Measuring Rural Health Nutrition Outreach

Outcomes

Katherine Smalleykatherines@yvfwc.orgPlanning and DevelopmentYakima Valley Farm Workers Clinics

YVFWC P&D Dept.

Yakima Valley Farm Workers Clinic

• Community/migrant health center system

• Clinics in WA and OR• Served >124,000

patients CY2009• 67% Hispanic• 77% Below 100% FPL• 12% of adults with

Diabetes

YVFWC P&D Dept.

RHNO Project -Yakima County

Yakima County

YVFWC P&D Dept.

Yakima County, Washington State

• YVFWC service base and administrative

headquarters

• Produces more apples, winter pears,

hops, and mint than any other U.S. county

YVFWC P&D Dept.

Population of Yakima County

• County population 239,054 (2009 est)

• 41.4% Hispanic

• 31.8% Language other than English (>5yr old)

• Highest concentration of migrant/seasonal farm workers in Washington State

• 75,149 m/sfw + family members (2009 est)

YVFWC P&D Dept.

RHNO Project - Lower Yakima Valley2006 - 2009

**

*

YVFWC P&D Dept.

RHNO Project Goals

For Hispanic and rural populations with Diabetes, Obesity and other Nutrition-related conditions:

– Reduce health disparities– Improve access to Self Management

Education– Improve the quality of health services

YVFWC P&D Dept.

RHNO Activities

• Registered Dietitian at GV Primary Care

• Spanish-language Chronic Disease Self Management classes

• Spanish Public Radio health programs

• Community individual diabetes education

• Quarterly Consortium meetings

YVFWC P&D Dept.

RHNO Consortium Members

• Yakima Valley Memorial Hospital

• Public Radio KDNA

• Prosser Memorial Hospital

• Yakima Valley Farm Workers Clinic

YVFWC P&D Dept.

Registered Dietitian Output Measures

• Number of patients seen per year

• Number of encounters per year

• Attendance at Interdisciplinary meetings

• Patient Hemoglobin A1c & Body Mass

Index pre & post RD visit

YVFWC P&D Dept.

Self Management Education Output Measures

• Participant Attendance

• Pre and Post Survey

• Physiological Measures

• Model Fidelity

• Participant Satisfaction

YVFWC P&D Dept.

Spanish Language Public Radio Output Measures

• Number of Health-related programs

• Number of PSA advertising CDSMP classes

YVFWC P&D Dept.

Individual Diabetes Education Output Measures

• Number of clients served

• Number of visits per client

• Change in Hemoglobin A1c

YVFWC P&D Dept.

Consortium Function Output Measures

• Quarterly Consortium meeting minutes

• Quarterly Consortium Survey

YVFWC P&D Dept.

Helpful Data Collection Tips

• Develop forms for collection (where possible use pre-existing forms or systems)

• Train your data team

• Budget for staff to collect & enter data

• Schedule data compiling at least quarterly

• Provide feedback to your team

Example:

Data Collection

for Chronic Disease

Self Management Classes

YVFWC P&D Dept.

Number of Classes Attended

0%

5%

10%

15%

20%

25%

30%

1 2 3 4 5 6

Number of Class Session Attended

Pe

rce

nt

of

Pa

rtic

ipa

nts

YVFWC P&D Dept.

Challenges with Attendance

• Inconsistent record keeping

• Different Names

• Retention Issues

YVFWC P&D Dept.

Pre and Post Survey

• Attitude toward Diabetes

• Self Care

• Stages of Change

YVFWC P&D Dept.

Challenges with Pre-Post Survey

• Length of Survey

• Limited Literacy

• Language Differences

• Difficulty with Gradations of Agreement

YVFWC P&D Dept.

Gradations of Agreement

• Strongly Agree, Agree, Neutral, Disagree, Strongly Disagree

• Stair Step – Strongly Agree is Top Step

Strongly Disagree is Bottom Step

• Face Expressions <->

– Strongly Agree is Big Smile

- Strongly Disagree is Big Frown

YVFWC P&D Dept.

Physiological Measures

• Hemoglobin A1c

• Body Mass Index

YVFWC P&D Dept.

Challenges with Physiological Measures

• Pre-Electronic Medical Record inconsistent records

• Patients’ financial limitations (↓labs)

• Limited response from outside our clinic system

YVFWC P&D Dept.

Model Fidelity

• Stanford Training of Master Trainers and Lay Leaders

• Class Fidelity Checklist

• Master Trainer Periodic Monitoring

YVFWC P&D Dept.

Class Fidelity Checklist

Dates of Class Series:___________________ Site: GV TOPP PORTLAND WB

Instructor #1:_____________________ Phone/email contact:

_________________________

Instructor #2:_____________________ Phone/email contact:

_________________________

Characteristics: #1 #2 #3 #4 #5 #6 Comments/Concerns:

Length of class? (# hours/min)              

How many participants with diabetes? # # # # # #  

How many participants who are support people? # # # # # #  

Primary Language of Instruction?

Span/Eng Span/Eng Span/Eng Span/Eng Span/Eng Span/Eng

 

All participants either have Type 2 diabetes or are support for someone with Type 2 diabetes?

Y/N Y/N Y/N Y/N Y/N Y/N

 

2 trained leaders? Y/N Y/N Y/N Y/N Y/N Y/N  

YVFWC P&D Dept.

Challenges with Model Fidelity

• Inconsistent record keeping

• Lack of feedback

• Distant supervision

YVFWC P&D Dept.

Addressing Challenges

• Project Coordinator at local level

• Data Collection Training for all Lay Leaders

• Consistent, timely feedback

• Electronic Medical Records

• Continuous Improvement (i.e. PDSA cycles)

YVFWC P&D Dept.

Noemi, a busy mom with 3 and 6 year old sons, says Tomando "has helped my family eat healthier – especially my kids.”

Noemi says with the help of Tomando she feels better, no longer needs medication to control her Diabetes and has lost weight. "I learned a lot of things.  I learned about supporting one another, there are people going through the same thing I was going through.”

YVFWC P&D Dept.

KUDOS

• Maria Benavides• Nora Clemmons• Rose Jasso• Christina Muro• Laurie Ozanich• Sue Plaster• Norma Renteria• Joni Sobel• Terri Trisler

• Connie Ayala• Bertha Bustos • Maria Carillo• Lily Gonzalez• Diana Lucero• Grace Pablo• Thelma Perches• William Roller • Raquel Sanchez

YVFWC P&D Dept.