly related to sleep disorders. A board-certified behavior analyst (BCBA), Kaston has experience developing, implementing, and evaluating behavioral interventions with children and adults who have Autism Spectrum Disorder and other developmental delays. His current research focuses on primary prevention and health promotion, program planning and evaluation, and social and environmental determinants of health. Vicki Collie-Akers, M.P.H, Ph.D. Associate Director of Health Promotion Research University of Kansas Work Group for Community Health and Development Dr. Collie-Akers holds a Ph.D. in Behavioral Psychology from the University of Kansas, and a Masters of Public Health with a concentration in Behavioral Science and Health Education from Saint Louis University. Her research is primarily focused on applying a community-based participatory research orientation to working with communities to understand how collaborative partnerships and coalitions can improve social determinants of health and equity and reduce disparities in health outcomes. Throughout her career, Dr. Collie-Akers has worked to promote health through research and practice, including assisting in research projects that studied coverage of prevention research in small market media, environmental assessments of walkability for children, mammography usage among African American women, and promoting involvement of neighborhood and faith-based organizations in a CDC-funded REACH 2010 project in Kansas City, Missouri. In her position at the KU Work Group, she directs several evaluation projects that support partners, such as the Medical Legal Partnership of Western Missouri, who are working to promote health through their comprehensive initiatives. Additionally, she serves as principle investigator or co-investigator on several projects promoting health equity and reduction in health disparities in the Kansas City metropolitan area. Dr. CollieAkers has provided consultation to a number of community initiatives on topics such as evaluation, logic model development, and sustainability. She has also been active in capacity building through trainings and webinars of individuals including public health practitioners and grass-roots community representatives. 16 Evaluation Workshop Leads (cont.) Steve Fawcett, Ph.D Co-Director of Work Group for Community Health and Development University of Kansas Dr. Stephen Fawcett (sfawcett@ku.edu) is Kansas Health Foundation Distinguished Professor of Applied Behavioral Science at the University of Kansas. He is also Director of the Work Group for Community Health and Development http:// communityhealth.ku.edu/, a World Health Organization Collaborating Centre at the University of Kansas. A former VISTA volunteer, he worked as a community organizer in public housing and low-income neighborhoods in the United States. In his work, he uses behavioral science and community development methods to help understand and improve conditions that affect population health and health equity. Dr. Fawcett is co-author of nearly 200 articles and book chapters and several books in the areas of health promotion, participatory research, capacity building, and community-based research and intervention. He is co-developer of the Community Tool Box http://ctb.ku.edu/, a widely used Internetbased resource for promoting community health and development. A former Scholar-in-Residence at the Institute of Medicine of the National Academy of Sciences, he served as a member of the IOM’s Board on Population Health and Public Health Practice. A former visiting scholar at the World Health Organization, he serves as a member of the World Health Organization Expert Panel on Health Promotion. Policy and Advocacy Workshop Leads Robert Greenwald, JD Director, Clinical Professor Harvard Law School Center for Health Law and Policy Innovation Robert Greenwald is Clinical Professor of Law and Director of the Center for Health Law and Policy Innovation (CHLPI) at Harvard Law School. As Director of CHLPI, Robert oversees the work of Harvard Law clinical staff and students engaged in state and national research, policy development and advocacy to improve the health of underserved populations, with a focus on the needs of lowincome people living with chronic illnesses and disabilities. Robert and the CHLPI team work with consumers, advocates, community-based organizations, health and social services professionals, food providers and producers, government officials, and others to expand access to high-quality healthcare and nutritious, affordable food; to reduce health disparities; to develop community advocacy capacity; and to promote more equitable, and effective healthcare and food systems. Robert is currently serving as a member of the Presidential Advisory Council on HIV/AIDS, as a co-convenor of the Chronic Illness and Disability Partnership, and as a member of the board of the Bessie Tart Wilson Initiative for Children and the Technical Assistance Collaborative for Housing. 17 Policy and Advocacy Workshop Leads (cont.) Emily Broad Leib, JD Associate Director, Food Law and Policy Clinic Harvard Law School Center for Health Law and Policy Innovation Emily Broad Leib is Associate Director of the Harvard Law School Center for Health Law & Policy Innovation and Associate Director of the Center's Food Law and Policy Clinic. The Food Law and Policy Clinic works with nonprofit organizations and government agencies to recommend food laws and policies aimed at increasing access to healthy foods, reducing obesity and diet-related disease, and assisting small farmers and producers in participating in food markets. Emily supervises Harvard Law students engaged in these projects and co -teaches (with Clinical Professor Robert Greenwald) a course entitled “Food: A Health Law and Policy Seminar.” Prior to her current position, Emily served as the Joint Harvard Law School/Mississippi State University Delta Fellow and worked with community members and outside partners to forge programmatic and policy responses aimed at improving public health and economic opportunity in the Mississippi Delta, with a focus on the food system. Emily received her B.A. from Columbia University in 2003 and her J.D. from Harvard Law School, cum laude, in 2008. She is a licensed member of the bar of New York. Maggie Morgan, MA, JD Clinical Fellow Harvard Law School Center for Health Law and Policy Innovation Maggie Morgan is a Clinical Fellow at the Center for Health Law and Policy Innovation at Harvard Law School, where she works on national and state-based health law and policy initiatives to increase access to care for low-income Americans suffering from diabetes, HIV and other chronic conditions. Currently, Maggie serves as the project lead for the BMS-sponsored PATHS project in North Carolina, and is also working on projects involving HIV policy in Louisiana, and immigrant and global health. In addition to her independent work, Maggie supervises Harvard Law students working on these projects. Prior to her work with the Center, Maggie clerked for the Honorable Nanette K. Laughrey in the Western District of Missouri. She received her A.B. from Harvard College in 2004, her M.A. in International Relations from the University of Chicago in 2007, and her J.D. from Harvard Law School in 2011. She is licensed to practice law in the state of New York. 18 Rapid Cycle Quality Improvement Workshop Lead George Rust, MD, MPH Director, National Center for Primary Care Morehouse School of Medicine Dr. George Rust is a Professor of Family Medicine and Director of the National Center for Primary Care at Morehouse School of Medicine. He has dedicated his career as a family practice physician to improving healthcare access, quality, and outcomes for low-income and uninsured segments of the population. He is a graduate of Loyola University School of Medicine, and completed family medicine residency training at Cook County Hospital in Chicago, and a Master’s of Public Health degree from University of Illinois -Chicago. He then worked with farm workers and other low-income populations for six years as Medical Director of the West Orange Farm-workers’ Health Association in Apopka, Florida. Since 1991, Dr. Rust has been a physician, teacher, researcher, and leader at the Morehouse School of Medicine. He is board-certified in both Family Practice and Preventive Medicine, and is a Profesor of Family Medicine with a joint faculty appointment in the Dept. of Community Health and Preventive Medicine. Dr. Rust led the development of the National Center for Primary Care at Morehouse School of Medicine. He is also the founding director of the Morehouse Faculty Development program. Over the past two decades, he has built bridges between the academic arena and the front lines of primary care by developing training programs and health quality-outcomes research partnerships between Morehouse School of Medicine and networks of community and migrant health centers. Dr. Rust is board chair of the At-lanta Community Access Coalition and co-chair of Georgia’s Minority Health Advisory Council, where he played a key role in development of the Georgia Health Disparities Report in 2008. He also received the 2007 national leadership award from the Disease Management Association of America (DMAA), and the 2009 ACT award from the Georgia Asian Pacific Islander Community Coalition (GAAPICC). Dr. Rust is the author of over 50 peer-reviewed publications related to primary care, health disparities, and underserved populations. 