1. Clinical and Community Teams:
An introduction to your role in FORGE AHEAD

2. Welcome and Introductions

3. Goals for today’s meeting
Explain, and provide an overview of, the FORGE AHEAD project
Explain and describe the readiness consultation process
Explain and describe the Community and Clinical teams, and their role in FORGE AHEAD
Introduce and explain the quality improvement part of the program

4. Program Letter of Information
Have you read the FORGE AHEAD Letter of information?
Have you signed your consent form?

5. Diabetes and Indigenous Peoples
There are more people with diabetes in First Nations communities compared to the rest of Canada1
First Nations people get diabetes at a younger age2
Studies have reported higher rates of diabetes complications (amputation, blindness, kidney disease)2,3,4
Death due to type 2 diabetes is higher for First Nations peoples compared to the general population1
1. Bramley et al,2004; 2. Harris et al, 2011; 3. Dyck et al, 2012; 4. Dyck et al, 2010

6. Factors Influencing Health
Reasons why Indigenous peoples may suffer from poor health:
Historical, political and psycho-social factors1
Higher unemployment rates, poor living conditions, less education2
Unhealthy foods and not enough exercise2
Heredity (children get the same diseases as their parents)1
Quality of healthcare (example: high staff turnover)2,3
1. Nettleton et al, 2007; 2. Gracey and King, 2009; 3. CDA Clinical Practice Guidelines Expert Committee, 2013

7. Healthcare in the Community
The literature suggests that:
To provide better care for people with diabetes there could be more communication between the doctors, nurses, diabetes educators, homecare workers, and community program leaders1,2,3,4
This way everyone understands what the patient needs and they can work together to provide the best care5,6,7,8,9,10,11,12,13
1. Nasmith et al, 2010; 2. Wagner et al, 2001; 3. Barr et al. 2003; 4. OMHTL, 2007; 5. Harris et al, 2013; 6. Chin et al, ; 7. Philis-Tsimikas et al, 2012; 9. Paquette-Warren et al, 201; 10. Tricco et al, 2012; 11. Shojana et al, 2006; Indian Health Service, 2012; 13. Gardner et al, 2012

8. Main Goal of FORGE AHEAD
To work with community healthcare providers and community members to improve the way care is being provided to people with diabetes
Use a series of inter-related projects to develop and evaluate community-driven primary healthcare delivery models that enhance chronic disease management with appropriate access to available services in First Nations communities for on-reserve community members.

9. FORGE AHEAD: Our Team
Strong multi-disciplinary and cross-jurisdictional team from 9 provinces
First Nations community representatives
Indigenous and non-Indigenous healthcare providers
Clinician scientists
Academic researchers reflecting a wide variety of disciplines from across Canada
Assembly of First Nations (AFN)
First Nations and Inuit Health Branch (FNIHB) of Health Canada
Canadian Diabetes Association (CDA)
Heart & Stroke Foundation

10. Program Activities Overview
National-level Activities
Preparatory Activities
- Community Profile Survey – all 617 First Nations Communities
- Best Practice and Policy Literature Review
- Readiness Tools Development
In-depth Community-level Activities (~ 14 First Nations Communities)
Intervention
Activities
Community Readiness Consultations
Community-driven Quality Improvement Initiative
Clinical Readiness Consultations
Clinical Quality Improvement Initiative
Diabetes Registry and Surveillance System
Wrap-up Activities
- Community and Clinical Readiness Consultations
- Readiness Tools Validation
- Cost Analysis - Common Indicators- Process Evaluation and Surveillance Data
- Scale-up Tool Kit Development

11. Timeline: Wave 1 October 2014 to March 2016
Readiness consultations Oct-Dec 2014
Quality Improvement initiatives Jan–Dec 2015
Registry and Surveillance Oct 2014-Mar 2016
Wrap up activities ~2017
2013
2014
2015
2016
2017
2018
Wave 1 Recruitment
Community Readiness Consultations (Oct-Dec 2014)
Community-driven Quality Improvement Initiative
(Jan – Dec 2015)
Post Community and Clinical Readiness (Jan –Mar 2016)
Cost Analysis
Common Indicators - Process Evaluation
Wave 1- sign CRA by June 2014, intervention start date Oct 2014
Clinical Readiness Consultations (Oct-Dec 2014)
Clinical Quality Improvement Initiative
(Jan – Dec 2015)
Community Facilitator Training (Sept 2014)
Diabetes Registry and Surveillance System (Oct 2014-Mar 2016)
months T months T months T months

12. Community Participation
Each community will have a number of representatives who will participate in the program, and help make decisions for your community. These include:
Community Advisory Board
One person on the FORGE AHEAD Advisory board
One person on the FORGE AHEAD Working Groups

13. Community Participation
To implement FORGE AHEAD, each community will select:
A Community Facilitator
A Community Team
A Clinical Team
A Data Coordinator

14. Community and Clinical Teams
There will be 2 teams of people working in the program (community and clinical team)
The teams will complete surveys and participate in workshops to:
Identify the community needs, strengths and challenges
Find new ways to care for people with diabetes
After the program in done, they will be asked to share their experience in participating in the program and their perceptions of the impact of the program

15. Community Team
The community team will work to improve awareness of diabetes and healthy lifestyles in the community
The community team will have 3-5 people
1 to 3 community primary prevention leaders, administrators, managers, workers/volunteers of existing community programs or services
at least one traditional health leader,
at least one community member living with diabetes,
at least one elder, and
at least one clinical care program leader.
What is the purpose of the team?

16. Clinical Team
The clinical team will work together to improve the care of community members with type 2 diabetes
The clinical team will have 3-5 people
at least one family physician
at least one nurse
at least one community health representative who provides healthcare to community members with type 2 diabetes
at least one clinic administrative staff

17. Community and Clinical Teams Activities
Intervention
Activities
Community Readiness Consultations
Community-driven Quality Improvement Initiative
Clinical Readiness Consultations
Clinical Quality Improvement Initiative
Diabetes Registry and Surveillance System

18. Community and Clinical Team Responsibilities
Oct-Dec 2014
Attend Team meetings
Answer and hand in the questionnaire
Prepare for QI workshop #1
Jan-Dec 2015
Attend team meetings
Complete the QI work (eg, the tasks and tests of PDSA cycles)

19. Registry and Surveillance
The goal of the Diabetes Registry and Surveillance System is to develop or update a registry and surveillance system of adult patients diagnosed with type 2 diabetes to gain knowledge of diabetes incidence/prevalence rates and care gaps
Access to the registry will be determined by individual Community Advisory Boards.
The research team will have access to aggregated, de-identified data from all participating communities.
Community Data Coordinators will be hired and trained to implement or update the diabetes registry and surveillance system.
Securely house: name, gender, year of birth, type of diabetes, health card #, Band status #, diagnosis date, and other clinical information (e.g. labs, meds, complications…)
Note: The FORGE AHEAD team will work with communities to determine the completeness of existing registry and surveillance systems.

20. Data Coordinator
Will help to develop or update a registry and surveillance system of people in the community with type 2 diabetes
The data will be used during the program to help guide quality improvement work and to help assess the impact of the program
 Responsibilities:
Sign confidentiality agreement(s) and the Letter of Understanding
Become familiar with the Data Coordinator Training and Chart Review Manual
Attend training sessions with a member of the research team
Attend monthly teleconference meetings with members of the research team
Review charts to gather data required for the FORGE AHEAD Research Program

21. Next Meeting Set up your next meeting
Set up a timeline for handing out and answering the questionnaires
The agenda for next meeting will cover readiness consultations