Thursday, July 20, 2017

Getting the word out to health care providers and community members: Call 211 to find the right diabetes prevention or diabetes management program for you!


We have completed the process of reviewing program descriptions in 211 and working with 211 call specialists to make sure they are attuned to comments callers might make that would indicate a need for diabetes support. Now all collaborative members are actively looking for ways to get this information out into the community! Download and share the flyers below to spread the word!

211 Diabetes CLIENT/COMMUNITY Handout

211 Diabetes PROVIDER Handout


Friday, May 19, 2017

Partnering with 211 to create a "single entry point" for community-based diabetes prevention and management programs


One of the most consistent things we hear medical providers say when we talk to them about the SEVEN+ evidence-based, community-based diabetes prevention/management programs in Buncombe County is, "Wow, that's GREAT, but I don't have the time in a patient visit to walk a them through seven programs to find the best fit. Now if there were one phone number we could call..."

One phone number. We already HAVE one phone number. Why reinvent the wheel? Asheville is home to one of the two 211 call centers in NC, so our CHIP Diabetes Workgroup invited Marla Browne, 211 Director, to our March meeting to educate us about all the amazing work they do connecting WNC residents to a huge array of resources, from housing to childcare to medication assistance and legal help. All of the diabetes programs were already in the 211 database, but our group has been working to update the program profiles to highlight the differences between the programs and focus on what is unique to each, so a 211 Referral Specialist will have the information they need to help a caller (patient or provider) identify the best program fit.At the end of May we will meet with Referral Specialists to give them an overview of the programs, answer their questions about referring to each, and also ask them questions about cross-referring, etc. And voila! One phone number where a provider can connect patients to find the diabetes program that fits their needs.

The next step is actually promoting this to both medical providers and community members--stay tuned!

Friday, March 3, 2017

Finalizing Work Plan and Beginning Outreach

January and February brought some new faces to the Diabetes Workgroup and some new energy to tackle the challenge for so many health programs--the gap between the NEED for high-quality programs (in this case, programs to help the tens of thousands of people in our community prevent the onset of diabetes or to better manage their diabetes through simple lifestyle changes) and the DEMAND for such programs. Here is a great article from Stanford Social Innovation about this very topic. We need to figure out how to design these programs and and package them and communicate about them in such a way that community members who need them most begin to seek them out tell their neighbors and friends about them and ask their doctors for the details! Part of this begins by working WITH the community members we want to enroll from the beginning, learning from them and inviting them to shape the messages and programs that will, indeed, be appealing and meet the needs they express and not the ones we imagine they have.

We walked through and discussed/added to our work plan, which we will revisit at each meeting and tweak as necessary. We are still looking for creative ways to engage with clinicians to let them know of all the community-based programs and resources that exist in Buncombe County and give them the tools to refer their clients directly, and progress has been made in that area with specific providers. Our next meeting, on March 20, will include a presentation from our local 211 director, Marla Browne, about how we might partner more closely with 211 to make that a "single entry point" for all the diabetes resources in the community.

For more information about this workgroup, its goals, action items, etc., please click "Workgroup Overview" on the right sidebar. You can also click here to see the Community Scorecard--local diabetes data, active partners, current initiatives and community strategies.

Tuesday, November 29, 2016

December Update:Identifying and Addressing Barriers

In the ongoing work to increase clinical referrals to the many high-quality, community evidence-based programs that help people prevent onset of or manage their diabetes, we have identified several systematic barriers that we are working to address:

                      Barrier      Activities to Address Barrier
1. The community programs are grant funded (leading to clinicians'  perception, and sometimes the  reality, that they change frequently, are not reliably available) 1. We are communicating with providers about grant life and local, ongoing program support
2. Electronic Medical Records do not have a place for this kind of community resource referrals, making it difficult to institutionalize community referrals 2. Each practice will address this differently. One partner practice has created a Diabetes reference folder in the EHR where clinicians can find referral information. 
3. There is no single entry point, no one phone number to call to refer a client to these various diabetes prevention and management programs. 3. Again, practices are addressing this differently. We are working with 211 so that they can be a single clinical referral point. One practice has chosen to work closely with and refer to just one community program that best fits their clients' demographics, eliminating this problem.
4. Primary Care providers assume in-house educators or endocrinology referrals are providing full range of support--from med titration to nutrition and activity coaching, though this is often not the case. 4. CHIP workgroup is focusing on long-term culture-change, as ACO looks more and more to population health, community diabetes programs are increasing their own visibility and developing relationships with primary care providers to extend support for clients outside clinic walls.