19 Evaluation Workshop Description Participatory Evaluation of the Together on Diabetes Initiative: Overview and Early Lessons Skill Building Morning Workshop– Participatory Evaluation Training A. Population Health Learning Collaborative Trillum Boardroom B. Innovative Interventions Learning Collaborative Basswood Room Skill Building Afternoon Workshop– Participatory Evaluation Training A. African American Women’s Collaborative Trillium Boardroom B. Open Evaluation Session Basswood Room Workshop Lead, Population Health Learning Collaborative: Jerry Schultz, Work Group for Community Health and Development, University of Kansas Workshop Lead, Innovative Interventions Learning Collaborative: Vicki Collie-Akers, Work Group for Community Health and Development, University of Kansas Workshop Lead, African American Women Learning Collaborative: Steve Fawcett and Kaston AndersonCarpenter, Work Group for Community Health and Development, University of Kansas Workshop Lead, African American Women Learning Collaborative: Steve Fawcett, Work Group for Community Health and Development, University of Kansas The Together on Diabetes™ initiative is using a participatory evaluation approach to help understand what is being accomplished—by individual projects and the overall Together on Diabetes initiative—and to improve our efforts. An online monitoring and evaluation system provides real-time information about project activities, progress on intended outcomes and factors that may be facilitating or constraining our efforts. This workshop offers an introduction to the monitoring and evaluation approach as well as the online documentation and support system (ODSS) used to gather and make sense of information about accomplishments. This workshop will provide training in using the monitoring and evaluation system. Grantees will learn to document and characterize their Together on Diabetes™ activities and accomplishments such as services provided, advocacy efforts, and other important grantee activities and outcomes. Information entered into the ODSS will be readily available in a dashboard of data displays for key measures of success. We will also review how the data can be used to enable systematic reflection – what we are seeing, what it means, and implications for adjustment. The session will be enriched by guidance and lessons learned from pilot sites that already are using the participatory evaluation system. This introductory workshop will focus on how to access and navigate the ODSS, document project activities and accomplishments, and characterize the data by types of contribution. Project staff who are responsible for documenting activities and using the information for decision making and reporting are particularly encouraged to attend. Presented by: 20 Policy & Advocacy Workshop Description The Affordable Care Act in 2013: Strategies for State-Based Advocacy on Behalf of People Living with Diabetes Peachtree Creek Room Workshop Leads: Robert Greenwald, Harvard Law School Center for Health Law and Policy Innovation Maggie Morgan, Harvard Law School Center for Health Law and Policy Innovation Emily Broad Leib, Harvard Law School Center for Health Law and Policy Innovation The Affordable Care Act offers the most promising opportunity in decades to strengthen access to quality preventive care and treatment for people with chronic conditions, including the approximately 26 million Americans living with diabetes and the millions more estimated to be pre-diabetic. Several provisions in particular stand to benefit low-income Americans with diabetes, including 1) expansion of Medicaid coverage to all persons below 138% of the federal poverty line; 2) removal of cost-sharing for recommended preventive services (including diabetes screenings); and 3) creation of a Medicaid state benefit plan establishing health homes for people with chronic conditions. However, as state Medicaid programs are not required to offer these benefits, there is a critical need and opportunity in 2013 for state-based policy advocacy on behalf of people with diabetes and comorbid conditions. This workshop will address the major diabetes-related decisions which states are facing in 2013 as the Affordable Care Act is implemented, with a focus on the benefits, challenges and opportunities for policy advocacy in the three areas described above. The workshop will first highlight the key provisions at stake, their potential impact on people with diabetes, and the status of implementation of these measures across states. The workshop will next explore the key challenges at the state level to full implementation of these provisions. Participants will then actively participate in identifying advocacy opportunities and strategies for influencing decisionmaking in their states so that all Americans with diabetes (and other chronic conditions) can receive full access to the care, treatment, and prevention services offered by the ACA, regardless of geography. Finally, the workshop will serve as an opportunity to update participants on the latest policy work being performed in North Carolina and New Jersey as a part of the Center for Health Law and Policy Innovation’s Together on Diabetes policy project, “Providing Access to Healthy Solutions” (PATHS). Presented by: 21 Rapid Cycle Quality Improvement Workshop Description Rapid Cycle Quality Improvement Starvine Ballroom Workshop Lead: George Rust, Morehouse School of Medicine Rapid-cycle improvement is a quality improvement method that identifies, implements and measures changes made to improve a process or system. Rapid cycle improvement implies that changes are made and tested over a short time period rather than the standard eight to twelve months. This method is import as it enables clinical settings and population health settings to continually improve how to use health information technology, workflow and workforce changes, and continually implementing improvements that will better serve patients, achieve business goals, realize the benefits of health information technology, and improve the quality of services. This workshop will provide training in utilizing the rapid cycle quality improvement method. Grantees will learn to use the Plan-Do-Study-Act (PDSA) cycle strategy. The PDSA cycle is a rapid-cycle quality improvement strategy that has four stages: Plan: Identify an opportunity to improve and plan a change or test of how something works Do: Carry out the plan on a small number of patients Study: Examine the results. Act: Use results to make a decision, incorporate changes into your workflow, and establish future quality improvement plans. Workshop leads will help grantees think through how to incorporate rapid cycle quality improvement methodology into their current Together on Diabetes™ project. Presented by: 22 Participant List Speakers and Summit Guests Ann Albright Director, Division of Diabetes Translation Center for Disease Control and Prevention Atlanta, GA aga6@cdc.gov Pedro Greer, MD Assistant Director of Academic Affairs Florida International University Miami, FL greerp@fiu.edu Harrison Jim Traditional Healer Indian Health Service- Navajo Nations Shiprock, NM Harrison.jim@ihs.gov Phangisile Manciya Director of Corporate Philanthropy Bristol-Myers Squibb Foundation Johannesburg, South Africa Phangisile.mtshali@bms.org Robert E. Ratner, MD Chief Scientific and Medical Center American Diabetes Association Alexandria, VA rratner@diabetes.org George Rust Director, National Center for Primary Care Morehouse School of Medicine Atlanta, GA grust@msm.edu Steve Wosahla Managing Director, Corporate Alliances and Cause Related Marketing American Diabetes Association Alexandria, VA swosahla@diabetes.org Grantees American Academy of Family Physicians Foundation Juana Ballesteros Project Manager Alivio Medical Center Chicago, IL jballesteros@aliviomedicalcenter.org Edwin