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INTEGRATING DISPARITIES REDUCTION, CULTURAL COMPETENCE AND LANGUAGE ASSISTANCE INTO EDUCATION INITIATIVES FOR DIABETES MANAGEMENT 2009 CMS Health Disparities Quality Improvement Meeting Washington, DC May 22, 2009 Dennis Andrulis Center for Health Equality Drexel University Philadelphia, PA 19102

Purpose To present a care model-based self management framework and template of action for addressing the educational needs of racially and ethnically diverse patients with diabetes.

Defining Cultural Competence ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Lessons From Chronic Care Model of Disease Management ,[object Object],[object Object],Rothman, A. & Wagner, E. Chronic Illness Management: What is the Role of Primary Care? Annals of Internal Medicine. 2003 v138, p. 256-261

Care Model characteristics ,[object Object],[object Object],[object Object],[object Object],Sources: Wagner, E. et al. Improving Chronic Illness Care: Translating Evidence into Action . Health Affairs, 2001 v20, p. 64-78

Wagner, E. H. Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice. 1998; 1(1): 2-4.]

Disproportionate Prevalence of Diabetes by Race/ Ethnicity ,[object Object],[object Object],[object Object],[object Object],[object Object]

Compared with White patients, Latinos are more likely to believe that… ,[object Object],[object Object],[object Object],[object Object],Sources: Caballero, A. Ethnicity & Disease , 2006, p. 559-569; Tripp-Riemer, T. et al. Diabetes Spectrum , vol. 14, 2001, p. 13-22.

[object Object],[object Object],[object Object],Compared with White patients, Indians are more likely to believe that… Sources: Caballero, A. Ethnicity & Disease , 2006, p. 559-569; Tripp-Riemer, T. et al. Diabetes Spectrum , vol. 14, 2001, p. 13-22.

Compared with White patients, Chinese Americans are more likely to believe that… ,[object Object],[object Object],Sources: Caballero, A. Ethnicity & Disease , 2006, p. 559-569; Tripp-Riemer, T. et al. Diabetes Spectrum , vol. 14, 2001, p. 13-22.

Compared with White patients, African Americans are more likely to believe that… ,[object Object],[object Object],[object Object],Sources: Caballero, A. Ethnicity & Disease , 2006, p. 559-569; Tripp-Riemer, T. et al. Diabetes Spectrum , vol. 14, 2001, p. 13-22.

Compared with White patients, Hmong are more likely to believe that… ,[object Object],[object Object],Sources: Caballero, A. Ethnicity & Disease , 2006, p. 559-569; Tripp-Riemer, T. et al. Diabetes Spectrum , vol. 14, 2001, p. 13-22.

[object Object],[object Object],Diabetes & Diversity: Challenges to Care and Patient Education

[object Object],[object Object],[object Object]

Diabetes Self Management for Racially and Ethnically Diverse Populations ,[object Object]

Identifying beliefs regarding health and illness New York Times; October 7, 2004

[object Object],[object Object],Encouraging practitioners to work within belief systems

Hospitalized Minority Patients Report More Problems with Respect for Their Preferences Percent of hospital patients reporting more problems* in dimensions of patient experiences * More problems defined as highest quintile of problem scores in each dimension. SOURCE: L. S. Hicks et al., “Is Hospital Service Associated with Racial and Ethnic Disparities in Experiences with Hospital Care?” American Journal of Medicine, May 2005 118(5):529–35.

[object Object],Addressing alternative treatments and considering who may play key roles in those treatments

The New York Times; January 3, 2006

[object Object],[object Object],[object Object],[object Object],[object Object],Determining acceptable levels of formality and interaction

[object Object],[object Object]

[object Object],[object Object],[object Object],Assessing language and literacy needs

[object Object],[object Object],[object Object],[object Object],Assessing language and literacy needs (continued)

Recognizing the importance of racism and other contextual factors ,[object Object]

[object Object],Recognizing the importance of racism and other contextual factors (continued)

Examples of diabetes disease management best practice programs for diverse patient populations ,[object Object],[object Object],[object Object],[object Object],Source: Disparities Solutions Center. Aetna’s program in health care disparities, 2007.

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Examples of diabetes disease management best practice programs for diverse patient populations continued…

CDC Project REACH in Detroit ,[object Object],[object Object],[object Object],[object Object],Sources: Heisler, M. Medscape . 2006.

Sources: Heisler, M. Medscape . 2006. Massachusetts Health Center Diabetes Program for Asian/ Pacific Islanders ,[object Object],[object Object]

Starr County Border Health Initiative ,[object Object],[object Object],[object Object],Sources: Caballero, A. Ethnicity & Disease , 2006.

Project Dulce ,[object Object],[object Object],Sources: Heisler, M. Medscape . 2006.

Preventing lower extremity amputations ,[object Object],[object Object]

Source: “The Development and Implementation of the Chronic Care Management Programme in Counties Manukau.” Wellingham, J. New Zealand Journal of Medicine. Vol 116, Number 1169.

Options for integrating disparities reduction/cultural competence into care teams ,[object Object],[object Object],[object Object]

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