Monday, May 19, 2025
5/19/2025
The Chickasaw Nation's Special Diabetes Program for Indians - The Chickasaw Nation (CN) Diabetes Care Center (DCC) is located at the Chickasaw Nation Medical Center (CNMC) in Ada, Oklahoma. The CN DCC is funded by the Special Diabetes Program for Indians (SDPI) community-directed grant. The CN DCC is primarily clinic based, but hosts or participates in community events and is staffed by a multidisciplinary team. Twelve key CN personnel are paid through SDPI funds. The CN DCC team provides medical and educational services for in-patient and out-patient care. One provider and one nurse travel to satellite clinics in Ardmore, Tishomingo or Purcell a total of twelve times per month to provide services and improve access to care. In fiscal year 2023, the team will focus on improving the numbers of CN community members who complete yearly influenza immunizations, as well as dental and foot exams, as these were the services found to be most in need of improvement per the 2021 and 2022 Indian Health Service (IHS) diabetes audits. Furthermore, the team will place a particular emphasis on increasing rates of foot exams in the CN community, as this was chosen to be the designated Best Practice. The IHS audits revealed, specifically, that there were decreased rates of completed dental exams and only minor improvements in both influenza vaccinations and comprehensive foot exam rates in 2021 and 2022. The CN DCC has decided that the best option to address both exam and vaccination rates will be to educate patients at each visit on the importance of annual exams and vaccinations to prevent complications, identify issues at the earliest stages before additional complications arise and protect overall health. Additionally, the program will begin to implement a detailed internal screening and history form and will use all visits as opportunities to identify patients due for exams, place consults for exams due and document accordingly. The goal is that by implementing more thorough measures to identify patients due for dental and foot exams, as well as influenza vaccinations, the completion rates for these services will improve. Moreover, in the wake of COVID-19 restrictions being lifted in the CN community, the resulting increased number of in-person patient visits will create more opportunities to identify patients due for a dental exam, comprehensive foot exam and/or influenza vaccination. Clinical care performance measures were collected from data from the Government Performance and Results Act (GPRA) measures to assess patient population needs. A patient population of 2,500 American Indian (AI) diagnosed with diabetes mellitus (DM) was identified and assessed to see whether or not they were up to date on their influenza immunizations and dental and foot exams. Of patients who received a screening at CNMC, data indicated the rate met for completed DM foot exams as 54.5 percent, DM influenza vaccination as 72.1 percent and DM dental exams as 32.5 percent. It was decided by the CN DCC team to place the most focus on foot exams and use them as their Best Practice, with the program goal of increasing the number of comprehensive foot exams completed. This project seemed most pertinent given that people with diabetes are at high risk for vascular and nerve damage that may compromise blood flow and reduce sensation in the feet. Pain sensation provides protection and early indication of wounds and other issues; without that protection, foot ulcers, infections and amputations may result, which can affect mobility and overall quality of health. The aim will be to improve the process of identifying patients due for comprehensive foot exams, document consultations for exams and increase opportunities to educate patients. The target population will be made up of AI patients diagnosed with diabetes referred to the CN DCC for any diabetes care visit. The clinic navigator manages all referrals and consults and will be responsible for tracking the patients who receive comprehensive foot exams.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).