Anne Tang M.D., FACP Chief, Bilingual Chinese Module Chief, Pharmacy & Therapeutics
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Health Equity: Diabetes Care, Health Equity: Diabetes Care, Hypertension Control and Hypertension Control and Cancer Screening in the San Cancer Screening in the San Francisco Kaiser Permanente Francisco Kaiser Permanente Chinese Clinic Population Chinese Clinic Population Anne Tang M.D., FACP Anne Tang M.D., FACP Chief, Bilingual Chinese Module Chief, Bilingual Chinese Module Chief, Pharmacy & Therapeutics Chief, Pharmacy & Therapeutics Kaiser Permanente Kaiser Permanente San Francisco Medical Center San Francisco Medical Center
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Health Equity: Diabetes Care, Hypertension Control and Cancer Screening in the San Francisco Kaiser Permanente Chinese Clinic Population. Anne Tang M.D., FACP Chief, Bilingual Chinese Module Chief, Pharmacy & Therapeutics Kaiser Permanente San Francisco Medical Center. - PowerPoint PPT Presentation
Transcript of Anne Tang M.D., FACP Chief, Bilingual Chinese Module Chief, Pharmacy & Therapeutics
Health Equity: Diabetes Care, Health Equity: Diabetes Care, Hypertension Control and Cancer Hypertension Control and Cancer
Screening in the San Francisco Kaiser Screening in the San Francisco Kaiser Permanente Chinese Clinic PopulationPermanente Chinese Clinic Population
Anne Tang M.D., FACPAnne Tang M.D., FACPChief, Bilingual Chinese ModuleChief, Bilingual Chinese ModuleChief, Pharmacy & TherapeuticsChief, Pharmacy & TherapeuticsKaiser PermanenteKaiser PermanenteSan Francisco Medical CenterSan Francisco Medical Center
Assessment of Health Care NeedsAssessment of Health Care Needs of KPSF Chinese Population of KPSF Chinese Population
Patient Survey ResultsPatient Survey Results Bilingual Chinese physicians and staffBilingual Chinese physicians and staff Health Education Materials in ChineseHealth Education Materials in Chinese InterpretersInterpreters Convenience Convenience AffordableAffordable
The KPSF Bilingual Chinese Module (BCM) The KPSF Bilingual Chinese Module (BCM) 15 Board Certified Primary Care Physicians15 Board Certified Primary Care Physicians 1 RN Diabetic Health Educator (DHE)1 RN Diabetic Health Educator (DHE) 1 Complex Chronic Condition RN Case manager1 Complex Chronic Condition RN Case manager 1 Behavioral Medicine Specialist (BMS)1 Behavioral Medicine Specialist (BMS) 1 Clinical Health Educator (CHE)1 Clinical Health Educator (CHE) 1 Physical Therapist (PT)1 Physical Therapist (PT) 15 Medical Assistants 15 Medical Assistants 1 Charge/Triage RN, ½ Unit Manager1 Charge/Triage RN, ½ Unit ManagerAll physicians, staff, and allied professionals are bilingual All physicians, staff, and allied professionals are bilingual The Module takes care of >20,000 Chinese patientsThe Module takes care of >20,000 Chinese patientsMission: To provide affordable, integrated, culturally Mission: To provide affordable, integrated, culturally
