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Diabetes Prevention and Control Best and Promising Practices.

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Presentation on theme: "Diabetes Prevention and Control Best and Promising Practices."— Presentation transcript:

1 Diabetes Prevention and Control Best and Promising Practices

2 Prevent and Control Diabetes Rick Schwertfeger, M.A.T. Program Manager Steps to a Healthier Austin Program Division of the Medical Director Austin/Travis County Health & Human Services Austin, Texas

3 The Biggest Impact: REDUCE OBESITY

4 Prevent and Control Diabetes Increase physical activity throughout a population

5 Prevent and Control Diabetes Improve nutrition throughout a population

6 Prevent and Control Diabetes Case Management

7 Prevent and Control Diabetes Formalized patient education

8 Prevent and Control Diabetes Clinicians refer high risk individuals to preventive services

9 Prevent and Control Diabetes HbA1c = or < 7.0

10 Prevent and Control Diabetes Foot Checks: Self Check: Daily Clinical at least 1x / Yr. Posters in Exam Room

11 Prevent and Control Diabetes Eye checks at least 1x / year

12 Prevent and Control Diabetes Yearly Flu Shot

13 Prevent and Control Diabetes Define, analyze and intervene on your Community Diabetes System

14 Prevent and Control Diabetes Local Diabetes Coalition

15 Steps to a Healthier Austin Reduce the burden of Obesity Reduce risk behaviors –Poor nutrition –Lack of physical activity Overarching Goals 4. Prevent overweight and obesity 6. Improve nutrition 7. Increase physical activity Austin/Travis County Health and Human Services Department

16 The Data What does our data say?

17 Baseline: Obesity Rates Disease/behaviorNumber%95% CI Overweight188,78434.8 %27.8 – 41.8 Obese102,93819.0 %9.7 – 28.3 Overweight/Obesity291,72253.8 %46.7 – 60.9 Nutrition – 5 or more vegetables and fruit per day 174,92930.5 %21.5 – 39.5 Physical Activity – Any leisure time physical activity 490,25185.6 %80.6 – 90.5 Source: 2003 BRFSS Data 180,796 - 221,740 Overweight/Obese

18 Baseline: Obesity Rates Disease/behaviorFromTo Overweight 127,891192,297 Obese 44,624130,192 Overweight/Obesity 214,839280,165 Nutrition – 5 or more vegetables and fruit per day 98,909181,716 Physical Activity – Any leisure time physical activity 370,793416,337 Source: Stratified from the 2003 Travis County BRFSS data.

19 Austin/Travis County Health and Human Services Department Baseline: Intervention Area Causes of Death 2000-2001 Age adjusted mortality rate per 100,000

20 Obesity Trends 2004-2006 Source: BRFSS 2004-2006 Question:This was calculated from the self-reported height and weight.

21 Obesity Trends 2004-2006 Source: BRFSS 2004-2006 Question:This was calculated from the self-reported height and weight.

22 Obesity Trends 2004-2006 PopulationUpper 95 CI%Lower 95 CI% Obesity Yr 1 2004 Yr 2 2005 Yr 3 2006 Yr 1 2004 Yr 2 2005 Yr 3 2006 Yr 1 2004 Yr 2 2005 Yr 3 2006 SHA54.659.362.8 55.7 63.467.7 51.7 55.0 57.5 White47.056.757.8 51.162.163.7 43.051.251.8 African American74.167.877.2 80.679.684.9 66.353.267.1 Hispanic59.162.468.1 64.070.077.5 54.2 57.0 Male62.365.467.8 66.671.575.7 57.758.8 Female46.451.957.1 50.057.062.4 42.946.651.6 Texas63.064.1 65.938.7 60.125.5 US60.161.1 Source: BRFSS 2004-2006 Question:This was calculated from the self-reported height and weight.

23 % trying to lose weight Source: BRFSS 2005-2006. Question:Are you now trying to lose weight?

24 Eating Fewer Calories/Fat to Lose Weight Source: BRFSS 2005-2006. Question:Are you eating fewer calories or less fat either lose weight or keep from gaining weight?

