Overview of Evaluation Strategy for Faith-Based Community Component Kelly Hunt APHA: November 2011

1. Overview of Evaluation Strategy for Faith-Based Community ComponentKelly HuntAPHA: November 2011

3. Mobilizing Communities Improving Clinical Care Promoting Policy Diabetes Campaign:Three major areas of emphasis Live (housing and community) CHCs Work (workplace wellness programs) OPDs CAMPAIGN Private Physicians Worship (faith based organizations) Employers State Medicaid Private Payers

4. Clinical Strategy: Getting 3000 Physicians Recognized for High Quality Diabetes Care • Work through statewide professional and trade associations • CHCANYS: 56 CHCs in NYS • HANYS: 154 OPDs in NYS • ACP: 7000 internists • AAFP: 4000 family physicians • Align Campaign with EMR Meaningful Use Implementation Projects and PCMH initiatives • New York e-Collaborative (NYeC) • New York City Primary Care Improvement Project (PCIP) Together working with 16,000+ providers in NYS • Other healthcare institutions and QI initiatives working on EMR implementation and PCMH initiatives • Partners will drive change among members or constituencies • Providing technical assistance to achieve certification • Communicating and disseminating information • Developing and fostering learning networks • Outcomes verified • NCQA Diabetes Physician Recognition • Bridges to Excellence Diabetes Care Link

5. Clinical Arm of Diabetes Campaign:Moving forward in 2011 • To date 860 Physicians have achieved recognition • Align work with EMR Meaningful Use Implementation Projects and PCMH initiatives • Issue a results-driven RFP soliciting proposals to advance Campaign targets • Foundation commitment of $2,500 per provider that achieves certification + underwriting certification fees

6. Policy Strategy: Change Payment Policies to Reward High Quality Care • Support initiatives to increase the number of public and private payers that reward physicians who are achieving positive outcomes for their patients with diabetes • By 2011, four payers had implemented incentive programs • With the rapidly changing health care payment and delivery system, our policy strategy will likely change in 2012

7. Community Strategy: Address Diabetes Where People Live, Work, & Worship • Estimated 3.7 million to 4.2 million New Yorkers have pre-diabetes (i.e., 25 percent of the adult population). [1] • On average, the cost of healthcare for a person with diabetes is more than five times as much as the cost for those without diabetes – $13,000 vs. $2,500. [2] • Nearly 80% of Americans identify with a religion, and the average American spends more than 50 hours per year engaged in religious activities compared with 18 hours per year spent in health care settings. [3],[4], [5] • Most Americans (54%) say they attend religious services fairly regularly – at least once or twice per month. [3]

8. Community Strategy: Address Diabetes Where People Live, Work, & Worship • Outside the doctor’s office, we support programs in faith-based and other community settings that focus on helping participants prevent and manage diabetes, with a focus on healthy eating and physical activity. • The Institute for Leadership (IFL) is a faith-based, nonprofit organization that develops leadership capacity at faith-based organizations. • In 2009, NYSHealth awarded a grant to IFL to spread diabetes self-management and prevention programs in faith-based settings throughout New York State. • The program, Faith Fights Diabetes, is yielding significant positive changes in people’s understanding and lifestyle choices. More so, the program has resulted changes in participants’ knowledge and understanding of diabetes.

9. Community Strategy: Address Diabetes Where People Live, Work, & Worship • Cornerstone of program is six-week, self management course, implemented by two trained volunteers/community health workers (CHW). • IFL trains CHWs and provides all supplemental materials in advance. • Program focuses on healthy eating, spiritual well-being, and stress management.

10. Faith-Based Diabetes Consortium • IFL created a Faith-Based Consortium to extend its reach to targeted populations. • The Consortium is comprised of a range of networks and mega churches across a myriad of religious groups representing 2,000 places of worship and 2 million people. • Leaders from the Consortium assist IFL in its efforts to recruit places of worship across New York State. The three year goal is to implement self-management programs in 200 places of worship.

