Navajo Health Foundation-Sage Memorial Hospital Inc

SPECIAL DIABETES PROGRAM FOR INDIANS

SMH PRODUCT PRESCRIPTION PILOT PROGRAM (P4)

SMH SPECIAL DIABETES GRANT PROGRAM - NAVAJO HEALTH FOUNDATION – SAGE MEMORIAL HOSPITAL (SMH) IS A 25-BED ACUTE AND CRITICAL ACCESS HOSPITAL LOCATED IN GANADO, ARIZONA ON THE NAVAJO NATION. IT SERVES EIGHT SURROUNDING COMMUNITIES INCLUDING CORNFIELDS, GANADO, GREASEWOOD, KLAGETOH, KINLICHEE, STEAMBOAT, WIDE RUINS, AND NAZLINI. THE POPULATION FOR THE SERVICE AREA IS APPROXIMATELY 10,700 COMMUNITY MEMBERS AND SMH SERVES AN AVERAGE OF 9,500 PATIENTS PER YEAR. ACCORDING TO DATA EXTRACTED FROM SMH'S EHR SYSTEM, IN 2021 OVER 1,097 A1C TESTS WERE ADMINISTERED TO 885 PATIENTS. OF THESE PATIENTS, APPROXIMATELY 236 PATIENTS (27%) HAD AN A1C LEVEL BETWEEN 5.7-6.49 INDICATING THEY WERE PREDIABETIC AND 363 PATIENTS (41%) HAD AN A1C OF 6.5 AND OVER SHOWING AN INDICATION OF TYPE 2 DIABETES. FOR PATIENTS WHO HAD DIABETES, 49% WERE FEMALE AND 51% WERE MALE. FOR ALL PATIENTS WHO WERE TESTED, 68% CAME BACK WITH PREDIABETES OR HAVING DIABETES SO FAR IN 2022 (JANUARY - SEPTEMBER), 606 A1C TESTS HAVE BEEN ADMINISTERED TO 530 PATIENTS. OF THESE PATIENTS, 169 (32%) WERE PREDIABETIC, AND 218 PATIENTS (41%) SHOWED TYPE 2 DIABETES RESULTS. FOR PATIENTS WITH DIABETES, 42% WERE FEMALE AND 58% WERE MALE. RESULTS FOR ALL PATIENTS WHO WERE TESTED, 73% SHOWED THEY HAVE PREDIABETES OR HAVE DIABETES. ACCORDING TO THE ANNUAL AUDIT REPORT, DENTAL EXAMS HAVE NOT SURPASSED 40% FOR THE TARGET GROUP FOR THE PAST FIVE YEARS; THEREFORE, SMH HAS CHOSEN DENTAL EXAM AS ITS REQUIRED KEY MEASURE FOR 2023. THE GOAL IS TO INCREASE THE PERCENTAGE OF PATIENTS WHO COMPLETE THEIR ORAL EXAMS AS PART OF THEIR STANDARDS OF CARE TO AT LEAST 80%. THE DIABETES TEAM PROPOSES TO ACCOMPLISH THIS THROUGH BRIEF ORAL EXAMS DURING EACH ENCOUNTER, DESIGNATING A DAY EACH MONTH IN THE DENTAL CLINIC SPECIFICALLY FOR PATIENTS WITH DIABETES, AND THROUGH AWARENESS MESSAGING. SMH’S DIABETES PROGRAM IS DESIGNED TO ADDRESS TWO OF FIVE HIGHEST HEALTH NEEDS IDENTIFIED BY ITS 2019 COMMUNITY HEALTH NEEDS ASSESSMENT: DIABETES AND OBESITY. UTILIZING AMERICAN DIABETES ASSOCIATION’S STANDARDS OF MEDICAL CARE IN DIABETES AS A GUIDE FOR COMPREHENSIVE CARE, THE DIABETES TEAM WILL CONTINUE TO TAKE A PATIENT-CENTERED CARE APPROACH TO TREATMENT.