25 Risk Factors Addressed by Community Changes Risk Factor Yr 1 2004 Yr 2 2005 Yr 3 2006 Cumulative Good Nutrition43228 64 Physical Activity295436 119 Physical Activity & Good Nutrition113876 125 Tobacco Cessation & Prevention167570 161 Awareness & Knowledge325118 101 Disease Management199449 162 Self – Management of Disease8386 52 Access to Services & Opportunities 73822 67 (Reduction of Environmental Triggers)0120 Blank210 3 Total 128433305866 Source: SHA Online Documentation Surveillance System (ODSS)

26 Target Population Addressed by Community Changes Target Population Yr 1 2004 Yr 2 2005 Yr 3 2006 Cumulative Children (<12 Yrs)6413683 Children and Youth1610746169 Youth (13 – 17 Yrs)5122744 Adults (>18 Yrs)85253193531 Older Adults (65+ yrs)158124 Blank112215 Total128433305866 Source: SHA Online Documentation Surveillance System (ODSS)

27 Fruit and Vegetable Consumption Stages of Change Do you consistently eat 5 servings of fruits and vegetables a day?YearN Rate (%) 95 % CI Lower 95 % CI Upper Yes, I have been for more than 6 months 2005434292532 2006500353040 Yes, I have been for less than 6 months20051188611 200686658 No, but I intend to in the next 30 days2005334221926 2006314221826 No, but I intend to in the next 6 months200517712914 2006186131017 No, and I do not intend to in the next 6 months 2005449302634 2006343242128 Source: BRFSS 2005-2006 Question: Do you consistently eat 5 servings of fruits and vegetables a day?

28 People Who Report Eating 5 or More Fruits and Vegetables Daily Source: BRFSS 2004-2006

29 Number of Fruit and Vegetable Servings per Day Source: BRFSS 2004-2006 Question: Five Fruit and Vegetable Servings per Day Index-DSHS calculated

30 Leisure Time Physical Activity in the Past Month Source: BRFSS 2004-2006 Question: During the past month, other than your regular job, did you participate in any physical activities or exercises?

31 % Using Physical Activity to Lose Weight Source: BRFSS 2005-2006. Question:Are you using physical activity or exercise to lose weight or to keep from gaining weight?

32 Recommended Physical Activity Levels Source: BRFSS 2004-2006 Question: Meets Recommendations for Moderate or Vigorous Physical Activity is a calculated value from multiple questions about level of physical activity.

33 Percentage of People Meeting Recommended Moderate or Vigorous Physical Activity Levels Source: BRFSS 2004-2006 Question: Meets Recommendations for Moderate or Vigorous Physical Activity is a calculated value from multiple questions about level of physical activity.

34 Physical Activity Reported Stages Source: BRFSS 2005-2006 Question: (Based on a definition of physical activity) Do you exercise regularly according to that definition?

35 How People are Lowering Their Risk of Health Problems Source: BRFSS 2005

36 Use of Areas Conducive to Physical Activity Source: BRFSS 2004-2006

37 Level of Physical Activity in the Neighborhood Source: BRFSS 2004-2006 Approximately 75% of Neighborhoods are physically active

38 Steps Approach Community based physical activity and nutrition approaches

39 Medical Model Limited approaches Medicines –Slow –Lack of effectiveness in the long term Bariatric Surgery –Costly –Complications –Lifelong medical management

40 Steps Model Working through collaborative partnerships to increase outreach capacity Build capacity of partners to reach target Work at the systems level Focus on community actions and community changes Focus on nutrition and physical activity strategies

41 Overall Impact *A community change is a new program, policy or practice **A community action is an action taken to lead to a new program, policy or practice Source: SHA Online Documentation Surveillance System (ODSS) (9/22/2003-9/21/2006) Community Capacity Building Community Actions** Community Changes* Overall 1402878 Asthma 338251 Diabetes 353181 Obesity 625410 Blank 8635 Collective Consortium Achievements

42 Steps Unique Encounters Total Number of Encounters = 964,314 Source: SHA Partner Reports Years 1-3 Physical Activity141,395 Nutrition215,549 Diabetes607,112 Obesity258 OVER ALL TOTAL964,314 These are unique encounters. Individual persons may have had more than one encounter.