11. Building Capacity in Faith-Based Organizations • In an effort to maintain and expand the impact of Faith Fights Diabetes, IFL has focused on building the capacity of the program and the organizations it serves. • Over the past two years, IFL has decreased the cost of running the self-management program, as it works towards becoming sustainable and replicable without additional NYSHealth funding. • IFL has developed criteria for places of worship that show promise and a commitment towards sustaining their program.

12. Building Capacity in Faith-Based Organizations Additional Recruitment Tools Training CHWs to help recruit and train future CHWs Continual Education through NYSDOH, Centers for DiseaseControl Building Capacity of Places of Worship Reducing Start-up Costs of Six Week Self-Management Program Technical Support from IFL Connecting Networks across the State

13. Approach to Evaluating the IFL Initiative • Study Questions: • What are the strengths and weaknesses of the Consortium developed under this initiative? • What are the programmatic outcomes of the initiative (at the aggregate, regional, and congregation level)? • What are the behavioral and health outcomes of the initiative (at the aggregate, regional, and congregation level)? • What are the characteristics of congregations that demonstrate positive change in their behavioral and health outcomes?

14. Approach to Evaluating the IFL Initiative • Approach to evaluation: • Non-experimental study design • Quantitative: • Pre-, interim, and post-intervention data on Defy Diabetes participants’ height, weight, and health knowledge, attitudes, and behavior from all congregations • Qualitative: • Focus groups of volunteers and program participants • Interviews of Consortium Leaders

15. Results from the IFL Evaluation • Demographics of participants: • Typically older and female • More racially and ethnically diverse than general population • Fewer report good health compared to general population • Majority of participants at-risk for or diagnosed with diabetes

16. Results from the IFL Evaluation

17. Results from the IFL Evaluation

18. Results from the IFL Evaluation • During the first class of the Defy Diabetes program, about one-quarter of participants reported a very good or excellent understanding of overall diabetes care. By their sixth and last class, 58% of participants reported a very good or excellent understanding. • Only one-third of participants reported a very good or excellent understanding of the benefits of improving blood sugar control in their first Defy Diabetes class. By the last class, nearly three-quarters of participants reported a very good or excellent understanding. • The percentage of participants reporting that they agree or strongly agree with the statement “taking the best possible care of diabetes will delay or prevent eye problems” grew from 79% in the first class to 94% in the last class. • The percentage of participants reporting that they had trouble getting enough exercise because it takes too much effort dropped from 32% in the first class to 16% in the last class.

19. Results from the IFL Evaluation • On average, participants have lost 1.17 pounds during the six week program—a statistically significant change. • Though not a significant difference, men lost slightly more weight on average then women. • 15% of participants lost five pounds or more during the six weeks, with some people losing up to 15 pounds.

20. References [1] Full Accounting of Diabetes and Pre-Diabetes in the U.S. population in 1988-1994 and 2005-2006, Cowie, C.et al. Diabetes Care, 2008 Feb; 32(2):287-294. [2] Hogan P, Dall T, Nikolov P (2003). Economic costs of diabetes in the U.S. in 2002. Diabetes Care, 26(3):917-32, cited in http://ahrq.hhs.gov/qual/diabqual/diabqguideref.htm#hogan2003. [3] Newport F (2010, June 25). “Americans' Church Attendance Inches Up in 2010” in Gallup News: http://www.gallup.com/poll/141044/Americans-Church-Attendance-Inches-2010.aspx. [4] McCarthy D, Leatherman S (2006). The Commonwealth Fund Performance Snapshot: Time Spent with Physicians, cited in http://www.commonwealthfund.org/Performance-Snapshots/Responsiveness-of-the-Health-System/Time-Spent-with-Physician.aspx. [5] Press Ganey (2009). Emergency Department Pulse Report: Patient Perspectives on American Health Care cited in http://www.prnewswire.com/news-releases/patients-spent-an-average-of-four-hours-and-three-minutes-in-us-emergency-departments-in-2008-according-to-latest-press-ganey-report-61839842.html.