Fisher Global Director, Peers for Progress University of North Carolina at Chapel Hill Chapel Hill, NC edfisher@unc.edu Lizette Martinez Health Promoter Alivio Medical Center Chicago, IL lmartinez@aliviomedicalcenter.org Manuela McDonough Program Manager National Council of La Raza Washington, DC mmcdonough@nclr.org Phyllis Naragon Director, Foundation Programs American Academy of Family Physicians Foundation Leawood, KS pnaragon@aafp.org Diana Urlaub Program Manager American Academy of Family Physicians Foundation, Peers for Progress (UNC Chapel Hill) Chapel Hill, NC diana_urlaub@unc.edu 2013 Together of Diabetes Grantee Summit February 25-27, 2012 Atlanta, GA Registered Participants as of February 7, 2013 23 Participant List (by Grantee Teams) American Association of Diabetes Educators Laura Downes Chief Operating Officer AADE Chicago, IL ldownes@aadenet.org Ruth Lipman Chief Science and Practice Officer American Association of Diabetes Educators Chicago, IL rlipman@aadenet.org American Pharmacists Association Foundation Benjamin Bluml Vice President Research APhA Foundation Washington, DC bbluml@aphanet.org Kelly Goode Professor VCU School of Pharmacy Richmond, VA jrgoode@vcu.edu James Kirby Clinical Coordinator Kroger Pharmacy Cincinnati, OH james.kirby@kroger.com Lindsay Watson Director, Applied Innovation American Pharmacists Association Foundation Washington, DC lwatson@aphanet.org Black Women’s Health Imperative Angela Ford Health Program Manager Black Women's Health Imperative Washington, DC afford@blackwomenshealth.org Samantha Griffin Program Assistant Black Women's Health Imperative Washington, DC sgriffin@blackwomenshealth.org Valerie Rochester Director of Programs Black Women's Health Imperative Washington, DC vrochester@blackwomenshealth.org Belinda Whittle Health Ministry Coordinator Covenant Baptist United Church of Christ Washington, DC Bmw6619@aol.com The Camden (NJ) Coalition of Healthcare Providers Nadia Ali Project Manager, Camden Citywide Diabetes Collaborative Camden Coalition of Healthcare Providers Camden, NJ nadia@camdenhealth.org Victoria DeFiglio Nurse Care Manager Camden Coalition of Healthcare Providers Camden, NJ victoria@camdenhealth.org Francine Grabowski Lead Diabetes Educator Camden Coalition of Healthcare Providers Oaklyn, NJ grabowski-francine@cooperhealth.edu Andrew Katz Program Assistant Camden Coalition of Healthcare Providers Camden, NJ andrew@camdenhealth.org Steven Kaufman Staff Endocrinologist Camden Coalition of Healthcare Providers Camden, NJ kaufman-steven@cooperhealth.edu 24 Participant List (by Grantee Teams) Duke University Medical Center Lisa Davis Senior Project Manager Duke University Durham, NC lisa.p.davis@duke.edu Ashley Dunham Project Leader Duke University School of Medicine Kannapolis, NC Ashley.Dunham@duke.edu Michele Easterling Nutrition Director Durham County Health Dept. / Durham County Government Durham, NC measterling@durhamcountync.gov Michelle Lyn Division Chief Duke University Medical Center Durham, NC Michelle.Lyn@duke.edu Pamela Maxson Research Director Duke University/University of Michigan Durham, NC pm12@duke.edu East Carolina University Doyle Cummings Professor, Brody School of Medicine East Carolina University Greenville, NC cummingsd@ecu.edu Bert Hambidge Program Coordinator East Carolina University Center for Health Disparities Research Greenville, NC hambidgeb@ecu.edu Johnnie Jordan Community Ambassador East Carolina University Center for Health Disparities Research Greenville, NC dtcc@embarqmail.com Kerry Littlewood Assistant Professor East Carolina University, School of Social Work Greenville, NC littlewoodk@ecu.edu Feeding America Georgina Bradshaw Diabetes Program Coordinator Food Bank of Corpus Christi Corpus Christi, TX gbradshaw@feedingamerica.org Kathy Garrison Program Manager The Ohio State University Columbus, OH kgarrison59@gmail.com Amy Headings Director of Nutrition Mid Ohio Foodbank Grove City, OH Kgarrison59@gmail.com Katie Hilliard Registered Diatitian Food Bank of Corpus Christi Corpus Christi, TX khilliard@feedingamerica.org Kimberly Prendergast Consulting Project Manager Feeding America Sudbury, MA kprendergast@feedingamerica.org Morgan Smith Diabetes Wellness Project Lead Redwood Empire Food Bank Santa Rosa, CA morgansmith@refb.org Elaine Waxman VP of Research & Partnerships Feeding America Chicago, IL ewaxman@feedingamerica.org 25 Participant List (by Grantee Teams) Harvard Law School Center for Health Law and Policy Innovation Emily Broad-Leib Clinical Instructor & Lecturer Harvard Law School Center for Health Law and Policy Innovation Boston, MA ebroad@law.harvard.edu Robert Greenwald Director Harvard Law School Center for Health Law and Policy Innovation Jamaica Plain, MA rgreenwa@law.harvard.edu Maggie Morgan Clinical Fellow Harvard Law School Center for Health Law and Policy Innovation Boston, MA mmorgan@law.harvard.edu Johns Hopkins Center for American Indian Health Alison Barlow Associate Director Johns Hopkins Center for American Indian Health Baltimore, MD Abarlow@jhsph.edu Jeff Powell Medical Officer Johns Hopkins Center for American Indian Health Shiprock, NM Jeffery.powell@jhsph.edu Raymond Reid Study Physician Johns Hopkins Center for American Indian Health Shiprock, NM rreid@jhsph.edu Rachel Storm Project Coordinator Johns Hopkins Center for American Indian Health Baltimore, MD rstrom@jhsph.edu Gerilene Tsosie Shiprock Site Coordinator Johns Hopkins Center for American Indian Health Shiprock, NM gtsosie@jhsph.edu University of Kansas Work Group for Community Health and Development Kaston Anderson-Carpenter Graduate Research Assistant University of Kansas Lawrence, KS kandersonjr@ku.edu Vicki Collie-Akers Assistant Research Professor University of Kansas Lawrence, KS vcollie@ku.edu Stephen Fawcett Director University of Kansas Lawrence, KS sfawcett@ku.edu Ithar Hassaballa Graduate Research Assistant University of Kansas Lawrence, KS ithar@ku.edu Jenna Hunter-Skidmore Evaluation Project Manager University of Kansas Lawrence, KS jmhunter@ku.edu Jerry Schultz Co-Director University of Kansas Lawrence, KS jschultz@ku.edu Charles Sepers Graduate Research Assistant University of Kansas Lawrence, KS csepers@ku.edu 26 Participant List (by Grantee Teams) Marshall University Center for Rural Health Richard Crespo Professor Marshall University School of Medicine Huntington, WV crespo@marshall.edu Rick Davis Executive Director, Graham Revitalization Economic Action Team Marshall University Center for Rural Health Robbinsville, NC great@email.dnet.net Sara Davis Coalition Member, Graham Revitalization Economic Action Team Marshall University Center for Rural Health Robbinsville, NC great@email.dnet.net Marie Graverly Rural Health Coordinator Marshall University Center for Rural Health Leon, WV graverly3@marshall.edu Shelia Plogger ADCTP Project Coordinator Marshall University Center for Rural Health Gordon, WV splogger@marshall.edu Patricia Thompson-Reid Community-based Health System Specialist Centers for Disease Control and Prevention Atlanta, GA pet0@cdc.gov Eric Stockton Health Program Manager Appalachian Regional Commission Washington, DC estockton@arc.gov Mississippi Public Health Institute Ricky Boggan Deputy Director Mississippi Public Health Institute Madison, MS ricky.boggan@gmail.com Stephanie Evans Medicaid Liaison Mississippi Public Health Institute Madison, MA evans.stephanie.j@gmail.com Ellen Jones Executive Director Mississippi Public Health Institute Madison, MS elljax@aol.com Clinton Smith Medical Consultant MS Public Health Institute Madison, MS clinton39@hotmail.com Anna Lyn Whitt Project Manager MS Public Health Institute Brandon, MS annalyn.whitt@gmail.com National Council on Aging Kathy English Director, Public Health Policy Wellpoint Denver, CO Kathy.English@anthem.com Jay Greenberg Senior Vice President-Social Enterprise & Online Consumer Services National Council on Aging Washington, DC jay.greenberg@ncoa.org Julie Kosteas Senior Director, HASE National Council on Aging Washington, DC Julie.kosteas@ncoa.org Valerie Lawson Manager, Program Development YMCA of the USA Chicago, IL Valerie.lawson@ymca.net 27 Participant List (by Grantee Teams) Kate Lorig Professor Emeritus/Director Patient Education Research Center Stanford University Palo Alto, CA lorig@stanford.edu James Teufel National Health Director OASIS Institute St. Louis, MO jteufel@oasisnet.org Sixteenth Street Community Health Center Kelly Barboza Diabetes Educator Specialist- Linkage To Care Sixteenth Street Community Health Center Milwaukee, WI Kelly.barboza@sschc.org Holly Nannis Director, Diabetes & Asthma Programs Sixteenth Street Community Health Center Milwaukee, WI holly.nannis@sschc.org Wina