Optimizing CDEs and CHWs for Kentucky’s Rural Diabetes Belt Counties

CDC scientists have identified a diabetes belt located mostly in the southern portion of the United States. This diabetes belt consists of 644 counties in 15 states. Sixty-eight (68) of Kentucky’s 120 counties are in this diabetes belt, which requires that ≥ 11% of adults aged ≥ 20 have been diagnosed as having type 2 diabetes. Certified Diabetes Educators (CDEs) are a major resource for health campaigns to prevent type diabetes, delay its onset, and to lessen its serious negative health outcomes. Unfortunately Kentucky has only 257 publicly listed CDEs and becoming a CDE is a long and arduous process. Further exacerbating this workforce problem is the mal-distribution of CDEs relative to the needs throughout Kentucky, with the majority of CDEs concentrated in urban areas and in the 52 Non-Diabetes Belt Counties. Community Health Workers (CHWs) of the Kentucky Homeplace Program by contrast are located mostly in rural underserved counties that have some of the highest rates of type 2 diabetes

Healthy WAY: Wellness in All Youth

Healthy WAY encourages student led teams to work collectively on an identified problem, by reviewing local data, trends, and research to develop a strategic plan of action with key stakeholders in their schools and communities. Community organizations can partner to invest in initiatives like Healthy WAY to restore hope and resilience in our youth. Tips to ensure success include: Organizational support, a staff mentor dedicated to the project for the entire period, partners in the school systems and venues for the students to share their outcomes

Kentucky’s Growing Need for Medical Laboratory Practitioners

Context: The U.S. Bureau of Labor Statistics predicts a 15% growth in medical laboratory science (MLS, formerly clinical laboratory science and medical technology) graduates from 2010 to 2020. Kentucky is underserved and has a maldistribution of medical laboratory practitioners, composed of scientists and technicians, with rural communities more likely to be underserved by MLS graduates. 1 Implementation of the Affordable Care Act (ACA) is likely to increase demand for medical laboratory practitioners because of the ACA’s preventative health focus and the expansion of access to healthcare. An increase in the aging population will also contribute to a greater need to diagnose medical conditions such as cancer or type 2 diabetes using laboratory procedures. Objective: Estimate the need for graduates from medical laboratory science/technician programs and evaluate a potential educational model centered at the UK Center for Excellence in Rural Health that would build on in-place education and guide medical laboratory science graduates to underserved rural communities. Design: Comparative analysis of Kentucky’s population ratio of medical laboratory science/technician graduates with its seven border states. Data are from the Bureau of Labor Statistics, Kentucky Labor Market Information system, Kentucky State Data Center. Participants: University of Kentucky Center of Excellence in Rural Health and University of Kentucky College of Health Sciences. Main Outcome Measure(s): Estimates of need for MLS graduates. Results: Kentucky has a current need of 461 medical laboratory scientists and 1,067 medical laboratory technicians when compared to the seven states that border Kentucky. Conclusions: The Center of Excellence in Rural Health can take the lead in the development of a cooperative model that educates and trains MLS students through an associate degree program (e.g., associate of science) and prepares them for beginning a baccalaureate program offered at the Center of Excellence in Rural Health. This program can help meet a substantial need for MLS graduates and offer opportunities for new careers for persons displaced through downturns in the coal industry and other labor dislocations in Eastern Kentucky

Effectiveness of Community Health Workers (CHWs) in Coordinating Diabetes Self Management Education (DSME) for High-Need Appalachian Clients

Objective Examine effectiveness of CHWs in supporting a nurse-led DSME intervention among clients who are characterized by high rates of poverty and poor education. Methods Study Population/Research Design: New Kentucky Homeplace clients (3,217) ages 18-65+ from a 26-county study area who were processed prior to study starting date July 1, 2011. The 30.6% (983) of clients who had been told by a health professional they were diabetic, could speak English, and were willing to sign IRB consent were eligible to participate. Women who were diagnosed with diabetes during pregnancy were not eligible. Clients were able to enroll on a first-come basis up to a cutoff of the sample size of 495, with approximately 20 from each county to maintain geographic representation. After dropouts and disqualification for failure to keep appointments, 215 clients completed a single-group pretest and posttest design. Demographic and background variables included age, gender, marital status, education, income, federal poverty level, health insurance status, visit to diabetes educator, and New Vital Sign (NVS) test of health literacy level. Pretest and posttest measures included A1C , Weight (pounds), Height (ft., in.), Diabetes Knowledge Test (DKT), Diabetes Empowerment Scale – Short Form (DES - SF), and the Summary of Diabetes Self-care Activities (SDSCA) Measure. Demographic and background data were collected by CHWs, and they administered the NVS, DKT, DES - SF, and SDSCA tests. The nurse educator administered measures of weight, height, and A1C. Key Findings Study group was predominantly female (65.7%), poorly educated (29.8% \u3c high school), 45.6% in poverty, 58.1% without health insurance, 68.8% never visited a diabetes educator, and 44.7% with the possibility of limited health literacy. Glucose testing improved and A1C lowered in post testing after DSME intervention. Conclusions CHWs were effective in providing support for DSME. They succeeded in screening clients, obtaining their IRB consent, and enrolling them in the study. They successfully administered study instruments, provided follow-up assistance to clients regarding the DSME and entered data into the Homeplace database. CHWs can play a key role in DSME in areas where there is a shortage of primary care physicians and CDEs

