REACH U.S. SEA-CEED Charleston and Georgetown Diabetes Coalition and the
Legacy Projects:A Community-Academic
Partnership for Decreasing Diabetes Disparities
REACH U.S. SEA-CEED Charleston and Georgetown Diabetes Coalition and the
Legacy Projects:A Community-Academic
Partnership for Decreasing Diabetes Disparities
The REACH Team and Community Partners
The REACH Team and Community Partners
Your Questions related to:• Impact of social supports on health of our
community
• How supports change our community’s social determinants of health
• Implications of these changes for prevention, treatment, and recovery of people with behavioral health problems
• Impact of social supports on health of our community
• How supports change our community’s social determinants of health
• Implications of these changes for prevention, treatment, and recovery of people with behavioral health problems
“Everyone has the right to a standard of living adequate for the health and well being of himself and his family, including food, clothing, housing and medical care.”
Universal Declaration of Human Rights 1948
From Meredith Minkler, DrPH University of California, Berkeley
Diabetes Initiative of South Carolina
• In 1994, the South Carolina Code of Laws established the Diabetes Initiative of South Carolina
(Note: Data supported Policy Change)
• In 1994, the South Carolina Code of Laws established the Diabetes Initiative of South Carolina
(Note: Data supported Policy Change)
Diabetes Initiative Board
Med. Univ. of SC
Center of Excellence Council
MUSC Diabetes Center of Excellence
USC School of Medicine
Department of Family/Preventive
Medicine
Outreach Council
ADA-SC Outreach Program
REACH
And
23 Other Community
Coalition
Surveillance Council
DHEC Diabetes Prevention and
Control Program
Carolinas Center for Medical Excellence
Other Programs
• Enterprise Neighborhood Health Program with goal to recruit and train Community Health Advocates and conduct needs assessment. (1994–1998)
• Healthy SC- Hypertension and Diabetes Management and Education—HAD-ME with goal to improve health. (1997-2001)
• Enterprise Neighborhood Health Program with goal to recruit and train Community Health Advocates and conduct needs assessment. (1994–1998)
• Healthy SC- Hypertension and Diabetes Management and Education—HAD-ME with goal to improve health. (1997-2001)
Enterprise Health Center 1995 - 2001
Donation of Lot
Building Completed
Opened November 2001Now a FQHC site(FCFFHC)
Student Involvement and Service Learning
>700 students (MUSC, Clemson, UNC Howard, SCSU, USC, Rhode Island)9 Doctoral Candidates/Graduates10 Certified Diabetes Educators
7 doctoral dissertations5 masters thesis32 regional or national presentations35+ peer-reviewed publications
REACH U.S. Charleston And
Georgetown Diabetes
Coalition Goal: Decrease
Disparities for African
Americans with Diabetes
1999-2012
REACH U.S. Charleston And
Georgetown Diabetes
Coalition Goal: Decrease
Disparities for African
Americans with Diabetes
1999-2012 Arlene Case-The Lesson
REACH U.S Centers of Excellence for Eliminating Disparities (CEED)
CEED Communities n = 18
The MountSinai School
of Medicine, NY
Medical University of South CarolinaSC, GA, NC
Khmer HealthAdvocates, Inc,
CT, MA, IL, CA, OR, FL
Public HealthInstitute, CA
The Regents ofthe University of
California, CA
Genesee CountyHealth Department,
MI, WI, IL, MN, IN, OH
University of Alabamaat Birmingham,
AL, AK, KY,LA, MS, TN
Orange County Asianand Pacific Islander
CommunityAlliance, CA
Institutefor
Urban FamilyHealth, NY
HidalgoMedical
Services, NM
Boston Public HealthCommission, MA
Morehouse School of Medicine,GA, NC, SC
The University
ofIllinois
at Chicago,IL
University of Coloradoat Denver and
Health Sciences Center,CO, AZ, NM, SC, WA, AK
Oklahoma StateDepartment of Health, OK
NYUSchool
of Medicine,NY
University of HawaiiHI, American Samoa, North Mariana Islands, Guam
Micronesia, Palau, Marshal Islands
Greater LawrenceFamily Health
Center, MA, Six New England States
REACH CommunitiesREACH Communities
Racial/ethnic groups include:
• African Americans• American Indians &
Alaska natives• Asian Americans• Hispanics/Latinos• Native Hawaiians/Pacific
Islanders
Health Disparities are focused on:
• CVD• Diabetes• Infant Mortality• Breast & Cervical Cancer• AIDs/HIV• Adult Immunizations
REACH: Charleston and Georgetown
Diabetes CoalitionTennessee
South Carolina
SC DHECRegion 6
GeorgetownDiabetes
CORE Group
St. James Santee Health
Center
Enterprise HealthCenter
