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Project Dulce History, Outcomes, Future Presented by Chris Walker, MPH

Project Dulce History, Outcomes, Future Presented by Chris Walker, MPH Director, Public Health Programs April, 2008. The Collaborators-1997. Community Health Improvement Partners (CHIP) Council of Community Clinics The Whittier Institute for Diabetes Clinic-based Design Teams.

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Project Dulce History, Outcomes, Future Presented by Chris Walker, MPH

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  1. Project Dulce History, Outcomes, Future Presented by Chris Walker, MPH Director, Public Health Programs April, 2008

  2. The Collaborators-1997 Community Health Improvement Partners (CHIP) Council of Community Clinics The Whittier Institute for Diabetes Clinic-based Design Teams Hospitals County Health Department School of Public Health School of Medicine Healthcare Foundations

  3. Nurse-led TeamsDiabetes Management in Clinics

  4. Promotoras – Peer Educators Education and Support

  5. Electronic Registry • Identifies health status • Risk status using A1c, other clinical measures • Reports outcomes and impact • Compliance with Standards of Care; • Changes in health status over time • Tracks patient care • Missed appointments • Class attendance; dietary referrals

  6. Documenting Results • Electronic Registry tracks clinical data • Validated instruments measure behavior and knowledge change • Studies ongoing to document impact on utilization and cost • Publication of results in medical journals

  7. Pilot Project – 1998-1999 Baseline versus 1 Year Philis-Tsimikas et al. Diabetes Care (accepted 2003)

  8. Standards of Care-Pilot Philis-Tsimikas et al. Diabetes Care (accepted 2003)

  9. Educational Outcomes • Improved diabetes knowledge (p=.001) • Shift to stronger internal locus of control (p = .04) • Positive treatment satisfaction (p=.001) Philis-Tsimikas et al. Diabetes Care (accepted 2003)

  10. Published Outcomes of Pilot Project

  11. San Diego County – Adopted as Model for Indigent Care, FY 2000 Health System Expansion 3 to 17 Community Health Centers sites 0 to 2 University of California-SD sites 1 to 4 Diabetes Teams Cultural Adaptation to include African-American, Vietnamese, Filipino, White peer educators 300 to 3500 Patients Technology Expansion • Formal Central Registry

  12. Developed Universal Materials(in 12 languages)

  13. Formal Curricula to Train Promotoras to Teach

  14. Cultural (and gender) Adaptation

  15. Results of Promotora-led Classes 8 classes Initial HbA1C (%) 9.11 End measure 8.06 Change in measure 1.05 N=133

  16. Results – Project Dulce Cost Study, 2004 • Significant improvements in clinical indicators (p< .001) • HbA1c, Blood Pressure, Total Cholesterol, LDL • Saved 60% in ER/Hospital costs • Economic modeling over 3 years projects savings of $1,216/patient Gilmer T, Philis-Tsimikas A, Walker C. ADA abstract 2004

  17. Spreading the Model Training Programs Comprehensive Diabetes Management for Clinicians Basics of Diabetes Insulin Management Peer Education Train-the Trainer Community Health Workers as Care Coordinators and Advocates Peer Educator-led Diabetes Self Management Curricula

  18. Replication in Multiple Sites New Jersey Philadelphia Alameda County Tennessee Los Angeles San Diego Miami India

  19. More Growth – 2007 State/County Health Care Access Initiative: • $39 million over 3 years to expand chronic care to uninsured • 8 clinic sites added • Project Dulce will manage the program, train clinics, and provide direct services.

  20. Recognition US Mexico Border Health Commission Model of Excellence Nova Award, 2005, national award for best community benefit program by American Hospital Association One of two models recommended by Medicare to address health disparities

  21. Addressing theDiabetes and Obesity Epidemic Project Dulce’s model: • Adapts to diverse cultures • CHWs widely used in international health programs • Using nurses instead of physicians decreases costs and expands reach • Replicable – Training and Technical Assistance Programs

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