Zorro Director, Grants and Program Development Sixteenth Street Community Health Center Milwaukee, WI wina.zorro@sschc.org United Hospital Fund David Gould Senior Vice President for Program United Hospital Fund New York, NY dgould@uhfnyc.org Debbie Halper Vice-President, Education and Program Initiatives United Hospital Fund New York, NY dhalper@uhfnyc.org Fern Hertzberg Executive Director, Director of ARC Ft. Washington Senior Center Washington Heights/Inwood Council on Aging New York, NY fhjefe@aol.com Tracey Solohoff Administrator, Isabella Home and Community Based Services Isabella Geriatric Center New York, NY lberritta@uhfnyc.org Mark Kator President and CEO Isabella Geriatric Center New York, NY mkator@isabella.org Fredda Vladeck Director, Aging In Place Initiative United Hospital Fund New York, NY fvladeck@uhfnyc.org United Neighborhood Health Services Nancy Mason Diabetes Project Director United Neighborhood Health Services Nashville, TN nmason@unitedneighborhood.org University of Virginia Natalie May Project Director University of Virginia Health System Richmond, VA nbmay@verizon.net Mohan Nadkarni Professor Internal Medicine University of Virginia Charlottesville, VA mmn9y@virginia.edu Barbara Yager Chair Community Action on Obesity Taskforce Charlottesville, VA Barbara.yager@vdh.virginia.gov 28 Participant List (by Grantee Teams) Whittier Street Health Center Osangie Ebekozien Administrative Officer Whittier Street Health Center Roxbury, MA osangie.ebekozien@wshc.org Ubah Hashi Diabetes Case Manager Whittier Street Health Center Roxbury, MA Ubah.Hashi@wshc.org Linda Hardemon Diabetes Health Ambassador Whittier Street Health Center Roxbury, MA lhardemon@comcast.net Patrick Healy Diabetes Specialist Whittier Street Health Center Roxbury, MA patrick.healy@wshc.org National Network of Public Health Institutes Staff Christopher Kinabrew Associate Director, Government and External Relations National Network of Public Health Institutes New Orleans, LA ckinabrew@nnphi.org An Nguyen Program Manager National Network of Public Health Institutes New Orleans, LA anguyen@nnphi.org Luke Galford Health Disparities and Equity Intern National Network of Public Health Institutes New Orleans, LA lgalford@nnphi.org Bristol-Myers Squibb Lynn Anyaele Pharm.D. Public Health Resident Bristol-Myers Squibb Foundation Plainsboro, NJ Lynn.anyaele@bms.com John Damonti Vice-President Bristol-Myers Squibb New York, NY John.damonti@bms.com Patricia Doykos Director Bristol-Myers Squibb Foundation Princeton, NJ patricia.doykos@bms.com Amy Waschenfelder Consultant Bristol-Myers Squibb Foundation Princeton, NJ Amy.waschenfelder@bms.com 29 Diabetes Report Card 2012 CS230427 National Center for Chronic Disease Prevention and Health Promotion Division of Diabetes Translation 30 Purpose of This Report This report is required under the Catalyst to Better Diabetes Care Act of 2009, which is part of the Patient Protection and Affordable Care Act (Section 10407 of Public Law 111-148, hereafter called the Affordable Care Act). The act states that the report card should be published by the Centers for Disease Control and Prevention (CDC) every 2 years and include data about diabetes and prediabetes, preventive care practices, risk factors, quality of care, diabetes outcomes, and, to the extent possible, trend and state data. The Diabetes Report Card 2012 uses 2010 data (the most recent data available) to present a profile of diabetes and its complications at the national and state level. It includes information about prediabetes awareness, diabetes outcomes, and risk factors. The estimates in this report were calculated by CDC staff and are available in more detail at CDC’s National Diabetes Surveillance System Web site at www.cdc.gov/ diabetes/statistics. Opportunities for Better Diabetes Prevention and Care in the Affordable Care Act The Affordable Care Act (the health care law of 2010) includes several provisions that directly address gaps in diabetes prevention, screening, care, and treatment. The Catalyst to Better Diabetes Care Act of 2009, which is included in the Affordable Care Act, directs the U.S. Department of Health and Human Services and CDC to enhance diabetes surveillance and quality standards across the country. In addition, diabetes is specifically targeted by provisions on administering private health insurance wellness and prevention programs (Section 2717), Medicaid health homes for enrollees with chronic conditions (Section 2703), the Medicaid Incentives to Prevent Chronic Disease Program (Section 4108), and the Medicare Independence at Home demonstration program (Section 3024). For more information on health care provisions in the Affordable Care Act, visit www.healthcare.gov. For More Information Division of Diabetes Translation National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention Atlanta, GA 1-800-CDC-INFO (232-4636); TTY: 1-888-232-6348 cdcinfo@cdc.gov www.cdc.gov/diabetes/pubs/pdf/DiabetesReportCard.pdf Suggested Citation Centers for Disease Control and Prevention. Diabetes Report Card 2012. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2012. 31 Diabetes Overview Diabetes is a group of diseases characterized by high blood glucose (blood sugar). When a person has diabetes, the body either does not produce enough insulin or is unable to use its own insulin effectively. Glucose builds up in the blood and causes a condition that, if not controlled, can lead to serious health complications and even death. The risk of death for a person with diabetes is twice the risk of a person of similar age who does not have diabetes. Diabetes is a major cause of heart disease and stroke. Death rates for heart disease and the risk of stroke are about 2–4 times higher among adults with diabetes than among those without diabetes.1 In addition, 67% of U.S. adults who report having diabetes also report having high blood pressure.1 For people with diabetes, high blood pressure levels, high cholesterol levels, and smoking increase the risk of heart disease and stroke.2 This risk can be reduced by controlling blood pressure and cholesterol levels and stopping smoking. Diabetes can also lead to other complications, such as vision loss, kidney failure, and amputations of legs or feet. Effective glucose control, as measured by A1c levels, and blood pressure control can prevent or delay these complications.1 Average medical expenses are more than twice as high for a person with diabetes as they are for a person without diabetes. In 2007, the estimated cost of diabetes in the United States was $174 billion. That amount included $116 billion in direct medical care costs and $58 billion in indirect costs (from disability, productivity loss, and premature death).1 ●● Gestational diabetes develops and is diagnosed as a result of pregnancy in 2%–10% of pregnant women.3 Gestational diabetes can cause health problems during pregnancy for both the child and mother. Children whose mothers have gestational diabetes have an increased risk of developing obesity and type 2 diabetes.4 Women who have gestational diabetes face a higher risk of developing type 2 diabetes in the future. Research has shown that 10–20 years after a woman has had gestational diabetes, she has a 35%–60% chance of developing type 2 diabetes.5 Rates for type 2 diabetes rise sharply with age for both men and women and for members of all racial and ethnic groups. The prevalence of diagnosed diabetes is about seven times as high among adults aged 65 years or older as among those aged 20–44 years. Race and ethnicity also are risk factors for diabetes. Most minority populations in the United States, including Hispanic Americans and nonHispanic blacks, have a higher prevalence of diabetes than their white non-Hispanic counterparts. Although diabetes prevalence varies widely among popu­ lations and tribes, diabetes disproportionately affects American Indians and Alaska Natives in the United States, with diagnosed diabetes rates more than twice as high as the rates for non-Hispanic whites.1 Asian Americans are at higher risk of developing type 2 diabetes, despite having, on average, a substantially lower body mass index when compared with non-Hispanic white counterparts.6 Diabetes develops at younger ages in racial and ethnic minority populations, which puts minorities at higher risk of developing complications at a younger age.7 The most common forms of diabetes are as follows: ●● ●● Prevalence of Diagnosed Diabetes, 2007–2009 Type 1 diabetes accounts for about 5% of all diagnosed cases of diabetes. Type 1 is usually first diagnosed in children and young adults, although it can occur at any time. To survive, people with type 1 diabetes use insulin