Enterprise Community
Tri County Black
Nurses
MUSCMUHA
Diabetes InitiativeCollege of Nursing
Alpha KappaAlpha Sorority
Franklin C. FetterFamily
Health Center
Trident United Way
GeorgetownGeorgetown
North Carolina
Georgia
CharlestonCharleston
County Library
Statewide REACH home-basedin Columbia:
Communicare SC DHEC SC DPCP
Carolina Center for Medical Excellence
Trident Urban League
SC DHECRegion 7
County Library
East Cooper Community
OutreachS. SanteeSt. James
Senior Center
Charleston Diabetes Coalition
GreaterSt. Peters
Disparities for African Americans with Diabetes in Charleston and Georgetown
• Lower levels of:– Per capita income and
education– Access to health care– Funding and insurance– Care and education– Satisfaction with care*– Medications and
continuing care– Treatment– Trust in health systems*
• Lower levels of:– Per capita income and
education– Access to health care– Funding and insurance– Care and education– Satisfaction with care*– Medications and
continuing care– Treatment– Trust in health systems*
• Higher levels of:– Poverty– Prevalence of diabetes– Complications including:
• Amputations
• Renal failure (dialysis)
• CVD
– EMS and ED use– Hospitalizations– Costs of care paid by client*– Deaths, especially CVD
• Higher levels of:– Poverty– Prevalence of diabetes– Complications including:
• Amputations
• Renal failure (dialysis)
• CVD
– EMS and ED use– Hospitalizations– Costs of care paid by client*– Deaths, especially CVD
*All disparities were first identified through focus groups and validated with epidemiological or quantitative data except those with asterisk. For those with asterisk, quantitative data showed difference in outcome.
Centers for Disease Control and Prevention
REACH US CEED MUSC College of Nursing
Diabetes Initiative of South CarolinaCollege of Nursing
REACH USCharleston and Georgetown
Diabetes Coalition
National African American Networks Alpha Kappa Alpha Sorority
Black Nurses Association (Professional Organization)Urban League
Baptist Association and COOLJC
Community Systems and Policy Change Health Systems Change
Regional and National NetworksSoutheastern Region of
American Diabetes AssociationCarolinas and Georgia Chapter off
American Society of HTNNational and Regional Network of Libraries of Medicine
Statewide InstitutionsDiabetes Initiative of South Carolina
South Carolina DHECDiabetes Prevention and Control Program
Medical University of South CarolinaCenter for Health Care Disparities
South Carolina State Library
Stroke Belt Counties in Georgia, SC, NC
(Expanded to include all SE States)
Our Coalition Goals• Improve diabetes care and education in 5 health systems
for >13,000 African Americans with diabetes.
• Improve access to diabetes care and self-management education, diabetes supplies and social services for people with diagnosed diabetes.
• Decrease health disparities for African Americans at risk and with diabetes.
• Increase community ownership and sustainability of program.
• Improve diabetes care and education in 5 health systems for >13,000 African Americans with diabetes.
• Improve access to diabetes care and self-management education, diabetes supplies and social services for people with diagnosed diabetes.
• Decrease health disparities for African Americans at risk and with diabetes.
• Increase community ownership and sustainability of program.
Methods for CollaborationThe health professionals/scientists determine “science” or “evidence-base” for diabetes care.
Community leaders/members/CHA determine “what, when, where, and how” to apply “science” or “evidence” in their community while generating evidence for community empowerment.
Together we translate into skills for individual, organizational, and community behavior change, advocacy, and policy change and we evaluate/report our results.
The health professionals/scientists determine “science” or “evidence-base” for diabetes care.
Community leaders/members/CHA determine “what, when, where, and how” to apply “science” or “evidence” in their community while generating evidence for community empowerment.
Together we translate into skills for individual, organizational, and community behavior change, advocacy, and policy change and we evaluate/report our results.
Community Actions Community-driven activities and creating healthy
learning environments where people live, worship, work, play, and seek health care.
Evidence-based health systems change using continuous quality improvement teams (CQI).
