Health Proposal

I would like to focus my Competency 3 Assessment Business Proposal on a project that I am currently working on in my job as the Lead Health Educator and Bariatric Case Manager for Kaiser Permanente, Kern County. I am gathering data and focusing on disproportionately affected populations within my county. I am utilizing equity hot spot reports, insulin use reports, A1c target range reports, med adherence reports along with hospitalization reports showing chief complaints, amputations and dialysis . These reports primarily focus on Latin and African American populations living in specific geographical areas of my county. These reports will highlight the greatest areas of need for outreach and education on these patients. The end goal would be to decrease hospitalizations, complications and noncompliance in their care and overall health. The costs of this project are yet to be determined as I am compiling information currently and am not sure how much extra time, or additional staff will be required.

There was no additional costs for staff time; space or supplies as The Center For healthy living within Kaiser does this outreach annually as a part of its Line of sight goals for the year.
2 staff members, myself and Ruth Espinoza, Lifestyle educator. . already both Full time employees and already focused on this group.
Regional A1c targets in the age group 18-64 years of age is to treat to target below 6.5

https://research.kpchr.org/Research/Research-Areas/Diabetes#readMore Kaiser permanente Center for Health Research is a great resource.

Effect of diabetes self-management education on glycemic control in Latino adults with type 2 diabetes: A systematic review and meta-analysis
Janett A Hildebrand 1, John Billimek 2, Jung-Ah Lee 3, Dara H Sorkin 4, Ellen F Olshansky 3, Stephen L Clancy 5, Lorraine S Evangelista 6
Affiliations expand
• PMID: 31542186

• PMCID: PMC8087170

• DOI: 10.1016/j.pec.2019.09.009

Abstract
Purpose: This systematic review and meta-analysis evaluated the effectiveness of diabetes self-management education (DSME) in reducing glycosylated hemoglobin (A1C) levels in adult Latinos with type 2 diabetes (T2DM).
Methods: Five databases were searched for DSME randomized controlled trials or quasi-experimental trials published between January 1997 and March 2019. A random effects model was utilized to calculate combined effect sizes. Subgroup analyses were performed to explore possible sources of heterogeneity between studies.
Results: Twenty-three unique studies met criteria for this systematic review and of these, 18 were included in the meta-analysis. Pooled estimate effect of DSME on A1C from the random effect model was -0.240 (95% confidence interval = -0.345, -0.135, p < 0.001). There was moderate heterogeneity (Cochrane Q=30.977, P=0.020, I^2 = 45.121) between the studies. Subgroup analyses demonstrated greater A1C reductions in studies with intervention duration ≤6 months, initial A1C baseline values >8.0 [69 mmol/mol], and team-based approach.
Conclusions: Meta-analysis results showed that culturally tailored DSME interventions significantly reduce AIC in Latinos with T2DM despite the heterogeneity across the studies.
Implications: The heterogeneity in the study methodologies reinforce the need for additional studies to better understand DSME interventions to reduce disparities in Latino adults with T2DM.
Keywords: Diabetes self-management education; Disparities; Latino adults; Meta-analysis; Type 2 diabetes.

Hildebrand JA, Billimek J, Lee JA, Sorkin DH, Olshansky EF, Clancy SL, Evangelista LS. Effect of diabetes self-management education on glycemic control in Latino adults with type 2 diabetes: A systematic review and meta-analysis. Patient Educ Couns. 2020 Feb;103(2):266-275. doi: 10.1016/j.pec.2019.09.009. Epub 2019 Sep 9. PMID: 31542186; PMCID: PMC8087170.

The effect of diabetes self-management education on HbA1c and quality of life in African-Americans: a systematic review and meta-analysis
Amy T Cunningham 1, Denine R Crittendon 2, Neva White 3, Geoffrey D Mills 4, Victor Diaz 4, Marianna D LaNoue 4
Affiliations expand
• PMID: 29769078

• PMCID: PMC5956958

• DOI: 10.1186/s12913-018-3186-7
Free PMC article
Abstract
Background: Type 2 diabetes presents a major morbidity and mortality burden in the United States. Diabetes self-management education (DSME) is an intervention associated with improved hemoglobin A1c(HbA1c) and quality of life(QOL), and is recommended for all individuals with type 2 diabetes. African-Americans have disproportionate type 2 diabetes morbidity and mortality, yet no prior meta-analyses have examined DSME outcomes exclusively in this population. This systematic review and meta-analysis examined the impact of DSME on HbA1c and QOL in African-Americans compared to usual care.
Methods: Randomized controlled trials, cluster-randomized trials, and quasi-experimental interventions were included. 352 citations were retrieved; 279 abstracts were reviewed, and 44 full-text articles were reviewed. Fourteen studies were eligible for systematic review and 8 for HbA1c meta-analysis; QOL measures were too heterogeneous to pool. Heterogeneity of HbA1c findings was assessed with Cochran’s Q and I2.
Results: HbA1c weighted mean difference between intervention and usual care participants was not significant: – 0.08%[- 0.40-0.23];χ2 = 84.79 (p < .001), I2 = 92%, (n = 1630). Four of five studies measuring QOL reported significant improvements for intervention participants.
Conclusions: Meta-analysis results showed non-significant effect of DSME on HbA1c in African-Americans. QOL did show improvement and is an important DSME outcome to measure in future trials. Further research is needed to understand effectiveness of DSME on HbA1c in this population.
Trial registration: PROSPERO registration: CRD42017057282 .
Keywords: African-Americans; Diabetes self-management education; Disparities; Type 2 diabetes.
Cunningham AT, Crittendon DR, White N, Mills GD, Diaz V, LaNoue MD. The effect of diabetes self-management education on HbA1c and quality of life in African-Americans: a systematic review and meta-analysis. BMC Health Serv Res. 2018 May 16;18(1):367. doi: 10.1186/s12913-018-3186-7. PMID: 29769078; PMCID: PMC5956958.

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Curr Diab Rep
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. 2021 Jan 9;21(1):2.
doi: 10.1007/s11892-020-01369-x.
Diabetes Complications in Racial and Ethnic Minority Populations in the USA
J Sonya Haw 1, Megha Shah 2, Sara Turbow 2 3, Michelle Egeolu 4, Guillermo Umpierrez 5
Affiliations expand
• PMID: 33420878

• PMCID: PMC7935471

• DOI: 10.1007/s11892-020-01369-x
Free PMC article
Abstract
Purpose of review: Racial and ethnic minority populations have a higher burden of diabetes-related complications. There have been many epidemiologic studies to better define these racial/ethnic disparities in diabetes outcomes with additional studies offering interventions to mitigate them. This narrative review highlights the epidemiologic trends in diabetes complications specific to racial and ethnic minorities and underscores differences in microvascular and macrovascular complications of diabetes, health care utilization, and diabetes prevention efforts and also reviews interventions aimed to reduce racial/ethnic disparities and their limitations.
Recent findings: While we have seen in general an overall improvement in complication rates for all people with diabetes, the disparities between Black and Hispanic compared to non-Hispanic White people with diabetes seem to persist. There is a continued need to better understand the underlying causes of and strategies to mitigate race/ethnicity disparities in diabetes complications in the USA.
Keywords: Diabetes complications; Disparities; Epidemiology; Minority.
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References

1. Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2020. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2020.