from an injection or a pump. Risk factors for type 1 diabetes can be autoimmune, genetic, or environmental. At this time, there are no known ways to prevent type 1 diabetes.1 U.S. Adults, by Agea 20–44 years 2.6% 45–64 years 11.7% >65 years 18.9% U.S. Adults Aged >20 Years, by Race and Ethnicityb,c American Indian and Alaska Native Type 2 diabetes accounts for about 95% of diagnosed diabetes in adults. Several studies have shown that healthy eating and regular physical activity, used with medication if prescribed, can help control health complications from type 2 diabetes or can prevent or delay the onset of type 2 diabetes.1 Asian American 16.1% 8.4% Hispanic 11.8% Non-Hispanic black 12.6% Non-Hispanic white 7.1% National Health Interview Survey. National Diabetes Fact Sheet, 2011. c Data were age adjusted. See Technical Notes for more details. a b 32 Incidence of Diagnosed Diabetes Figure 1 shows diabetes incidence in the United States, which is the number of new cases diagnosed each year. The number of new cases of diabetes changed little from 1980 through 1990, but began increasing in 1992. From 1990 through 2010, the annual number of new cases of diagnosed diabetes almost tripled. The rise in the incidence of type 2 diabetes cases is associated with increases in obesity, decreases in leisure-time physical activity, and the aging of the U.S. population.7 Prevalence of Diagnosed Diabetes Figure 2 shows diagnosed diabetes prevalence in the United States, which is the total number of existing (including newly diagnosed) cases for each year. Similar to the incidence, the prevalence of diabetes remained fairly constant from 1980 through 1990. However, since 1990, the prevalence has steadily increased. Many people also have undiagnosed diabetes and are unaware of their condition. A 2010 CDC study projected that as many as one of three U.S. adults could have diabetes by 2050 if current trends continue.8 To avert this increase, the U.S. Department of Health and Human Services (HHS) has a multipronged strategy that encompasses population-based prevention and individual prevention, care, and treatment. 33 Diagnosed Diabetes Table 1 presents the percentages of U.S. adults who report that they have ever been told that they have diabetes, by state. Data for people with undiagnosed diabetes are not included. The estimates in Table 1 are based on data from CDC’s Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is an ongoing, state-based, household telephone survey of the U.S. population aged 18 years or older. Estimates range from 5.8% in Vermont to 11.3% in Mississippi. For Figure 3, CDC used data from the BRFSS and the U.S. Census Bureau to develop model-based county estimates of adults with diagnosed diabetes. County-level estimates allow community leaders and health care providers to identify local areas that would benefit most from diabetes prevention and control efforts. Figure 3 shows the distribution of diagnosed diabetes across the United States, with percentages generally higher in the Southeast. CDC used these data to define a geographic area, called the diabetes belt, where the prevalence of diagnosed diabetes is especially high. This area includes 644 counties in 15 states.9 Table 1. Percentage of U.S. Adults with Diagnosed Diabetes, by State, 2010 State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Percentage (%) 11.1 6.3 8.1 9.2 8.9 6.0 6.4 7.7 8.0 8.7 9.8 7.8 7.7 8.2 9.1 6.9 8.0 10.1 10.3 7.4 8.9 7.2 9.2 6.2 11.3 8.0 6.2 7.1 8.1 7.0 8.3 8.1 8.4 9.3 6.9 9.4 10.1 7.2 8.7 6.8 9.9 6.4 10.2 9.8 7.1 5.8 8.1 7.4 10.7 7.1 6.6 Data were age adjusted. See Technical Notes for more details. Source: National Diabetes Surveillance System, Behavioral Risk Factor Surveillance System data. 34 Prediabetes: A Risk Factor for Type 2 Diabetes People with prediabetes have blood glucose levels that are higher than normal, but not high enough to be diagnosed as diabetes. Unfortunately, prediabetes can put people at increased risk of developing type 2 diabetes, heart disease, and stroke. Although about 33% of U.S. adults have prediabetes,10,11 awareness of this risk condition is low. Less than 10% of U.S. adults with prediabetes report that they have ever been told that they have prediabetes.11 Table 2 presents estimates of the percentage of U.S. adults who reported ever being told by a doctor that they have prediabetes. Data for adults with prediabetes who have never been tested for diabetes or who have not been told that they are at risk of developing type 2 diabetes are not included. State estimates of prediabetes awareness range from 4.4% in Vermont to 10.2% in Tennessee. These estimates are consistent with analyses of national data that suggest awareness of prediabetes is low. Progression to type 2 diabetes among those with prediabetes is not inevitable. Studies have shown that people with prediabetes can prevent or delay the onset of type 2 diabetes by losing 5%–7% of their body weight and getting at least 150 minutes per week of moderate physical activity.12 Because awareness of prediabetes is low, we anticipate that the percentage of people who are aware that they have prediabetes will rise as diabetes prevention efforts progress. Table 2. Percentages of U.S. Adults Who Have Ever Been Told They Have Prediabetes, by State, 2010 State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Percentage (%) 7.0 7.0 6.2 NA 8.0 5.7 5.3 6.1 5.5 6.4 5.7 7.5 7.3 5.5 6.2 5.4 6.1 7.2 6.1 6.5 NA 4.8 6.3 6.6 6.7 NA 4.7 5.4 NA 6.8 NA 5.7 5.5 6.1 NA 5.3 6.5 6.1 5.9 NA 6.6 5.2 10.2 6.4 5.1 4.4 5.7 NA 6.1 6.2 4.8 NA = not available. Data were age adjusted. See Technical Notes for more details. Source: National Diabetes Surveillance System, Behavioral Risk Factor Surveillance System data. 35 Preventive Care Practices and Quality of Care Diabetes complications are debilitating, costly, and sometimes deadly. Diabetes complications tend to be more common or more severe among people whose diabetes is poorly controlled. Diabetes control, achieved through diabetes care and management and clinical preventive care practices, keeps people with diabetes healthy and can improve health outcomes. Preventive care practices are essential to diabetes care. Figure 4 shows the percentage of U.S. adults with diagnosed diabetes who received some of the preventive care practices recommended for them during the survey period of 2009–2010. Examples include annual eye exams, annual foot exams, and daily monitoring of blood glucose. Several of the national health objectives in Healthy People 2020 call for increasing the percentage of people with diabetes who are practicing these recommendations. Table 3 (see next page) presents state-level percentages of U.S. adults with diabetes who report receiving the recommended preventive care practices. State-specific trend data for these services are available at www.cdc.gov/ diabetes/statistics/state. 36 Table 3. Percentage of U.S. Adults Aged >18 Years with Diabetes Who Report Receiving Preventive Care Practices, by State, 2009–2010a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Annual Foot Exam Annual Eye Exam A1c Checked >2 Times a Year Daily SelfMonitor of Blood Glucose Ever Attended Diabetes SelfManagement Class Annual Flu Vaccine 71.5 71.3 68.2 NAb 64.9 73.1c 72.7 75.1 81.9 71.1 70.7 74.0 69.3d 72.8 72.9 78.0 69.0 67.5 72.1 85.8 75.8 77.8 70.7 80.9 67.7d 74.2c 73.5 74.5 60.3 80.5 67.5 74.8 75.9 75.9 78.1 70.5 69.5d 72.5 73.4 76.8c 73.0 74.9d 70.9 68.0 71.3 81.6 74.4 74.2c 67.5 77.4 64.7 66.2 58.3 67.2 NA 65.4 60.4c 69.4 71.3 74.9 68.5 67.4 68.2 61.9d 61.3 62.6 76.5 68.5 60.2 67.0 73.1 68.1 75.7 68.1 72.6 60.1d 64.6c 60.6 65.1 63.9 72.0 69.7 65.7 67.0 67.2 65.6 65.2 56.2d 61.4 67.2 76.1c 62.8 66.5d 68.6 61.5 62.2 67.2 70.9 66.3c 66.9 72.4 59.4 72.3 72.0 66.5 NA 75.8 69.0c 74.6 66.9 77.3 71.8 74.4 75.0 60.9d 70.9 68.5 78.9 70.8 73.7 71.3 78.8 75.2 74.6 70.5 73.7 72.3d 74.5c 68.3 74.3 63.0 76.7 71.5 73.3 71.4 73.0 67.2 68.0 70.2d 68.4 78.1 72.9c 73.6 73.8d 72.6 67.5 68.7 79.3 72.4 72.1c 69.7 73.5 66.0 68.5 65.9 60.4 NA 58.6 62.2c 58.1 61.4 68.8 60.1 68.9 58.0 59.3d 62.7 66.3 63.9 62.2 68.8 66.6 58.5 61.9 62.0 59.0 60.8 71.9d 60.3c 57.0 65.0 58.3 61.3 59.7 68.4 66.9 63.3 60.5 62.7 60.6d 64.5 63.2 58.7c 65.3 55.0d 73.2 62.4 61.6 60.0 60.1 63.6c 67.9 60.1 59.3 58.1 59.1 52.9 NA 59.5 68.9c 51.3 50.5 65.0 56.8 59.7 52.5 57.2d 60.2 61.7 64.3 59.8 51.7 56.0 62.6 51.2 50.3 53.0 77.1 46.0d 58.2c 63.2 62.7 55.6 63.3 43.7 60.1 40.9 56.1 58.8 56.0 60.7d 67.8 57.3 47.3c 57.1 62.3d 52.1 59.8 62.0 55.2 60.9 65.5c 44.6 59.4 57.7 52.0 62.0 50.2 57.8 51.8 61.5 58.6 57.2 54.4 47.1 50.0 69.3 58.1 49.7 55.2 63.2 55.6 54.8 52.8 66.5 57.5 66.4 55.4 71.4 50.8 61.8 61.0 64.0 48.6 65.4 52.0 63.7 57.6 58.4 