Coalition power built through collaboration, trust, and sound business planning and focused on systems, community, and policy change and sustainability.
Community-driven activities and creating healthy learning environments where people live, worship, work, play, and seek health care.
Evidence-based health systems change using continuous quality improvement teams (CQI).
Coalition power built through collaboration, trust, and sound business planning and focused on systems, community, and policy change and sustainability.
Bio-Psycho-Social Management of Diabetes
• Healthy Eating• Being Active• Monitoring• Taking Medications• Problem Solving• Reducing Risks• Healthy Coping
• Healthy Eating• Being Active• Monitoring• Taking Medications• Problem Solving• Reducing Risks• Healthy Coping
• Self Management• Family Management• Medical Health Care
Management• Community
Management• More………..
• Self Management• Family Management• Medical Health Care
Management• Community
Management• More………..
Approaches
• Individual behavior change &
lifestyle modification
• Environmental restructuring
• Social ecological approach
E.T. Anderson and J.M. McFarlane (2006)
Our Community Systems Wheel
CDC Social Determinants of Health• Socioeconomic status • Education• Employment• Transportation • Housing • Access to services • Discrimination by social grouping
(e.g., race, gender, or class) • Social or environmental stressors • Urban-rural environments http://www.cdc.gov/dhdsp/library/maps/social_determinants.htm
• Socioeconomic status • Education• Employment• Transportation • Housing • Access to services • Discrimination by social grouping
(e.g., race, gender, or class) • Social or environmental stressors • Urban-rural environments http://www.cdc.gov/dhdsp/library/maps/social_determinants.htm
The Community Chronic Care Conceptual Model REACH Charleston and Georgetown Diabetes Coalition
(Jenkins, Pope, Magwood et al., PCHP 4 (1): 73)
External InfluencesExternal Influences
Evaluation Logic Model
CoalitionCoalition
Understanding Context, Causes, & Solutions for Health Disparity
CommunityAction Plan
Planning & Capacity Building
Targeted REACH Action
Existing Activities
Change Agents Change
Widespread Change in Risk/Protective
Behaviors
Reduced HealthDisparity
Community & Systems Change
OtherOtherOutcomesOutcomes
REACH Charleston And
Georgetown Diabetes
Coalition’s Efforts to Decrease
Diabetes-RelatedAmputations
REACH Charleston And
Georgetown Diabetes
Coalition’s Efforts to Decrease
Diabetes-RelatedAmputations
Specific Aims
• Improve foot care for African Americans with diabetes.
• Eliminate disparities in number of amputations for African Americans with diabetes.
• Improve foot care for African Americans with diabetes.
• Eliminate disparities in number of amputations for African Americans with diabetes.
Interventions• Community skill-building & neighborhood clinicsCommunity skill-building & neighborhood clinics
– 175 lay educators trained175 lay educators trained– Diabetes Self Management & Foot Care educationDiabetes Self Management & Foot Care education– Wise Women & Wise Men helping each otherWise Women & Wise Men helping each other
• Community health professional trainingCommunity health professional training– > 90% of health professionals in 5 systems attended update on diabetes care> 90% of health professionals in 5 systems attended update on diabetes care– 225 RNs completed advanced foot/wound education225 RNs completed advanced foot/wound education– 27 physicians completed foot care education27 physicians completed foot care education
• Outreach by professional & lay educators/navigators (CHAs)Outreach by professional & lay educators/navigators (CHAs)– 30 minute TV program aired 34 times on cable30 minute TV program aired 34 times on cable– Library program/Internet useLibrary program/Internet use– Weekly diabetes management groups in 10 sitesWeekly diabetes management groups in 10 sites– Navigation for diabetes care, supplies & social servicesNavigation for diabetes care, supplies & social services
• Health systems changeHealth systems change– Registry & reminder systemRegistry & reminder system– CQI teams with chart audit & feedbackCQI teams with chart audit & feedback
• Coalition building, sustainability (501c3), & policy changeCoalition building, sustainability (501c3), & policy change
• Community skill-building & neighborhood clinicsCommunity skill-building & neighborhood clinics– 175 lay educators trained175 lay educators trained– Diabetes Self Management & Foot Care educationDiabetes Self Management & Foot Care education– Wise Women & Wise Men helping each otherWise Women & Wise Men helping each other
