November is National Diabetes Awareness Month. A Time To Reflect on the care for patients with diabetes. Care for Patients with Type 2 Diabetes, 2001 …
Fall 2001
Volume 1, Issue 4
The Northwest Portland Area Indian Health Board
Western Tribal Diabetes Project
November is National Diabetes Awareness Month
A Time To Reflect on the Quality of Care for Diabetes
Chawse
Indian Grinding Rock, CA State Park, Pine Grove
Inside this issue:
Diabetes Screening Toolkit Initiative Pilot Screening Project at Colville
2
2
Code This ICD-9 Coding
Hearty Beef Vegetable Soup–a recipe using commodities Diabetes Management System Training Iformation
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The Indian Health Service IHS released Standards of Care for Patients with Type 2 Diabetes in the Spring of 2001 These Standards Of Care were developed to help provide consistent, quality care for patients with diabetes Similarly, the Center for Disease Controls Task Force on Community Preventive Services Morbidity and Mortality Weekly Reports, Sept 28, 2001 strongly recommends the following for community members with diabetes: Disease management includes: Disease Management 1 Identifying everyone with di Case Management and agnosed diabetes in the commu Self-Management Education These strategies have been shown to improve glycemic control nity 2 Implement care plans proven and screening
rates for diabetic complications to be effective 3 Track, measure, and manage The IHS Standards of Care are an excellent tool to ensure the highest quality of care for patients with diabetes The following is a check list of the IHS Standards Of Care
For more information on these issues please see web sites listed below or call Jen or Tim at 1-800-862-5497
IHS Standards of Care for Patients with Type 2 Diabetes, 2001
4 Baseline Information q Height q Date of Diabetes Diagnosis q ECG baseline, repeat every 1-5yrs q P1DD status Each Clinic Visit q Blood Pressure q Weight q Blood Glucose q Foot Check qHbA1c quarterly as clinically indicated Annually q Creatinine q Complete UAMicroalbuminuria q Lipid Profile q Eye Exam-Retinal q Dental Exam q Foot Exam q Screen for Neuropathy Immunizations Skin Tests q Flu Vaccine q dT every 10 years q Pneumovax q PPD once Self-Care Education q Nutrition Education q Diabetes Education q Exercise Education q Glycemic Control q Self-Blood Glucose Monitoring q Tobacco Cessation Routine Health Maintenance q Physical Exam q Pap Smear, Pelvic Exam q Breast Exam q Mammogram q Rectal Exam, Stool Guaiac q Tobacco Use
Crater Lake, OR Near Klamath Tribe
Web
Resources for Diabetes Awareness Month wwwcdcgov/diabetes/projects/communityhtm–find out more about improving the quality of care for patients with diabetes Center For Disease Control wwwihsgov/MedicalPrograms/Diabetes/NDPreferencesasp–IHS Standards of Care wwwdiabetesorg–get the latest news on diabetes American Diabetes Association wwwbluemountaincom/eng3/diabetes/ - send an electronic card for Diabetes Awareness Month
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V o l u m e 1, I s s u e 4
Diabetes Screening Toolkit Initiative By Tim OHearn, MPH
We need to develop a strategy for preventing diabetes is a phrase being voiced by many tribes throughout the Pacific Northwest In an effort to answer this need, the Indian Health Service IHS, Portland Area Office and
the Northwest Portland Area Indian Health Board NPAIHB and Northwest Tribes have collaborated to initiate and develop the Northwest Portland Area Diabetes Screening Toolkit NPADST The NPADST started in August 2001, and includes individuals from six tribal communities from the Pacific Northwest Cow Creek, Quinault, Colville, Coquille, Coeur dAlene Warm Springs In addition to answering community needs, the purpose of the toolkit includes: Serving as a
proactive approach in reducing the disparity of diabetes Functioning as a comprehensive, community-based screening resource Serving as standardization tool for community-based screening activities Components of the screening toolkit:
Screening target populations Intervention strategies and examples Diagnostic standards Screening considerations Institutional Review Board IRB issues Managing screening data
The toolkit will be a screening resource for tribes in the Northwest The expected completion and availability date for the toolkit is December 2001 The materials will include articles, web addresses relating to a particular topic or screening intervention The toolkit will also provide information on the Institutional Review Board IRB issues, and provide its users a database training manual, as well as screening data base examples The toolkit will take the form of a binder, professionally reviewed and complied Additionally, as new screening information becomes available it will be added to the toolkit binder For more information contact Tim OHearn at 1-800-862-5497
Pilot Screening Project at Colville October 2000
Screening on the cutting edge
Once Colvilles diabetes