63.1 51.9 59.2 54.2 62.0 62.5 50.9 67.1 55.8 54.2 62.4 68.4 58.4 59.8 59.1 62.4 54.5 Data were age-adjusted. See Technical Notes for more details. Data not available for 2009 or 2010. c Only 2009 estimates available. d Only 2010 estimates available. Source: National Diabetes Surveillance System, Behavioral Risk Factor Surveillance System data. a b 37 Trends in Diabetes Outcomes Figures 5, 6, and 7 offer examples of trends in diabetes complications in the United States over the past 2 decades. Among adults with diagnosed diabetes, death rates from hyperglycemic crisis have declined since the mid-1980s. Diabetic hyperglycemic crises are serious health events that can occur in people with diabetes, and they can lead to death. Rates of lower-limb amputation (of legs or feet) and kidney failure (end-stage renal disease) have declined since the mid-1990s. These declines may be attributed in part to improvements in the rates of high blood pressure, high cholesterol, and smoking in recent decades.10 Other possible reasons include improvements in blood glucose control;13 early detection and management of diabetes complications; and improvements in preventive care, treatment, and diabetes care management.14, 15 38 CDC and HHS Respond to Diabetes As the leading public health agency for HHS, CDC has a unique role in preventing, controlling, and managing diabetes. CDC provides public health leadership to translate evidence-based science on what works into practice to improve health outcomes for people with diabetes and those at risk of developing type 2 diabetes. The agency also analyzes data to measure the burden of diabetes, conducts and funds research, works to reduce health disparities, and creates a variety of educational resources. that includes a personalized prevention plan at no additional cost to beneficiaries. ●● In its scientific and programmatic activities, CDC works to reduce differences in health status and health care that are based on race, ethnicity, economic status, or other factors. The agency provides information on health disparities to raise awareness about how diabetes care can reduce health gaps. CDC partners with national, tribal, territorial, state, and local organizations to support programs to prevent and control diabetes. In addition to CDC’s efforts, HHS works through all of its relevant agencies and programs to fight the diabetes epidemic by using a broad range of research, education, and programs that strengthen the prevention, detection, and treatment of diabetes. Efforts to address diabetes across HHS will improve care for people living with diabetes today and help prevent the onset of diabetes in more Americans in the future. ●● Supporting Diabetes Prevention and Control Empowering Patients with Tools and Resources ●● Affordable Care Act and Diabetes Benefits: The health care law expands insurance coverage, consumer protections, and access to primary care. For example, important preventive services are now covered with no cost sharing in most private plans if the service is graded A (strongly recommended) or B (recommended) by the U.S. Preventive Services Task Force (USPSTF). These services include type 2 diabetes screening, diet counseling, and blood pressure screening. In addition, immunizations recommended by the Advisory Committee on Immunization Practices and other recommended preventive services that are specifically for children, youth, and women will also be covered with no cost sharing by many private health plans. Beginning in 2013, state Medicaid programs that eliminate cost sharing for these clinical preventive services may receive enhanced federal matching funds. Medicare now covers certain preventive services recommended by the USPSTF with no cost sharing, as well as an annual wellness visit Medicare and Diabetes Preventive Benefits: Medicare covers diabetes screening tests to identify beneficiaries with diabetes or at high risk of developing diabetes. Medicare also covers screening for glaucoma, which may be a comorbidity of diabetes. Other Medicare preventive benefits (e.g., diabetes selfmanagement training, medical nutrition therapy) support beneficiaries in self-care and in making lifestyle changes to prevent or minimize development of the comorbidities and complications of diabetes. These benefits are available both to people with traditional Medicare and those enrolled in Medicare Advantage plans. In addition, Medicare prescription drug plans (Part D) cover insulin and other medications that may be needed for diabetes self-management. Medicare Diabetes Special Needs Plans: Within Medicare Advantage, 36 Special Needs Plans (SNPs) focused on chronic care, known as chronic condition SNPs (C-SNPs), are being offered in 2012 specifically for Medicare beneficiaries with diabetes. These C-SNPs may offer extra benefits, and they use a model of care approved by the Centers for Medicare & Medicaid Services (CMS) that is designed to support and improve the health status of beneficiaries with diabetes. In addition, regular Medicare Advantage plans may offer supplemental benefits that go beyond those covered by traditional Medicare. These benefits may include the following: ➢➢Health education for all beneficiaries as a way to prevent diabetes. ➢➢Extra self-care skills training for those with diabetes. ➢➢Focused disease management programs that provide care coordination and in-home monitoring to prevent development of comorbidities and complications of diabetes. ●● Medicare’s Everyone with Diabetes Counts Program: The CMS developed the Everyone with Diabetes Counts program to help Medicare beneficiaries with diabetes who are members of vulnerable populations actively participate in their care. Beneficiaries complete diabetes self-management education classes that focus on basic anatomy, healthy lifestyles, healthy nutrition choices, and the importance of eye exams, foot exams, and regular laboratory tests such as hemoglobin A1c and lipid panels. Classes are taught in community locations. To date, more than 20,000 Medicare beneficiaries have completed classes through this program. 39 ●● Lower Extremity Amputation Prevention Program (LEAP): This program is designed to reduce lowerextremity amputations in people with diabetes, Hansen’s disease, or other conditions that result in loss of protective sensation in the feet. LEAP is a five-step program that includes annual foot screenings, patient education, daily self-inspection, footwear selection, and management of simple foot problems. Montana, Nevada, New York, and Texas) are focused on diabetes management or prevention. The target population is Medicaid beneficiaries aged 18 years or older with diabetes. Prevention programs and incentives focus on demonstrating changes in health risk and outcomes, including the adoption of healthy behaviors. ●● ●● ●● Chronic Disease Self-Management Program: The U.S. Administration for Community Living, in collaboration with CDC and CMS, directs this program, which enables older Americans with chronic diseases, such as diabetes, to learn how to manage their conditions and take control of their health. State units on aging and state health departments work with their state Medicaid agency and local partners to increase availability and access to these self-management tools and programs, especially among low-income, minority, and other underserved populations. Local partners include senior centers, meal programs, faith-based organizations, libraries, YMCAs, YWCAs, and senior housing programs. Healthfinder.gov: This award-winning prevention Web site includes tools to help people take steps to prevent diabetes. Information is based on USPSTF recommendations, HHS’s Dietary Guidelines for Americans, 2010 and 2008 Physical Activity Guidelines for Americans, and other preventive initiatives. Investing in Opportunities to Combat Diabetes ●● ●● ➢➢Improve health outcomes for people living with diabetes by preventing health complications among those most at risk. ➢➢Adopt diabetes care guidelines in health care settings. ➢➢Help state Medicaid programs monitor quality care outcomes among people with diabetes. ➢➢Educate health care providers, public health professionals, and the public about optimal diabetes care and self-management. ➢➢Involve communities in diabetes prevention and control activities. Creating Partnerships to Combat Diabetes ●● Innovation Awards: The Health Care Innovation Awards announced by the CMS Innovation Center include multiple projects that specifically target diabetes. Examples include projects designed to improve the care and oral health of American Indians with diabetes on South Dakota reservations; reduce death and disability from type 2 diabetes among