Diabetes Education with a Teaching Kitchen Intervention Can Improve Hemoglobin A1c for Type 2 Diabetics Compared to Traditional Diabetes Education

AuthorsJill Christensen MD MPH Providence Milwaukie HospitalHeidi Davis MSW Providence Milwaukie HospitalCharlotte Navarre RN Providence Milwaukie HospitalHsin-Fang Li PHD Providence Medical Data Research CenterKathy Schwab MPH RDN Providence Health EducationRichard O’Neil MBA Providence Planning Analyst Title Diabetes Education with a Teaching Kitchen Intervention Can Improve Hemoglobin A1c for Type 2 Diabetics Compared to Traditional Diabetes Education Purpose The Providence Milwaukie Community Teaching Kitchen offers health-focused, budget friendly cooking classes for patients. In 2019, we piloted diabetes education classes with an added hands-on culinary session. This study compares the change in hemoglobin A1c for patients who participated in the pilot with those in the standard curriculum and those referred to diabetes education but did not enroll. Methods This retrospective analysis compared change in hemoglobin A1c for all patients referred to diabetes education in the Providence Northern Oregon region in 2019. Patients referred to diabetes education but not enrolled were considered a control group. To balance patient characteristics (e.g. age, gender, and pre-A1c score), two-to-one propensity score matching method was used to identify two matched controls for each enrollee. Change in hemoglobin A1c from baseline to 3-6 months were compared among matched comparison groups. Results 13,582 patients were identified including 19 patients enrolled in diabetes education plus kitchen class, 640 patients in traditional diabetes education, and 12,923 patients referred but did not enroll. After matching, 1,318 matched patients were selected from the non-enrollees as the control group. The change in hemoglobin A1c was -0.49, -0.81, and -0.95 for the control group, diabetes education group, and diabetes education group with kitchen classes, respectively. Compared to the control group, both diabetes education groups had a greater reduction in hemoglobin A1c (difference of 0.32, 95% Confidence Interval [CI]=0.17, 0.48 for the diabetes education group; difference of 0.46, 95% CI=-0.28, 1.19) for the diabetes plus kitchen class group). Even though the diabetes education plus kitchen intervention had the largest reduction in hemoglobin A1c, the sample was small with large variation. Conclusions Integrating a teaching kitchen component into the traditional diabetes education curriculum is a promising approach that can further improve initial biometric outcomes. Future studies are warranted to demonstrate clinical effectiveness of this enhanced intervention. Financial Support Health Share Oregon Coordinated Care Organizationhttps://digitalcommons.psjhealth.org/milwaukie_family/1004/thumbnail.jp

Increasing Vaccination Rates of Children up to 24 months old at PMG Milwaukie Family Medicine

Increasing Vaccination Rates of children up to 24 months old at PMG Milwaukie Family Medicine Authors: Justin Ferley DO; Rachel Jackson MD; Aubrey Miller MD; Sebastian Reeve MD; Christelle Serra Van-Brunt DO; Jamie Skreen DO; Jeffrey Sun DO; John Yates MD; Daniel Ruegg MD Introduction: Each year in the US, 42000 adults and 300 children die of vaccine preventable diseases. Yet across the country, clinics – including ours – fall short of the CDC Healthy People 2020 goals of pediatric vaccination rates. This resident-led quality improvement (QI) project aimed to improve our clinic vaccination rates in the under 24mo population. Methods: We identified 3 opportunities for vaccinating children under our clinic current processes: well child visits, medical assistants’ vaccinations visits, and acute care visits. Using a multidisciplinary approach comprising residents, MAs, clinical care coordinators and our nursing quality supervisor, we analyzed our current vaccinations processes and our iterative plan-do-study- cycles (PDSA) included: PDSA #1: standardize our work flow for vaccine reconciliation. PDSA #2: sending personal reminder lebers to patients and overall improving our vaccine recall/ reminder system. PDSA #3: Minimizing provider variation for vaccines given at the 12-18mo WCC. Results: We saw an improvement in our vaccinations rates after personalized reminder letters were sent out, outlining that we do not have a reliable vaccine schedule reminder system. We also noted that different providers created different vaccinations schedules in order to prevent giving 5 vaccines at the same $me – with no system in place to follow on missed vaccination, thus creating missed opportunities and suggesting that we need to implement a clinic-wide vaccine schedule. Conclusion: Our last PDSA cycle was interrupted by current CIVD-19 pandemic. We have however found valuable data to help improve our clinic’s vaccination rates, and plan to continue this project over the next 2 years.https://digitalcommons.psjhealth.org/milwaukie_family/1007/thumbnail.jp