• Community health professional trainingCommunity health professional training– > 90% of health professionals in 5 systems attended update on diabetes care> 90% of health professionals in 5 systems attended update on diabetes care– 225 RNs completed advanced foot/wound education225 RNs completed advanced foot/wound education– 27 physicians completed foot care education27 physicians completed foot care education
• Outreach by professional & lay educators/navigators (CHAs)Outreach by professional & lay educators/navigators (CHAs)– 30 minute TV program aired 34 times on cable30 minute TV program aired 34 times on cable– Library program/Internet useLibrary program/Internet use– Weekly diabetes management groups in 10 sitesWeekly diabetes management groups in 10 sites– Navigation for diabetes care, supplies & social servicesNavigation for diabetes care, supplies & social services
• Health systems changeHealth systems change– Registry & reminder systemRegistry & reminder system– CQI teams with chart audit & feedbackCQI teams with chart audit & feedback
• Coalition building, sustainability (501c3), & policy changeCoalition building, sustainability (501c3), & policy change
Check Yourself to Protect YourselfCheck Yourself to Protect YourselfTake Care of Our Feet Take Care of Our Feet
A Lesson Plan, Kit of Materials, and A Lesson Plan, Kit of Materials, and Slide Series/Flip Chart for Lay LeadersSlide Series/Flip Chart for Lay Leaders
REACH Charleston & Georgetown Counties Diabetes Coalition
Ezekiel 37:10 “So I prophesied as he commanded me, and the breath came into them, and they lived, and stood up upon their feet, an exceeding great host.”
Lesson ObjectivesAfter the lesson, participants will be able to demonstrate:
• Taking care of feet• Cutting nails to prevent foot problems.• Selecting appropriate footwear.• Checking feet each day to identify early signs of foot
problems.• Using the monofilament to check for loss of feeling in feet.• When and how to notify health provider.• Asking the health care provider for foot exam.• Methods for prevention of foot problems.
After the lesson, participants will be able to demonstrate:
• Taking care of feet• Cutting nails to prevent foot problems.• Selecting appropriate footwear.• Checking feet each day to identify early signs of foot
problems.• Using the monofilament to check for loss of feeling in feet.• When and how to notify health provider.• Asking the health care provider for foot exam.• Methods for prevention of foot problems.
Testing for Loss of FeelingMethod for testing with Monofilament
Sites for testing with Monofilament
Bottom of FeetCheck eachof these sites 3 times
>6,000 monofilaments were distributed to professionals and people with diabetes.
A Book on Diabetes Care
and Management
&
Patient-Held Mini-Record(available on website)
Working effectively with communities
moves the science from
Bench to Bedside to
Countryside more rapidly.
Skill-Building forCHAs and Volunteers
Neighborhood Walk and TalkGroups
Individual/ Group
Education
> 3 sessions = 3.2% drop in
A1c
Community and Media Activities reached >125,000
African Americans
Community Screening and
Education
Photos used with permission of clients and partners
Georgetown County Diabetes Core Activities
Physical ActivityHealth Screenings
Educational Classes
Walk-A-Thon
Healthy Cooking
Gardening
Dinner TheaterGardening Class
REACH at theLibrary
Equipped with 6 Internet laptop computers
Cybermobile
Diabetes at the Library
Womanless Wedding
Men’s Talk Talk about Diabetes & Foot Care
Recognitionand
Rewards
MediaMedia
Results
% Change in Diabetes Care for African Americans
• A1C Testing 76.8 97.1
• Blood Pressure <130/80 24 38
• Lipid Testing 47.3 87.2
• Eye Exam 34 76
• Feet Exam 64 97.3
• Kidney Tests 13.4 56
• A1C Testing 76.8 97.1
• Blood Pressure <130/80 24 38
• Lipid Testing 47.3 87.2
• Eye Exam 34 76
• Feet Exam 64 97.3
• Kidney Tests 13.4 56
2000 2007 2012
Charleston and Georgetown CountiesLEA Rate per 1000 DM Hospitalizations
Data Source: SC Hospital Discharge Data, Office of Research and Statistics
Charleston and Georgetown CountiesLEA Rate per 1000 DM Hospitalizations
Data Source: SC Hospital Discharge Data, Office of Research and Statistics
Prepared by SCDHEC Office of Epidemiology and Evaluation updated 03/12
Preliminary Estimated Outcomes for Reduction in Diabetes LEAs in African
Americans in 2 Counties
Preliminary Estimated Outcomes for Reduction in Diabetes LEAs in African
Americans in 2 Counties• Improved QOL for person whose legs were saved.• Cost savings:
– Costs per amputation in Georgetown County = $54,736 in 2008
– Costs per amputation in Charleston County = $42,783 in 2008
– Reduction in amputations compared to 1999 = 44% in African Americans
– Cost savings of >$2 million/year in 2008.