underserved and at-risk populations in the southeast portion of North Carolina; and use community health workers to help prevent the progression of diabetes in underserved populations in New Mexico, Pennsylvania, and the District of Columbia. Other projects include implementing and testing a care coordination and health information technology plan to improve the health of Medicaid-eligible patients with type 1 and type 2 diabetes in Hawaii and using collaborative partnerships to address diabetes in a multicultural, high-risk, high-cost population in San Mateo County, California. Medicaid Incentives for the Prevention of Chronic Diseases: Seven of the ten states that have received Medicaid Incentives for the Prevention of Chronic Diseases grants (California, Hawaii, Minnesota, CDC’s State-Based Diabetes Prevention and Control Programs: In all 50 states, the District of Columbia, 6 Pacific territories/former territories, Puerto Rico, and the U.S. Virgin Islands, CDC funding and technical assistance for diabetes programs support activities to National Diabetes Prevention Program: The Afford­ able Care Act established CDC’s National Diabetes Prevention Program (National DPP), a public-private partnership of community organizations, private insurers, employers, health care organizations, and government agencies working together to combat diabetes. Through this program, people who are at risk of developing type 2 diabetes work with a lifestyle coach in a group setting during the year-long program. The group classes are offered through communitybased organizations, wellness centers, and faith-based organizations. The inaugural partners of the National DPP were the YMCA and UnitedHealth Group. The National DPP’s goal is to reach 15 million people with prediabetes by 2020 to prevent them from developing type 2 diabetes or to diagnose them in early stages to avoid long-term health complications. ●● National Prevention Strategy: The U.S. Surgeon General led an effort by 17 federal departments to develop the first-ever U.S. National Prevention and Health Promotion Strategy, as directed by the Affordable Care Act. The goal is to increase the number of Americans who are healthy at every stage of life by identifying evidenced-based recommendations 40 to prevent chronic diseases such as diabetes. The National Prevention, Health Promotion and Public Health Council, its Advisory Group, and private and public partners are working together to implement the strategy at national, state, tribal, and local levels and to recognize the importance of engaging all sectors of society in improving the health and wellbeing of communities. Key indicators for successful implementation are drawn from Healthy People 2020 objectives and targets. prevention and treatment, Diabetes Prevention and Healthy Heart Initiative grants, and data infrastructure improvement for the IHS. ●● Engaging Communities to Address Diabetes and Reduce Health Disparities ●● ●● ●● ●● HHS Office of Minority Health/American Diabetes Association Partnership: The Office of Minority Health and the American Diabetes Association are collaborating to reduce amputations due to diabetes in minority populations. The aim of this partnership is to increase awareness about proper foot care and help patients of color, who experience higher rates of lowerextremity amputations, access the care they need to prevent amputations. Community Transformation Grant Program: Created by the Affordable Care Act and funded by the Prevention and Public Health Fund, the Community Transformation Grant program supports state and community efforts to address chronic health conditions, including diabetes, and to reduce chronic disease risk factors. These grants address a range of chronic diseases (including diabetes) and risk factors (such as obesity) and are designed to improve health, reduce health disparities, and control health care spending. National Institutes of Health’s (NIH’s) We Can! Initiative: This national initiative is designed to give parents, caregivers, and entire communities a way to help children aged 8–13 years maintain a healthy weight. It provides parents and caregivers with tools, activities, and more to help them encourage healthy eating and increased physical activity. The We Can! Initiative also offers organizations, community groups, and health professionals a centralized resource to promote a healthy weight in youth through community outreach, partnership development, and media activities that can be adapted to meet the needs of diverse populations. Indian Health Service (IHS) Special Diabetes Program for Indians: The Special Diabetes Program for Indians (SDPI) is a $150 million annual program that provides grants for diabetes prevention and treatment services to 400 IHS, tribal, and urban health programs for Native Americans. The SDPI has three major components: community-directed grants for diabetes Partnerships Active in Communities to Achieve Health Equity Program: This Office of Minority Health program seeks to improve health outcomes among racial and ethnic minorities through communitybased networks that adopt evidence-based disease management and preventive health activities and increase access to and use of preventive health care, medical treatment, and supportive services. Several grantees are working to improve the prevention, detection, and management of diabetes. Conducting Diabetes Research Investing in Research to Better Understand Diabetes ●● ●● NIH Diabetes Research: NIH is the primary source of federal support for diabetes research. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is the lead NIH component for supporting diabetes research. Diabetes research funded by NIH is supported by regularly appropriated funds that HHS receives through the Subcommittee on Labor-HHSEducation Appropriations. It is also supported by the Special Statutory Funding Program for Type 1 Diabetes Research, which is a special appropriation to the Secretary of HHS to pursue research on type 1 diabetes and its complications. Total NIH funding for diabetes research is approximately $1 billion. CDC Diabetes Prevention and Control Research: CDC studies trends in diabetes, related health outcomes, and new developments in treatment and prevention. CDC’s research also plays an important role in determining which programs are most effective in preventing and controlling diabetes and which are cost effective or can even save money. Research findings are used by CDC, state, territorial, local, and tribal public health programs and a variety of health care system partners to prioritize diabetes prevention and control interventions. CDC’s research in this area includes the SEARCH for Diabetes in Youth Study (SEARCH) and the Natural Experiments for Translation in Diabetes (NEXT-D) Study. SEARCH is a national, multicenter study that is the most complete examination of diabetes, both type 1 and type 2, in children and young adults ever conducted in the United States.16 The NEXT-D Study is a national, multicenter study that uses an observational approach to examine which policy changes initiated by health care systems, business and community organizations, and legislatures are improving the health of people 41 with diabetes. The research approach is unique, and the results will help researchers identify which health policy initiatives and actions are working.17 ●● NIH’s Diabetes Prevention Program (DPP): The results of this clinical research study, which were published in 2002, contributed to a better understanding of how type 2 diabetes develops in people at risk and how they can prevent or delay the development of diabetes by making behavioral changes that lead to weight loss. The positive effects of the DPP continue as new research—building on the study’s results—seeks the most effective ways to prevent, delay, or even reverse diabetes. This research provided evidence for programs being implemented through CDC’s National Diabetes Prevention Program. Measuring the Public Health Impact Tracking Progress ●● Mapping the Country ●● Providing Management and Support Educating the Nation About Diabetes ●● ●● National Diabetes Information Clearinghouse (NDIC): The NDIC is a service of NIDDK. Established in 1978, the NDIC provides information about diabetes to people with diabetes, their families, health care professionals, and the public. It answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and government agencies to coordinate resources on diabetes. National Diabetes Education Program (NDEP): The NDEP is jointly sponsored by CDC and NIH. It develops and provides educational tool kits and multimedia resources for a variety of audiences, including health care professionals