Cherokee Nation is the largest federally recognized Native American tribe with approximately 420,952 registered tribal citizens. There are approximately 266,425 enrolled Cherokees residing in Oklahoma and currently 135,029 citizens reside within the reservation of the Cherokee Nation, the final boundaries of which were fixed by treaty in 1866. The reservation covers all of six counties and parts of an additional eight counties in northeast Oklahoma with a total area of 6,950 square miles and 4,447,716 acres. Our health system includes one hospital and nine ambulatory health centers, with a user population of approximately 151,000, and nearly 11,200 diabetes patients. Cherokee Nation (SDPI) program is primarily clinic-based and an integral part of the Cherokee Nation Health System. Our role is to provide direction and resources that strengthen our health system’s capacity to prevent/treat complications of diabetes and prevent/delay the onset of diabetes.
The key health issues in our diabetes patient population include cardiovascular disease, chronic kidney disease, and diabetic foot complications. The high prevalence of obesity in our population, low levels of physical activity, and unhealthy nutrition are the key issues increasing the risk of diabetes in our population.
For FY 2023, we have selected “Foot Exam” as the Best Practice we will be implementing, in order to improve the comprehensive assessment of patients’ vascular and sensation status in their feet, and to help identify patients with high-risk feet that need diabetic shoes as part of our limb salvage program. Our activity for this Best Practice will be nurse-performed comprehensive Foot Exams of pediatric and adult patients with diabetes with a Target Population of approximately 11,200 patients receiving their comprehensive Diabetes Care Management at a Cherokee Nation Health Services facility.
We will also conduct five activities/services not related to the Best Practice, including:
1) Diabetes Self-Management Education and support for diabetes patients, including Cherokee Nation Diabetes Self-Management Education Program classes (accredited by the Association of Diabetes Care & Education Specialists), Blood Pressure Control classes, and one-on-one diabetes education by Diabetes Program Registered Nurses for new onset diabetes, patients with an A1C>9%, gestational diabetes, or insulin education, with a Target Population of 3,150 patients.
2) Nutrition education by Registered Dietitians, both for patients with diabetes (newly diagnosed; those with an A1C 7.0-9.0% or patients with an A1C >9% enrolled in Intensive Diabetes Management Support classes) and patients at-risk for type 2 diabetes (prediabetes; obesity; hyperlipidemia; gestational diabetes; and prenatal patients), with a Target Population of 8,450 patients.
3) Diabetes Limb Salvage Program and Foot Care Services for diabetes patients, including diagnosis and treatment of diabetic foot pathologies by primary care providers and/or podiatrists, nail-trimming clinics conducted by Registered Nurses with specialized training and certification in diabetic foot care; and provision of therapeutic footwear for diabetes patients with high-risk feet, with a Target Population of 1,500 patients.
4) Nutrition and physical education, in collaboration with 42 rural schools within the Cherokee Nation reservation, to improve nutrition and increase physical activity for a Target Population of 5,000 American Indian/Alaska Native school aged children.
5) Diabetes Prevention Program classes at Cherokee Nation Health Outpatient Health Centers or Cherokee Nation fitness centers, conducted by Personal Trainers, Dietitians and Physical Activity Specialists for participants with a BMI=>25 or patients with a diagnosis of prediabetes or a history of gestational diabetes, with a Target Population of 100 participants.
The Best Practice and our five additional activities all address our key diabetes-related health issues.