program felt confident and competent in their care, attaining a 70 good control rate HbA1c75 in their known patients with diabetes, they felt 
ready to go out into the community and do diabetes screening
We conducted a pilot screening at the Pascal Sherman Indian School PSIS, located on the Colville Reservation This activity was planned in conjunction with the Tribal Health Program Said Aloe Marrero, ARNP, CDE and Diabetes Coordinator at Colville After receiving permission from the Tribal Council, we received permission from the school principal, superintendent, and ultimately the school board Six weeks prior to the event we sent an informational letter to all parents of the children to be screened offering free screening to parents also We then sent a follow-up letter and permission slip one week prior to the event We organized a healthy breakfast to follow the screening as all blood tests were taken in the fasting state Each participant received a T-shirt with the Diabetes Prevention Program logo once they were screened Information gathered included height, weight, gender, date of birth, family history, body mass index, body fat, blood pressure, capillary glucose, cholesterol,
fasting insulin level, and acanthosis nigricans
Colville Diabetes Prevention Program Logo
Letters of each childs result were sent to all parents Abnormal results were highlighted Parents were urged to bring their child to their health care provider for more definitive testing Aggregate results were also shared with the Tribal Council, PSIS School Board, Colville Diabetes Program, Northwest Portland Area Indian Health Board, and the National Tribal Leaders Diabetes Committee
V o l u m e 1, I s s u e 4
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Code ThisBy
James Oliver, RD
It is extremely important to use the correct ICD9 code For diabetes diagnoses, these will be in Try coding these real narratives from Indian Country the range 25000-25093 Within the code, the providers: first three digits 250 refer to diabetes The 1 POV: Diabetes mellitus type 2 fourth digit 0-9 refers to complications check 2 POV: Peripheral neuropathy secondary to DM the ICD-9 book for additional codes to use with 3 POV: DM 2, insulin dependent, out of control complications The fifth digit specifies type 1 4 POV: Diabetes screening odd or type 2 even The fifth digit also indi5 POV: Acute bilateral DM cates blood sugar control Use a 2 type 2
or 3 type 1 if uncontrolled; use a 0 type 2 or 1 Answers: 1 25000 type 1 if not stated as uncontrolled For exam2 25060 if type 2, 25061 if type 1 ple, if the purpose of visit POV states DM 3 25002 dont be fooled by insulin dependent, this patient will type 2 uncontrolled, use the code 25002 If the always be type 2 4 V771 always use this for screening POV states Diabetes-hypoglycemia, use either 5 3829 trick question: the POV was intended to say Acute bilateral 25080 if the patient is type 2 or 25081 if the OM, but the handwriting was difficult to read patient is type 1
Hearty Beef Vegetable Soup
Makes about 24 one cup servings Ingredients: 1- 28 oz can commodity beef 2- 16 oz can vegetarian beans 2- 16 oz can sliced carrots 2- 16 oz can whole kernel corn 2- 16 oz can green peas 16 oz can green beans 16 oz cans whole tomatoes, coarsely chopped 1 2 2 2 8 1 small onion, coarsely chopped celery stalks, coarsely chopped large red potatoes, coarsely chopped small cloves of garlic or 1 teaspoon of garlic powder cups water small package of fresh basil, chopped or 2 tablespoons of Italian seasoning package cooked pearl barley it is easiest to cook this separately; follow the instructions
on the package
Nutrition Facts Serving size:
Calories: Protein: Carbohydrates: Fat: Saturated Fat: Cholesterol: Fiber: Sodium:
Instructions: 1 In a large pot, combine all ingredients except the basil and barley 2 Bring to a boil and simmer slowly for about 30 minutes, or until the red potatoes are tender 3 Stir in the cooked pearl barley and add black pepper to taste 4 Stir in the basil just before serving
1 cup
186 129 g 214 g 57 g 21 g 28 mg 41 g 289 mg
The Northwest Portland Area Indian Health Board
Western Tribal Diabetes Project
527 SW Hall Suite 300 Portland, OR 97201
Phone: 800-862-5497 Or 503-228-4185 Fax: 503-228-4801
W E R E
O N T H E W EB W W W N P A I H B O R G
The EpiCenter
Diabetes Management System
- Tribal Clinics moving forward with on-site
To have an on-site training contact:
California Region: Jen Olson 1-800-862-5497 jolson@npaihborg Northwest Idaho, Oregon, Washington James Oliver 1-800-862-5497 joliver@npaihborg
Pitt River Staff and Dawn LaBlanc, Indian Health Service October 3rd, 2001
Centralized Trainings:
? October 16-18, Northwest Portland
Toiyabe Indian Health Project September 19th 20th, 2001 Greenville Rancheria and Red Bluff Staff
October 1st and 2nd, 2001
Area Indian Health Board NPAIHB ? December 11th, 12th 13th, NPAIHB ? February 5th, 6th and 7th, Sacramento California Rural Indian Health Board ? ? thers dates to be determined O
Source:npaihb.org