and diabetes educators. It has more than 200 federal, state, and local partners that work together to improve the treatment and outcomes for people with diabetes, promote early diagnosis, and prevent or delay the onset of type 2 diabetes. Program audiences include those with and at risk of diabetes, health care professionals, and employers. Healthy People 2020: This national health agenda is tracking progress toward meeting several diabetesrelated objectives during this decade. The overall goal is to reduce the disease and economic burden of diabetes and improve the quality of life for all people who have or are at risk of diabetes. National Diabetes Surveillance System: Through this system, CDC analyzes national trends and provides state and county data. Public health professionals and communities can use these data to focus their diabetes prevention and control efforts on areas of greatest need. CDC connects state and local health departments across the United States by monitoring disease patterns and sharing information that improves state responses to diabetes. Reducing Disparities and Tracking Quality ●● National Healthcare Disparities Report and National Healthcare Quality Report: These reports from the Agency for Healthcare Research and Quality track the health care system through quality measures such as the percentage of U.S. adults receiving care for diabetes. For example, the 2011 National Healthcare Quality Report showed that only one of five adults with diabetes in 2008 had received all four recommended services (foot exam, dilated eye exam, flu shot, and two hemoglobin A1c tests) within the calendar year. 42 Technical Notes Diabetes data presented in this report card are from the U.S. Census Bureau and various CDC surveys and data collection systems, including the National Health Interview Survey, the National Hospital Discharge Survey, the Behavioral Risk Factor Surveillance System (BRFSS), and the National Vital Statistics System. CDC staff members used data from these original sources to calculate the estimates presented in this report. Many of these data appear in greater detail on CDC’s National Diabetes Surveillance System Web site at www.cdc.gov/diabetes/statistics. To make meaningful comparisons between states and over time, we used the 2000 U.S. standard population to age adjust our estimated rates. Age adjustment is a statistical process applied to rates of diseases, injuries, and health outcomes. It allows comparisons between communities with different age structures because it proportions rates to a standard age structure. Three-year moving averages are sometimes used to improve the precision of estimates. State estimates in this report card are based on BRFSS data. Because of the limitations of self-reported data in surveys, these estimates may underreport the rates of diagnosed diabetes and prediabetes in the U.S. population. For more information about the methods used to produce the estimates in this report, see CDC’s National Diabetes Surveillance System Web site at www.cdc.gov/diabetes/ statistics. 43 CDC Diabetes Web Resources Diabetes Public Health Resource www.cdc.gov/diabetes Provides information to consumers, health organizations, communities, health professionals, and researchers about CDC programs, training opportunities, videos, publications, research, data, and statistics. Data and Statistics National Diabetes Fact Sheet, 2011 www.cdc.gov/diabetes/pubs/factsheet11.htm Prepared in collaboration with several agencies in the HHS, as well as with other federal agencies, the American Association of Diabetes Educators, the American Diabetes Association, and the Juvenile Diabetes Research Foundation International. National Diabetes Surveillance System www.cdc.gov/diabetes/statistics This interactive Web site provides national and state information about diabetes and its complications. Users can choose a variety of customized views. ●● ●● State Surveillance Data www.cdc.gov/diabetes/statistics/state Allows users to view profiles of diabetes preventive care practices and other trends by state. Diabetes Data and Trends www.cdc.gov/diabetes/statistics Allows users to view national or state maps of countylevel estimates of diagnosed diabetes. Populations Especially Affected by Diabetes www.cdc.gov/diabetes/consumer/groups.htm Information on how diabetes affects certain populations, including specific racial and ethnic groups, and information about gestational diabetes. Healthy People 2020 Summary of Objectives: Diabetes www.healthypeople.gov/2020/topicsobjectives2020/pdfs/ Diabetes.pdf Healthy People 2020 provides science-based, 10-year national objectives for improving the health of all Americans. This link provides a list of objectives designed to improve the health of people with diabetes. CDC Diabetes Programs CDC Funding Information and Profiles www.cdc.gov/about/business/state_funding.htm Information on CDC funding for state and local health departments, universities, and other public and private agencies for a variety of public health programs, including diabetes programs. CDC Community Transformation Grants www.cdc.gov/communitytransformation The Community Transformation Grants program will support community efforts to reduce chronic diseases such as heart disease, cancer, stroke, and diabetes. By promoting healthy lifestyles, especially among population groups with the highest rates of chronic disease, these grants will help improve health, reduce health disparities, and control health care spending. National Diabetes Education Program www.yourdiabetesinfo.org The National Diabetes Education Program is a partnership between CDC and the National Institutes of Health. This Web site provides tools and publications in a range of languages for people who have diabetes, those who care for people with diabetes, and those at risk for the disease, as well as for public health practitioners, community health workers, and health care professionals. National Diabetes Prevention Program www.cdc.gov/diabetes/prevention A public-private partnership of community organizations, private insurers, employers, health care organizations, and governments working together to build a network that supports the development of evidence-based lifestyle interventions for people with prediabetes. Native Diabetes Wellness Program www.cdc.gov/diabetes/projects/diabetes-wellness.htm The Native Diabetes Wellness Program helps American Indian and Alaska Native communities develop effective strategies for diabetes care and prevention. The Web site features the Eagle Books, a series of children’s books for Native American children and others interested in healthy living. The books promote ways to prevent type 2 diabetes, such as by being more physically active and eating healthy foods. Chronic Kidney Disease Initiative www.cdc.gov/diabetes/projects/kidney/index.htm This Web site provides information on activities and data related to chronic kidney disease from the National Chronic Kidney Disease Surveillance System. Vision Health Initiative www.cdc.gov/visionhealth This Web site provides the State Data Tool, which is an interactive map of vision and eye health statistics by state. States that used the Behavioral Risk Factor Surveillance System’s vision module can produce reports on vision, eye health, and eye care. 44 References 1. Centers for Disease Control and Prevention. National Diabetes Fact Sheet, 2011. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2011. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011. pdf. Accessed April 16, 2012. 2. 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Geiss LS, Engelgau M, Pogach L, et al. A national progress report on diabetes: successes and challenges. Diabetes Technol Ther. 2005:7(1):198-203. 15. Saadine JB, Cadwell BL, Gregg EW. Improvements in diabetes processes of care and intermediate outcomes: United States, 1988–2002. Ann Intern Med. 2006;144:465-474. 16. Centers for Disease Control and Prevention. SEARCH for Diabetes in Youth. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2011. http://www.cdc.gov/diabetes/pubs/ factsheets/search.htm. Accessed April 16, 2012. 17. Centers for Disease Control and Prevention. Natural Experiments for Translation in Diabetes (NEXT-D) Study. Diabetes Public Health Resource Web site. http://www.cdc. gov/diabetes/projects/next-d.htm. Accessed April 16, 2012. 9. Barker LE, Kirtland KA, Gregg EW, Geiss LS, Thompson TJ. Geographic distribution of diagnosed diabetes in the U.S.: diabetes belt. Am J Prev Med. 2011;40(4):434-439. 45 2013 Together of Diabetes Grantee Summit February 25th-27th, 2013 “Notes to Self” Follow Up Items Websites to Check Out Materials to Read or Review Questions 50