SMH NATIVE CONNECTIONS PROGRAM - SAGE MEMORIAL HOSPITAL’S NATIVE CONNECTIONS PROGRAM BUILDS A COMMUNITY-WIDE SUICIDE AND SUBSTANCE MISUSE PREVENTION PLATFORM FOR THE YOUTH RESIDING IN THE COMMUNITIES OF CORNFIELDS, GANADO, KINLICHEE, KLAGETOH, GREASEWOOD SPRINGS, STEAMBOAT, AND WIDE RUINS, ARIZONA, WHICH HAS A COMBINED COMMUNITY POPULATION OF MORE THAN 9,500 COMMUNITY MEMBERS, OF WHICH, 3,300 ARE UNDER THE AGE OF 24 YEARS OLD. THE GOAL IS TO BUILD PARTNERSHIPS WITH YOUTH SERVING AGENCIES IN THE COMMUNITY AND PROVIDE THEM WITH THE SKILLS TO IDENTIFY AND PROVIDE MENTAL HEALTH FIRST AID SO THEY ARE ABLE TO GUIDE YOUTH TO NEEDED MENTAL HEALTH SERVICES. THE OBJECTIVES ARE: 1) TO USE EVIDENCE-BASED CURRICULUMS SUCH AS YOUTH MENTAL HEALTH FIRST AID, ASIST, QPR AND CRISIS INTERVENTION TRAINING TO TRAIN STAFF AND FACULTY AT SIX LOCAL SCHOOLS OVER THE NEXT FIVE YEARS; 2) TO REVISE POLICIES AND PROCEDURES SO MHAT TRAINEES HAVE A REFERRAL PATH TO ER AND BEHAVIORAL HEALTH SERVICES; 3) SCREEN ALL YOUTH PATIENTS FOR DEPRESSION AND SUICIDE; AND 4) CREATE PROTECTIVE FACTORS TO PREVENT SUICIDE AND SUBSTANCE MISUSE AND REDUCE THE IMPACT OF TRAUMA. THIS PROGRAM EXPECTS TO SERVE OVER 2,500 YOUTH, SCHOOL STAFF AND FACULTY, PARENTS AND GUARDIANS OVER THE NEXT FIVE YEARS. THE ANTICIPATED OUTCOME IS TO IDENTIFY ALL YOUTH WHO ARE EXPERIENCING A MENTAL HEALTH CRISIS, ENSURE THEY RECEIVE COUNSELING AND/OR TREATMENT AND HAVE THE OPPORTUNITY TO PARTICIPATE IN PROGRAMS THAT ENGAGE THEM IN POSITIVE AND CULTURALLY ENRICHING ACTIVITIES.

SAGE MEMORIAL HOSPITAL MENTAL HEALTH AWARENESS TRAINING GRANT PROGRAM - SAGE MEMORIAL HOSPITAL’S MENTAL HEALTH AWARENESS TRAINING (MHAT) PROGRAM WILL DEVELOP A COMMUNITY-WIDE BEHAVIORAL HEALTH SUPPORT SYSTEM SERVING THE COMMUNITIES OF CORNFIELDS, GANADO, KINLICHEE, KLAGETOH, GREASEWOOD SPRINGS, STEAMBOAT, AND WIDE RUINS, ARIZONA, WHICH HAS A COMBINED COMMUNITY POPULATION OF MORE THAN 9,500 COMMUNITY MEMBERS. THE GOAL IS TO INCREASE THE NUMBER OF PEOPLE WHO HAVE THE SKILLS TO RECOGNIZE THE SIGNS AND SYMPTOMS OF MENTAL ILLNESS AND GUIDE THOSE EXPERIENCING A MENTAL HEALTH CRISIS TO TREATMENT. THE OBJECTIVES ARE: 1) TO REVISE POLICIES AND PROCEDURES SO MHAT TRAINEES HAVE A REFERRAL PATH TO ER AND BEHAVIORAL HEALTH SERVICES; 2) TO USE EVIDENCE-BASED CURRICULUMS SUCH AS MENTAL HEALTH FIRST AID, YOUTH MENTAL HEALTH FIRST AID, AND CRISIS INTERVENTION TRAINING TO TRAIN 600 STAFF OF PUBLIC SERVING ENTITIES (SCHOOLS, MERCHANTS, SENIOR CENTERS, COMMUNITY CENTERS, FIRST RESPONDERS, ETC.) OVER THE NEXT FIVE YEARS; AND 3) DEVELOP A CULTURALLY APPROPRIATE MENTAL HEALTH AWARENESS CAMPAIGN TO REDUCE STIGMA. THE ANTICIPATED OUTCOME IS FOR ALL INDIVIDUALS WHO ARE EXPERIENCING A MENTAL HEALTH ILLNESS TO RECEIVE TREATMENT WITHOUT JUDGEMENT FROM THE COMMUNITY.

