HRSA grant funds improvements to diabetes navigation program

Aug 21, 2018

Thanks to a new three-year, $600,000 grant from the Health Resources & Services Administration of the U.S. Department of Health and Human Services, the Ohio University Heritage College of Osteopathic Medicine will be expanding a collaborative program launched in 2015 to improve health outcomes and lower costs for diabetes patients in southeastern Ohio. Among the improvements will be the addition of services aimed specifically at children with diabetes in seven southeast Ohio counties.

Diabetes and its complications are among the biggest health problems facing the United States, and the problem is especially severe in Appalachian Ohio. An eight-county Diabetes Needs Assessment conducted in 2016 by the Diabetes Institute at the Heritage College found that while the disease affected 9.4 percent of the U.S. population and 11 percent of Ohioans, 19.9 percent of adults in rural Appalachian southeast Ohio were affected by it.

Offering more services

Improvements funded by the new grant – “A New Approach to Diabetes Navigation in Rural Appalachia” – will include creation of a child diabetes navigation program for children with type 1 or type 2 diabetes; a peer mentoring program for these children using Ohio University students as mentors; and free mental health services and transportation for both children and adults. The award will also allow the college to offer free training to area residents to become certified community health workers. Training is expected to begin in the fall; one of the trainees will be hired by the Athens City-County Health Department to expand the reach of adult diabetes navigation services offered by the college.

Elizabeth Beverly, Ph.D., and Emily Guseman, Ph.D., are assistant professors of family medicine and Diabetes Institute investigators who serve respectively as principal investigator/director and evaluator on the project. Their aims are to further improve health outcomes and quality of life for people with diabetes and to develop and test a better and more cost-efficient model for diabetes navigation that can be replicated in other rural areas.

Lending their efforts will be the Heritage College; the Diabetes Institute; the Ohio University Psychology and Social Work Clinic; OhioHealth Physician Group Heritage College’s Endocrine Center and Primary Care Clinics; and the Athens City-County Health Department’s Health Education Division.

“At the Heritage College, one of our strongest and most consistent areas of focus has been on reducing the impact of diabetes in southeast Ohio,” said Ken Johnson, D.O., Heritage College executive dean and Ohio University chief medical affairs officer. “With the navigator program, we’re tackling the disease in a way we know is effective – as a population health issue, with an emphasis on prevention and on addressing the psychological, economic and social factors that complicate diabetes and make it harder for people to manage. This HRSA grant will allow Drs. Beverly and Guseman and their colleagues to make the program even more effective and create a model that others can use.”

Federal efforts put more focus on kids

Beverly said one reason for the changes in the project was a signal from HRSA that the agency plans to concentrate more resources on addressing diabetes in younger people. “They wanted a focus on children,” she said, adding that the project will build on Guseman’s expertise in the area of childhood obesity. Guseman noted that nationwide incidence of childhood obesity, which is a risk factor for type 2 diabetes, has been increasing for the last several decades, and that as with diabetes rates, childhood obesity is more common in Appalachian Ohio than it is nationally. In its earlier version, the HRSA-funded navigation program served only adults.

With the help of the Diabetes Institute, the new project will include a child diabetes navigation program that Beverly called the first of its kind. It will be unique, she said, in offering patient navigation for children in home, school and clinic.

A previous program sponsored by the Institute and the Heritage College’s  Community Health Programs, sent AmeriCorps members into Athens County public schools to help students manage diabetes while at school. The new, more comprehensive program will help fill the gap left when this earlier program ended, and will be free and open to any child with diabetes in Athens, Hocking, Meigs, Morgan, Perry, Vinton or Washington counties who is referred by a health care provider. Participants and their families will be directed to those who can provide assistance with a wide range of issues such as food insecurity, blood glucose monitoring, exercise options and mental health impacts of diabetes.

Tackling barriers to good disease management

An important change to the diabetes navigation program will be employment of a community health worker, rather than a nurse, to oversee diabetes navigation for adults, which largely consists of connecting participants with agencies and services that can help them overcome social/economic barriers to good disease management. While a C.H.W. will be qualified to handle the job, Beverly said, this change will significantly lower personnel costs. The medical college, in partnership with the Athens City-County Health Department, will provide free training to anyone who wants to become certified as a C.H.W.

The peer mentoring program for children with diabetes will recruit mentors from the membership of the Ohio University student organization DOSES (Diabetes Outreach, Support and Education for Students). Each of these college students will offer a supportive role model relationship to one or more children, similar to what is offered by the Big Brother Big Sister organization, Beverly said.

The provisions for free transportation and mental health treatment for both adults and children address two recognized issues facing people with diabetes in this area. Lack of adequate transportation makes it difficult for many to get to the help they need, such as health care appointments or exercise locations, Beverly said. “It’s a known barrier that we can actually do something about,” by providing gasoline cards and taxi vouchers, she explained.

Diabetes can co-occur with depression, which can make the depressed person less likely to get enough exercise or pay adequate attention to managing the disease. The navigation program will address this issue by offering free mental health services through the Ohio University Psychology and Social Work Clinic.

Making an effective program even better

Organizers will track the program’s impact in the form of improvements to measurable health indicators such as body weight, blood glucose levels, blood pressure and indicators of depression, as well as to overall quality of life, self-care behaviors, food security and health care expenses. Since the program’s creation three years ago, published research has shown improved control of blood glucose levels in participants. Beverly and Guseman expect the changes funded by the new HRSA grant to make it even better.

“Anyone can join, and all services are free,” Beverly said.