Note: release for photo
Hennessey, S. et al. (2005). The Community Action Model: American Journal of Public Health, 95, 611-616.
5 Step Community Action Model
Lessons from the Community
#1 “We want to know how much you care before we care how much you know.
#1 “We want to know how much you care before we care how much you know.
#2 Academic-community partnerships are build on TRUST, RELATIONSHIPS, and community needs.•Go to the community.
•Work collaboratively to identify priorities (CHA).
•Listen carefully, communicate clearly.
•Interventions can be creative---but never underestimate the power of community members.
•Balance the “problem” with strong emphasis on assets and collaborative problem solving.
#2 Academic-community partnerships are build on TRUST, RELATIONSHIPS, and community needs.•Go to the community.
•Work collaboratively to identify priorities (CHA).
•Listen carefully, communicate clearly.
•Interventions can be creative---but never underestimate the power of community members.
•Balance the “problem” with strong emphasis on assets and collaborative problem solving.
#3 Embrace CHANGE
•Start with easily accomplished steps to facilitate success and provide feedback related to progress.
•Share community successes from other communities to illustrate methods.
•Community-wide change often comes slowly, so provide ongoing encouragement.
•Community members may need to move to other community priorities.
#3 Embrace CHANGE
•Start with easily accomplished steps to facilitate success and provide feedback related to progress.
•Share community successes from other communities to illustrate methods.
•Community-wide change often comes slowly, so provide ongoing encouragement.
•Community members may need to move to other community priorities.
#4 Community and Academic “Champions” are needed as facilitators.
•Examine promotion and tenure criteria and include scholarly community engagement activities.
•Fund community members and include fringe benefits!
•Do NOT underestimate the power or knowledge of person who lacks a formal education.
#4 Community and Academic “Champions” are needed as facilitators.
•Examine promotion and tenure criteria and include scholarly community engagement activities.
•Fund community members and include fringe benefits!
•Do NOT underestimate the power or knowledge of person who lacks a formal education.
#5 Practice Cultural Empowerment!
•Ask the participant about preferred way of addressing individual, group or health issue.
•Find a trusted community member to guide and educate the researcher.
•Although cultural competence is important, it is often used to “stereotype” so appreciate diversity and nuances of all.
•Empower participant and community
to celebrate history and culture.
#5 Practice Cultural Empowerment!
•Ask the participant about preferred way of addressing individual, group or health issue.
•Find a trusted community member to guide and educate the researcher.
•Although cultural competence is important, it is often used to “stereotype” so appreciate diversity and nuances of all.
•Empower participant and community
to celebrate history and culture.
Thank you to all community residents with diabetes, community leaders, and our partners who have
worked to eliminate diabetes disparities:
Thank you to all community residents with diabetes, community leaders, and our partners who have
worked to eliminate diabetes disparities:
• Charleston Diabetes Coalition• AKA Sorority (N. Charleston)• Greater St. Peter’s Church• Diabetes Initiative of SC• East Cooper Community Outreach• Franklin C. Fetter Family Health
Centers• MUSC College of Medicine• MUSC College of Nursing• Georgetown Diabetes CORE
Group
• MUSC Library• SC DHEC Diabetes Prevention
and Control Program and Epidemiology
• SC DHEC Region 7 and 8• St James-Santee Family Health
Center• Tri-County Black Nurses
Association• Trident United Way 211 Help Line• Trident Urban League
Acknowledgements
This project is funded by the REACH Charleston and Georgetown Diabetes Coalition CDC
Grant/Cooperative Agreements U50/CCU422184 and 1U58DP001015 from the Centers for Disease Control
and Prevention.
Additional grant funding to document disparities related to ED and Hospitalizations from
NIH NINR 1 R15 NR009486-01A1
The contents are solely the responsibility of the author and community partners and do not
necessarily reflect the official views of the funding agencies.