appropriate high quality care to our Chinese membersappropriate high quality care to our Chinese members
The KPSF Bilingual Chinese ModuleThe KPSF Bilingual Chinese Module
Chinese Module Diabetes CareChinese Module Diabetes Care
2010,2011,2012
DiabetesComprehensive Diabetes Care
HgbA1cScreening HgbA1c <9% LDL C<100 mg/dl Blood Pressure
<140/90
KPSF Chinese Module 95,95,96 88,87,87 74,74,77 82,85,86
KP NCAL 92,94,95 80,84,84 66,68,72 75,82,84
KPSF 89,93,94 72,80,82 47,65,71 77,79,82
page page 66
豆奶
加
鈣 乳酪
Butter
糖尿病食物金字塔CHINESE FOOD PYRAMID FOR DIABETIC PATIENTS
脂肪，糖，酒，鹽及醬油 ( 盡量少用 )
奶類( 每日二至三份 )一份 =( 等於 )
• 1 杯奶• 1 杯脫脂及低糖的酸乳酪• 1 杯加鈣豆奶 ( 無附加糖 )
肉類( 每日二至三份 )一份 =(等於 )
• 2-3 安士瘦肉、家禽、或魚 ( 一副紙牌的尺寸 ) 1 湯匙花生醬 4 安士 (1/2 碗 ) 豆腐 1 隻蛋 水果
( 每日二至四份 )一份 =( 等於 )
• 1 個小的水果 ( 如網球的大小 )• ½ 個大水果• ½ 杯果汁• ¼ 碗乾果
• 1/3 碗飯、 麵、米粉、粉絲• ½ 碗熟豆、豌豆或粟米• ½ 碗粥 、熟麥片• 1 片方麵包• 1 個小饅頭• 4 片雲吞皮• 1/3 碗芋頭• 4-6 小塊無鹽梳打餅乾1碗 =8 安士
1杯 =8 安士 相等於一安士的肉
蔬菜( 每日三至五份 )一份 =(等於 )
• ½ 碗煮熟蔬菜• 1 碗生蔬菜
穀物、豆類及含澱粉質較高的蔬菜( 每日六至十一份 )一份 =( 等於 )
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糖尿病的併發症Diabetes Complications
• 腎衰竭 Kidneys(nephropathy)
• 眼睛 ( 視網膜病 ) Eyes(Retinopathy)
• 神經系統 ( 足部問題 ) Nerves(Neuropathy)
• 血液循環 ( 心臟及血管疾病 ) Circulation (stroke, Heart Disease)
• 傷口復原較慢 Ability to heal from wounds
• 牙齒 ( 牙周病 ) Teeth(Gum disease)
• 性健康問題 Sexual well being
page page 88
護理糖尿病的四大要點CORNERSTONES OF DIABETES CARE
健康的飲食習慣Healthy Eating
運動Exercise
自我監察Self Monitor
藥 物Medications
page page 99
Chinese Module Hypertension ControlChinese Module Hypertension Control
2010,2011,2012 Cardiovascular Diabetes
High Blood PressureControl
BP < 139/89
High Blood Pressure Control
BP < 139/89
KP SF Chinese Module 82,83,84 79,83,86
KP NCAL 80,82,84 78,82,84
KPSF 79,79,80 78,78,82
Hypertension Control ProgramHypertension Control Program
Culturally competent integrated care by a team of Culturally competent integrated care by a team of health professionalshealth professionals
Health education in patientsHealth education in patients’’ preferred language preferred language Free drop-in with timely intervention and follow upFree drop-in with timely intervention and follow up Enlisting patient partnership in their careEnlisting patient partnership in their care Chronic condition management programChronic condition management program Outcome data feedback to providers and staff Outcome data feedback to providers and staff Community outreach to promote preventive careCommunity outreach to promote preventive care
Hypertension EducationHypertension Education
page page 1212
健康的外出飲食範例 EXAMPLES OF EATING OUT IN A HEALTHY WAY
西人麥方包、焗餐包、蒸饅頭 雞尾包、叉燒包、奶油包、菠蘿包、蓮蓉包、蛋糕、蛋撻、西餅、沙翁
最佳選擇 : 全麥麵包含高纖維，有助控制血糖，降低膽固醇及利於排便
生魚
腸粉、菜肉包、雞包、雞 ( 脫皮，去肥 ) 、蒸餃 ( 如蝦餃、韭菜餃 ) 、菜心 ( 免油 )
高脂肪點心 : 燒賣、鳳爪、牛什、叉燒包炸點 : 春卷、叉燒酥、鹹水角、芋角
要求醬油與食物分開