Nurse Led Community Health Worker Lay Leader Model

In America’s Health Rankings 2018 Annual Report, Kentucky ranked 45 out of 50 in the nation’s healthiest states, signifying the poor overall health of the state.1 Additional statistics show that rural areas of Kentucky, especially the Appalachian region, face some of the highest rates of health disparities in the state and nation. Associated social, environmental, and health risk factors in this population further complicate matters, resulting in a higher prevalence of chronic diseases. Although chronic diseases can cause serious complications, most disease risk factors can be prevented or controlled. Evidence-based self-management education models, such as the Chronic Disease Self-Management Program (CDSMP), Diabetes Self-Management Program (DSMP), and Walk With Ease, may provide a solution to address the growing chronic disease epidemic. In these programs, participants receive self-management education for a variety of chronic diseases, including diabetes and arthritis, to improve and manage their health conditions. Led and trained by registered nurses, community health workers (CHWs) incorporate these self-management programs into the communities they serve and provide a supportive role by interacting with participants before, during, and after each session to aid in successful completion rates and improved health outcomes. One such CHW program, Kentucky Homeplace, has been providing self-management education since its inception in 1994, and began integrating CDSMP, DSMP, and Walk With Ease into the community in 2015

Appalachian Research Day: Come Sit on the Porch [2019]

Rural Appalachian communities in eastern Kentucky suffer from some of the Nation’s most concerning health disparities. Community-based research can be an effective way to address health disparities by identifying problems and sharing workable solutions. However, challenges exist in recruiting and retaining research participants in rural populations that can often be difficult to reach. Partnerships between researchers and communities are essential to the success of the research process, particularly translation of findings back into the community

Appalachian Research Day: Come Sit on the Porch [2016]

Rural Appalachian communities in eastern Kentucky suffer from some of the Nation’s most concerning health disparities. Community-based research can be an effective way to address health disparities by identifying problems and sharing innovative solutions. However, challenges exist in recruiting and retaining research participants in rural populations that can often be difficult to reach. Partnerships between researchers and communities are essential to the success of the research process, particularly translation of findings back into the community

Appalachian Research Day: Come Sit on the Porch

Rural Appalachian communities in eastern Kentucky suffer from some of the Nation’s most concerning health disparities. Community-based research can be an effective way to address health disparities by identifying problems and sharing innovative solutions. However, challenges exist in recruiting and retaining research participants in rural populations that can often be difficult to reach. Partnerships between researchers and communities are essential to the success of the research process, particularly translation of findings back into the communit

Medical Laboratory Science Workforce Shortage

Prior to 1900, laboratory tests were rudimentary, few in number, and often performed by a physician in his office or by a pathologist in hospitals. Epidemic outbreaks of diphtheria, pneumonia, typhoid, and tuberculosis created a demand for additional laboratory tests and individuals to perform them. The increase in civilian and military clinical (hospital) laboratories during World War I and the new American College of Surgeons requirement that hospitals establish a clinical laboratory contributed to a severe shortage of laboratory personnel (Kotlarz, 1998a)

A Diffusible Mobile Dental Services Model for Prevention-Focused Outreach for Underserved Children in Rural Communities

Background: In 2006 a mobile dental outreach program began operating full-time at the UK North Fork Valley Community Health Center in Hazard, Kentucky, a federally-qualified health center administered by the University of Kentucky and located at the UK Center of Excellence in Rural Health. This program continues to provide preventive dental care to children at forty different elementary schools and Head Start centers in a four county area of southeastern Kentucky located in the heart of rural Appalachia. The counties are Leslie, Knott, Letcher and Perry (LKLP), which are part of the Kentucky River Development District and encompass the LKLP Community Action zone created by the Kentucky General Assembly. The program serves approximately 2,500 children each school year. Context: Children in eastern Kentucky have the second highest rate of untreated tooth decay in the nation. Over half of the children in Perry County, where the mobile dental program is based, had untreated cavities, and 20 percent had painful dental abscesses when the UK dental outreach team started seeing children in local schools and Head Start centers in 2006. Objective: Development of a model mobile dental service for children that can be implemented in other rural communities where there are high levels of unmet need. Design: Comparative analysis of pre/post dental services intervention using data collected by the mobile outreach team. Setting: Eleven sites in Perry County, a rural Appalachian community. Participants: Children from underserved families. Intervention: Exams, cleanings, fluoride treatments and referrals through the Eastern Kentucky Ronald McDonald Care Mobile. Main Outcome Measure(s): Improved oral health through the reduction in cavities and abscesses and other other gum disease. Results: Decay rates reduced by 16 percent and urgent dental needs reduced by 10%. Conclusions: Mobile dental services can effectively screen and treat children in areas where services are unavailable through public school programs and through private dental practices that are closed to new patients or do not accept Medicaid patients. Mobile dental services are adaptable and can be focused in areas within communities to create access for high risk and underserved familie