Cooperative Agreement H1D4IHS0239

SPECIAL DIABETES PROGRAM FOR INDIANS DIABETES PREVENTION AND TREATMENT PROJECTS - THE SDPI DIABETES PROGRAM IS BASED OUT OF BRISTOL BAY AREA HEALTH CORPORATION WHICH S AN IHS COMPACTED FACILITY. - ABSTRACT: BRISTOL BAY AREA HEALTH CORPORATION (BBAHC) A NONPROFIT, TRIBAL HEALTH CARE ORGANIZATION, WAS INCORPORATED IN 1973 AS A 501 (C) (3) NON-PROFIT IHS COMPACTED FACILITY. BRISTOL BAY AREA HEALTH CORPORATION SDPI HAS BEEN RUNNING SINCE 1998. THE KANAKANAK HOSPITAL AND COMMUNITY HEALTH CENTER ARE LOCATED IN DILLINGHAM, WITH 21 VILLAGE-BASED CLINICS THROUGHOUT THE REGION. TEN OF THE CLINICS ARE RECOGNIZED AS FEDERALLY QUALIFIED HEALTH CENTERS BY THE BUREAU OF PRIMARY HEALTH CARE AND THE CENTERS FOR MEDICARE AND MEDICAID SERVICES OF THE U.S. DEPARTMENT. THE HOSPITAL HAS A FULL MEDICAL STAFF, THAT OFFERS DIABETIC CARE, LAB, PHARMACY, OPTOMETRY, RADIOLOGY, PHYSICAL THERAPY, AUDIOLOGY AND DENTAL. THE DIABETES TEAM TRAVELS TO THE VILLAGES TO PROVIDE DIABETIC CARE AND TESTING. BRISTOL BAY AREA HEALTH CORPORATION, BRISTOL BAY AREA SDPI PROGRAM ENGAGES IN A MULTI-FACETED AND INTEGRATED APPROACH IN PROVIDING DIABETES MANAGEMENT PLUS PREVENTION ACTIVITIES AND SERVICES TO ALASKA NATIVES/AMERICAN INDIANS THROUGHOUT BRISTOL BAY AREA SERVICE AREA, ALASKA. THE BRISTOL BAY AREA SDPI PROGRAM IDENTIFIED GOALS AND OBJECTIVES THAT ARE ROOTED IN THE IHS SDPI 2021 AUDIT FINDING, INPUT FROM BBAHC'S REGION-WIDE MEDICAL STAFF STAKEHOLDERS, AND DIABETES- RELATED REGIONAL CLINICAL HEALTH OUTCOMES ROUTINELY MONITORED BY BBAHC'S TRIBALLY-LEAD DIABETES ADVISORY COMMITTEE. THE SDPI DIABETES PROGRAM SELECTED BEST PRACTICE OF GLYCEMIC CONTROL, THE SDPI PROGRAM IS STRUCTURED TO ADVANCE THIS BEST PRACTICE WITHIN THREE CENTRAL PROGRAMMATIC COMPONENTS INCLUDING: COMPONENT I- COLLABORATIVE DIABETIC CARE COORDINATION, MANAGEMENT, AND PREVENTION: THE BRISTOL BAY AREA SDPI PROGRAM IN COLLABORATION WITH THE VILLAGE-BASED COMMUNITY HEALTH AIDE PROGRAM (CHAPS), AND COMMUNITY STAKEHOLDERS, WILL BE PROVIDING A RANGE OF DIABETIC CARE SERVICES AND PREVENTION ACTIVITIES. COORDINATION OF CARE WITH MEDICAL STAFF, AND RN'S, WILL SCHEDULE LABS AND SPECIALTY REFERRALS. HBA1C SCREENING BY RN'S AND COMPREHENSIVE NURSE CASE MANAGEMENT. PATIENT EDUCATION WILL BE PROVIDED BY RN'S RD, HEALTH EDUCATORS AND MD TO ALL COMMUNITY PARTICIPANTS. THE TEAM WILL INCLUDE THE FOLLOWING DISCIPLINES DIABETES TEAM: OF PODIATRIST, MD SPECIALIZING IN DIABETES CARE, REGISTERED NURSES, CDE REGISTERED DIETITIAN, CDE, PHARMACISTS, PHYSICAL THERAPIST, VILLAGE COMMUNITY HEALTH AIDE, OPTOMETRIST, DENTAL, AND ANCILLARY STAFF. COMPONENT 2- FOOT EXAMS; PATIENTS WILL SEE THE PODIATRIST DURING THEIR YEARLY DIABETES APPOINTMENTS, RN &/OR CERTIFIED DIABETIC NURSE ALSO WILL PROVIDE DIABETIC FOOT EXAMS AND REFER PATIENT TO PODIATRIST FOR ANY ABNORMAL ASSESSMENT FINDINGS. COMPONENT 3- RETINOPATHY SCREENING: DIABETICS WILL HAVE A RETINOPATHY EXAM ONCE A YEAR. THE DIABETES PROGRAM HAS 2 PORTABLE RETINOPATHY MACHINES, WHICH IS TAKEN OUT ON VILLAGES TRAVEL, AND USED TO PROVIDE EYE EXAMS. THE RESULTS ARE THEN TAKEN TO THE OPTOMETRIST AT THE MAIN HOSPITAL WHERE THEY WILL BE REVIEWED BY THE OPTOMETRIST TO SEE IF FURTHER EYE CARE IS NEEDED. EACH YEAR THE BRISTOL BAY AREA SDPI TEAM AND THE ANCHORAGE IHS DIABETES TEAM COMES TOGETHER IN DILLINGHAM TO HAVE A WEEK-LONG INTENSIVE JOINT DIABETES CLINIC.