SMH TOR GRANT PROGRAM - SAGE MEMORIAL HOSPITAL’S (SAGE) TRIBAL OPIOID RESPONSE PROGRAM WILL SERVE THE COMMUNITIES OF CORNFIELDS, GANADO, KINLICHEE, KLAGETOH, GREASEWOOD SPRINGS, STEAMBOAT, AND WIDE RUINS, ARIZONA, WHICH HAS A COMBINED COMMUNITY POPULATION OF MORE THAN 9,500 COMMUNITY MEMBERS. SAGE WILL ALSO SERVE COMMUNITY MEMBERS WHO RESIDE OUTSIDE OF THE SERVICE AREA, BUT CHOOSE TO RECEIVE SERVICES FROM SAGE. THROUGH THE IMPLEMENTATION OF MAT SERVICES, SCREENING FOR OPIOID MISUSE, OUTREACH TRAINING, AND REFERRALS TO BEHAVIORAL HEALTH SERVICES, SAGE INTENDS TO SERVE OVER 4,800 INDIVIDUALS PER YEAR. THE GOAL IS TO BUILD A SUPPORT SYSTEM TO IDENTIFY INDIVIDUALS WHO ARE AT RISK FOR OPIOID AND STIMULANT USE DISORDER AND GUIDE THEM TO TREATMENT BY TAKING PROACTIVE STEPS TO PREVENT THE INCREASE IN THE NUMBER OF OPIOID-RELATED AND METHAMPHETAMINE CASES IN THE SERVICE AREA. SAGE INTENDS TO DO THAT BY FIRST, CREATING STANDARDS OF CARE PROCEDURES AND RECOVERY SUPPORT SERVICES FOR THOSE DIAGNOSED WITH OUD/SUD SO THEY ARE ABLE TO FIND A PATH TO RECOVERY, THEN PROVIDING A LOCAL SOURCE WHERE PATIENTS CAN RECEIVE MAT SERVICES, AND FINALLY, DEVELOPING PREVENTION STRATEGIES THAT SPREAD AWARENESS AND EDUCATION. THE OBJECTIVE IS TO (1) ENSURE AT LEAST FOUR PROVIDERS OBTAIN DATA-WAIVERS TO ADMINISTER AND PRESCRIBE BUPRENORPHINE WITH THE IMPLEMENTATION OF THE EMERGENCY DEPARTMENT INITIATION OF OFFICE-BASED OPIOID TREATMENT, (2) MAKE SURE PATIENTS ARE SCREENED UTILIZING THE OPIOID RISK TOOL, AND (3) PROVIDE TRAINING TO STAFF AND COMMUNITY MEMBERS ON THE SERVICE DELIVERY MODEL, NALOXONE ADMINISTRATION, AND THE RISKS AND DANGERS OF OPIOID MISUSE.