43 Obesity Yr 1Yr 2 Yr 3Total Obj.1 - Reduce Adult Obesity… 224944115 Obj.2 - Increase Daily Consumptions Of Fruits And Vegetables… 4424793 Obj.11 - Increase Child And Adolescent Engagement In Physical Activity… 6262254 Obj.12 - Increase Child And Adolescent Engagement In School Physical Activity… 56516 Obj.3 - Increase Adult Engagement In Physical Activity… 315965155 TOTAL68182183433 Community Changes per Objective

44 Obesity Yr 1Yr 2 Yr 3 Total Obj.1 - Reduce Adult Obesity… 3077101208 Obj.2 - Increase Daily Consumptions Of Fruits And Vegetables… 103171112 Obj.11 - Increase Child And Adolescent Engagement In Physical Activity… 133778128 Obj.12 - Increase Child And Adolescent Engagement In School Physical Activity… 266819113 Obj.13 - Increase The Proportion Of Schools That Offer Physical Education Classes… 2215 Obj.3 - Increase Adult Engagement In Physical Activity… 261073109 TOTAL107225343675 Community Actions per Objective

45 Nutrition Strategies Community Cooking Classes –Sustainable Food Center Train the Trainer Model Individual participants Improved Early Childhood Nutrition –Family Connections Health Worker Certification for Child Care Centers Outreach to new mothers to increase breastfeeding and create awareness of services

46 Nutrition Strategies Farmers Markets and Farm Stands –WIC sites –Sustainable Food Center Lone Star Card to wooden tokens – Increased access Manors Farmers Market School Gardens –Sustainable Food Center and Marathon Kids Collaborative effort Targeting schools Increase availability and awareness

47 Nutrition Strategies School Nutrition Improvements –AISD Vending machine offering changes Revamped the school cafeteria menu –MISD, DVISD & PISD Vending machine offering changes Revamped the school cafeteria menu Adoption of school Wellness Policy AISD is sharing knowledge and tools with other districts

48 Nutrition Strategies Soda and Snack Vending Machine Offerings Fruit Basket Mini Project Wellness Wednesdays at Schools –Foods of the Month (Vegetable, Fruit, Dairy or Grain and a Food for Thought) HEB Initiatives – In the works –Environmental System Changes at 4 locations –Suggested change to Meal Deals –Suggested changes to Combo Loco –Suggested healthy shopping list

49 Physical Activity Strategies Increase the Use Underutilized PARD Facilities –Summer Splash Pool Parties approx. 867 –P3 Initiatives Expand the Participation of Marathon Kids –Year 3 SHA Area MK Participants: 14,239 –Year 4 SHA Area MK Participants: 15,897 = +12% –Year 3 SHA Area Completed 26M: 11,018 –Year 4 SHA Area Completed 26M: 12,026 = + 9%

50 Physical Activity Strategies YMCA Swim Safe – 800+ in 1 st year YMCA Walking Trail Walk with WIC –Stroller Program –Peer Support Group Walk Texas Austin Chapter –Supported by an Active Austin Guide Walk Across Texas –Texas Cooperative Extension Agency Program

51 Physical Activity Strategies Texas Round Up –Support of the Texas-wide Governors Fitness Initiative Healthy Built Environment –6 locations –Walking Trails (new, extensions, & renovations) –Outdoor Fitness Equipment –Mileage Markers

52 Physical Activity Strategies Model Programs: Capital Metro Mayors Fitness Council

53 Capital Metro Success Story! Steps to a Healthier Austin, in partnership with Capital Metro, the Austin transit authority, sponsors a worksite wellness program that provides a comprehensive range of services, including consultations with dieticians and personal trainers, a 24-hour company fitness center, and personalized health assessments. Through the wellness program, transit operators have unlimited access to Capital Metros newly developed fitness center, receive discounts for purchasing healthier choices in the companys cafeteria, and can enroll in a myriad of weight and nutritional management programs. What is the health impact? Since launching the program in 2003, Capital Metro has experienced substantial reductions in its health care costs. Total costs increased only 9.6% from 2004 to 2005, compared to 26.8% from 2003 to 2004. The company predicts health care costs to increase only 6% from 2005 to 2006. Program participants report significant improvements in exercise, healthy food consumption, weight loss, blood pressure management, reduced stress levels, and overall general health. Employee absenteeism rateswhich is an indicator of worker job satisfaction and healthalso decreased more than 44%, from a high of 12.4% in March 2004 to 6.9% in June 2006. Why is this program working? Studies indicate that comprehensive worksite health programs focused on lifestyle behavior change lead to improvements in health behaviors among employees and a return on investment or employers, in terms of improved employee health and saved health care costs.