For more information about this workgroup, its goals, action items, etc., please click "Workgroup Overview" on the right sidebar. You can also click here to see the Community Scorecard--local diabetes data, active partners, current initiatives and community strategies.

Friday, October 21, 2016

November Update: Gathering Information from Key Partners

At the September 29th meeting, two system-change objectives were identified for immediate work:
  1. Increasing clinical referrals to community-based diabetes prevention and management education programs
  2. Creating one user-friendly platform (or improving/promoting existing platform such as 211) for clinicians and community members to find diabetes-related services easily
In October and continuing into early November, meetings are being held with clinicians and referral specialists at WNCCHS and at MAHEC Family Medicine to identify 1) the information they need to make referrals to community diabetes programs and 2) the ideal platform(s) for accessing that information (paper, website, phone, etc.). These discussions are also addressing how these types of referrals to evidence-based community programs can be best institutionalized throughout the practices. After these needs and referral protocols are mapped, the community's six diabetes program providers will work together to create clinic-friendly tools and protocols.

The resources and referral protocols that come out of this work will also be integrated into the Care Process Model for Preconception Health, which will be rolled out to all Mission Health primary care providers in 2017.

For more information about this workgroup, its goals, action items, etc., please click "Workgroup Overview" on the right sidebar. You can also click here to see the Community Scorecard--local diabetes data, active partners, current initiatives and community strategies.

Monday, October 3, 2016

October Update: Gaining Momentum


The CHIP Diabetes Work Group met Thursday, September 29th at MAHEC's Biltmore Campus, and there was a wonderful mix of clinical and community service providers in attendance, representing WNCCHS, YMCA, YWCA, ABIPA, NC Cooperative Extension, MAHEC, Mission Health, and the Minority Health Equity Grant. We shared updates and successes in our own work, discussed at length what the diabetes community will be losing with the end of the Minority Health Equity Grant and Alma Atkins' coordination (ending September 30), and recommitted to working on two immediate priorities:

  1. Increasing clinical referrals to community-based diabetes prevention and management education programs
  2. Creating one user-friendly platform (or improving/promoting existing platform such as 211) for clinicians and community members to find diabetes-related services easily
For more information about this workgroup, its goals, action items, etc., please click "Workgroup Overview" on the right sidebar. You can also click here to see the Community Scorecard--local diabetes data, active partners, current initiatives and community strategies.

Tuesday, August 30, 2016

September Update

The full CHIP Diabetes Workgroup will be meeting September 29th at 9:00 to review the progress we've made on the Clinical Referral Tool, share feedback on the Diabetes Service Map and accompanying documents we created at the last meeting, and to begin discussing strategies to increase consumer demand for diabetes screening, testing, prevention and self-management support in the community. 

One highlight from August is the CHIP Diabetes Workgroup's presence at the
Management of Diabetes Through the Lifespan forum August 22nd at MAHEC. Partners came together to create a display about community-based prevention and management programs and update the clinical referral tool to showcase for providers attending the event. Melissa Baker (MAHEC) and Je'Wana Grier-McEachin (ABIPA) presented about the initial development and pilot testing of the referral tool. Several providers have since contacted me to get copies of the referral tool, and someone even heard a provider say, "this is the most useful information I've gotten today--this tool alone was worth coming!" 



For more information about this workgroup, its goals, action items, etc., please click "Workgroup Overview" to the right. You can also click here to see the Community Scorecard--local diabetes data, active partners, current initiatives and future tasks.