Thank you to all community residents with diabetes, community leaders, and our partners who have
worked to eliminate diabetes disparities:
Thank you to all community residents with diabetes, community leaders, and our partners who have
worked to eliminate diabetes disparities:
• Charleston Diabetes Coalition• AKA Sorority (N. Charleston)• Greater St. Peter’s Church• Diabetes Initiative of SC• East Cooper Community Outreach• Franklin C. Fetter Family Health
Centers• MUSC College of Medicine• MUSC College of Nursing• Georgetown Diabetes CORE
Group
• MUSC Library• SC DHEC Diabetes Prevention
and Control Program and Epidemiology
• SC DHEC Region 7 and 8• St James-Santee Family Health
Center• Tri-County Black Nurses
Association• Trident United Way 211 Help Line• Trident Urban League
Although studies documenting disparities are not in short supply, findings about what works to reduce disparities are. A 3-year, $6-million program called Finding Answers: Disparities Research for Change, sponsored by the Robert Wood Johnson Foundation, seeks to identify effective interventions to eliminate disparities.
Under the direction of Marshall Chin, MD, MPH, an associate professor of medicine at the University of Chicago Pritzker School of Medicine, the program reviewed more than 200 journal articles on disparity reduction interventions in cardiovascular disease, depression, diabetes, and breast cancer. The results appeared in October 2007 in a supplement to Medical Care Research and Review.
One of the few studies in the review that showed a reduction in racial disparities was part of the Racial and Ethnic Approaches to Community Health (REACH 2010) program, sponsored by the US Centers for Disease Control and Prevention in Atlanta, Ga. The demonstration program, which took place in Charleston and Georgetown counties in South Carolina, brought together 28 community partners, from health professionals to college sororities and local media, that set goals to improve diabetes care for blacks as well as eliminate health care disparities between black and white patients with diabetes.
The partners documented disparities in care for 12,000 black patients with diabetes in the 2-county community. The intervention included such community activities as health fairs, support groups, grocery store tours, community clinics, and church-based educational programs. After 24 months, the partners audited medical charts for 158 black patients and 112 patients who were white or of other racial or ethnic groups. They found that differences between black and white patients in rates of hemoglobin A1c testing, lipid and kidney testing, eye examinations, and blood pressure control that had ranged from 11% to 28% at baseline had been eliminated (Jenkins C et al. Public Health Rep. 2004;119[3]:322-330).
Chin is optimistic that other communities will develop their own, similar programs in the future. "There are a lot of promising models," he says. "But you may have to revise as you go along, just like in patient care."
Quote from R. Voelker in JAMA 2008;299(12):1411-1413.
Although studies documenting disparities are not in short supply, findings about what works to reduce disparities are. A 3-year, $6-million program called Finding Answers: Disparities Research for Change, sponsored by the Robert Wood Johnson Foundation, seeks to identify effective interventions to eliminate disparities.
Under the direction of Marshall Chin, MD, MPH, an associate professor of medicine at the University of Chicago Pritzker School of Medicine, the program reviewed more than 200 journal articles on disparity reduction interventions in cardiovascular disease, depression, diabetes, and breast cancer. The results appeared in October 2007 in a supplement to Medical Care Research and Review.
One of the few studies in the review that showed a reduction in racial disparities was part of the Racial and Ethnic Approaches to Community Health (REACH 2010) program, sponsored by the US Centers for Disease Control and Prevention in Atlanta, Ga. The demonstration program, which took place in Charleston and Georgetown counties in South Carolina, brought together 28 community partners, from health professionals to college sororities and local media, that set goals to improve diabetes care for blacks as well as eliminate health care disparities between black and white patients with diabetes.
The partners documented disparities in care for 12,000 black patients with diabetes in the 2-county community. The intervention included such community activities as health fairs, support groups, grocery store tours, community clinics, and church-based educational programs. After 24 months, the partners audited medical charts for 158 black patients and 112 patients who were white or of other racial or ethnic groups. They found that differences between black and white patients in rates of hemoglobin A1c testing, lipid and kidney testing, eye examinations, and blood pressure control that had ranged from 11% to 28% at baseline had been eliminated (Jenkins C et al. Public Health Rep. 2004;119[3]:322-330).
Chin is optimistic that other communities will develop their own, similar programs in the future. "There are a lot of promising models," he says. "But you may have to revise as you go along, just like in patient care."
Quote from R. Voelker in JAMA 2008;299(12):1411-1413.
For additional information
Carolyn Jenkins, DrPH
e-mail: [email protected]
Phone: 843-792-4625
Carolyn Jenkins, DrPH
e-mail: [email protected]
Phone: 843-792-4625