54 Capital Metro Success Story! Comprehensive worksite wellness program Consultations with dieticians and personal trainers 24-hour company fitness center (NEW!!!) personalized health assessments Healthy food choices discount in the companys cafeteria A myriad of weight and nutritional management programs Childcare program Since 2003

55 Capital Metro Success Story! Health Impact Reduced health care costs Employee absenteeism rates decreased more than 44%, from a high of 12.4% in March 2004 to 6.9% in June 2006. YearCost increase 2005-066% predicted 2004-059.6% 2005-0626.8% Participants report: increased exercise healthy food consumption weight loss better blood pressure management reduced stress levels better overall general health

56 Capital Metro Success Story! Why is this program working? Studies indicate that comprehensive worksite health programs focused on lifestyle behavior change lead to improvements in health behaviors among employees and a return on investment or employers, in terms of improved employee health and saved health care costs.

57 Mayors Fitness Council Partner Certification

58 Benefits of Being an MFC Certified Partner General (All Areas) Add value to the business Build and protect reputation and license to operate Reduce perceived company risk ( a better reputation) Manage stakeholder expectations and regulatory pressure Build a sustainable business Workplace Preferred employer, recruit talented people Broader risk management generating rationalization and cost savings Improve employee morale Improve productivity Marketplace Enhance brand value and customer loyalty Create competitive edge Become a preferred supplier or partner Improve supply chain performance Environment Improved environmental performance Resource conservation Waste reduction Cost savings Community Increased access to local resources Create mutual advantage within the community Austin/Travis County Health and Human Services Department

59 Mayors Fitness Council Partners Certification - Next Steps Contact the Mayors Fitness Council and meet with a council member to begin the partnering process Implement the Austin Fitness Index in your organization. Work with the MFC Nutrition and Physical Activity teams to implement effective change programs in each area. The MFC can provide programs, tools, messaging and support. Commit to health and fitness at both an individual and at the organizational levels. Austin/Travis County Health and Human Services Department

60 Physical Activity Strategies In the works… –Safe Routes to School Application –Point of Decision Prompts in COA buildings –COA PE Dept. Walk/Run and Swim Programs –Retrofitting some COA buildings with showers

61 How Far Have We Come? Data Speaks…

62 General Obesity Numbers 467 CCs with Obesity as the General Goal Total SPs on Obesity: 223 Total Number of People Served by Obesity SPs: 37,668 Total Number of Hours of SPs on Obesity: 3,872

63 General Nutrition & Obesity Numbers 108 CCs on Nutrition Total SPs on Nutrition: 235 Total Number of People Served by Nutrition SPs: 109,056 people Total Number of Hours of SPs on Nutrition: 6,329

64 Community Changes with Objectives in Nutrition & Obesity 127 CCs with Objective as reduce adult obesity 108 CCs with Objective as increase fruit and vegetable consumption 178 CCs with Objective on increasing adult physical activity 61 CCs with Objective on increasing child and adolescent physical activity 20 CCs with Objective to increase child and adolescent participation in school physical education

65 Services Provided with Objectives in Nutrition & Obesity 223 SPs with Objective to reduce adult obesity 235 SPs with Objective to increase fruit and vegetable consumption 269 SPs with Objectives to increase adult physical activity 87 SPs with Objective to increase child and adolescent physical activity 28 SPs with Objective to increase child and adolescent participation in school physical education

66 Nutrition Community Changes by Program SFC 33 CCs WIC 3 CCs

67 Nutrition Services Provided by Program SFC Farmers' Market SPs served 3,855 people with 125 hours of services SFC THK SPs served 35,191 people with 375 hours of services Walk with WIC served 414 people with 42 hours of services WIC nutrition education served 299 people with 10 hours of service SHA Core Staff presentations on nutrition served 1700 people with 8 hours of service ACS Worksite Wellness programs on nutrition served 12,374 people with 42 hours of service FC reached 46,283 people with nutrition education with 5,363 hours of service (thru trainings, expo, and the newborn packets delivered at hospitals) H&L served 3,597 people with nutrition programs with 514 hours of service

68 Steps to a Healthier Austin Thank you! For more information: Visit www.iThriveAustin.orgwww.iThriveAustin.org Call(512) 972-6761


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