白飯配一碟點心，如排骨 ( 去肥，免汁 )
原盅焗飯如鳳爪、排骨飯 在煮原盅焗飯的過程中排骨的脂肪已滲入飯內
湯麵或米粉、粥 炒麵、炒粉、炒飯 雖然湯粉麵含較少脂肪，但也要注意碳水化合物 ( 澱粉質 ) 的份量，以防血糖高
蒸魚、白灼蝦、蒸釀豆腐、雙菇扒豆腐、白切雞 ( 脫皮，去脂肪 ) 、白灼芥蘭、雜菜煲
炸石班球、核桃蝦、炸釀豆腐、芝麻雞、牛腩煲、京都排骨、芋頭鴨
要求減少油量及醬油來烹煮
生菜魚片粥、雲吞或水餃麵、米粉、粉絲
牛腩或牛什麵 腩肉及內臟含高飽和脂肪
冬菇蒸雞 ( 去皮 ) 飯菜遠魚片飯
燒臘 ( 燒鴨、燒肉、叉燒、油雞等 ) 飯、炒麵、炒粉、炒飯
盡量減低脂肪，應選擇少油煮的菜色
雜菜清湯、三文魚、焗薯仔、免醬意粉、西蘭花 ( 少油 ) 、奶茶 ( 免糖，免煉奶，可用代糖 ) 、雞絲或瘦肉湯麵 / 米粉
忌廉湯、炸魚柳或有醬意粉、炸薯條、紅豆冰、珍珠奶茶、午餐肉、火腿、香腸湯麵 / 米粉、即食麵
盡量減低脂肪，所以應選擇清湯，瘦肉及少油煮的菜色
Cancer ScreeningCancer Screening
2010,2011,20122010,2011,2012 Breast CancerScreening
Colon Cancer Screening
KP SF Chinese Module 86,87,88 77,83,85
KP NCAL 84,86,86 70,74,82
KPSF 82,82,84 68,78,80
Colon Cancer ScreeningColon Cancer Screening FIT test packet sent to all patients > age 50FIT test packet sent to all patients > age 50 Colon screening reminder on registration slipColon screening reminder on registration slip Staff Reminder to do FIT testStaff Reminder to do FIT test Bilingual FIT test instructionsBilingual FIT test instructions FIT test video in Cantonese/MandarinFIT test video in Cantonese/Mandarin Community outreachCommunity outreach
Bilingual Preventive Care Information on Bilingual Preventive Care Information on Registration SlipRegistration Slip
Bilingual Physician HomepageBilingual Physician Homepage
Health Education Materials in ChineseHealth Education Materials in Chinese
[ADVANCE DIRECTIVES] [ADVANCE DIRECTIVES] Advance Health Care Directive 醫療護理指示
[BACK/ JOINTS ] [BACK/ JOINTS ] Carpal Tunnel Syndrome - Prevention & Self Care Tip Sheet 腕骨隧道Chronic Pain 慢性疼痛Back Problem 如何克服你的背部問題
[CUTS/BLEEDING ] [CUTS/BLEEDING ] Cuts 割傷Nosebleeds 流鼻血
[DIABETES] [DIABETES] Diabetes Self-Care - SC 糖尿病自我護理What is Type 2 Diabetes - SC What is Type 2 Diabetes - SC 什麼是什麼是 22 型糖尿病型糖尿病Diabetes Prevention - SC Diabetes Prevention - SC 預防糖尿病預防糖尿病Blood Sugar Control - SC Blood Sugar Control - SC 控制血糖控制血糖
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Key Factors in Health Equity in KPSF Key Factors in Health Equity in KPSF Chinese Module MembersChinese Module Members
Culturally competent integrated care by a team of health Culturally competent integrated care by a team of health professionalsprofessionals
Health education in patientsHealth education in patients’’ preferred language preferred language Timely intervention and follow upTimely intervention and follow up Chronic condition management programsChronic condition management programs Outcome data feedback to providers and staff & follow upOutcome data feedback to providers and staff & follow up Service excellence and easy accessService excellence and easy access Health promotion in communitiesHealth promotion in communities Encourage member participation in preventive healthEncourage member participation in preventive health
Asian American & Pacific Islander (AAPI) Members
The AAPI group is the fastest growing group in the United States. The AAPI group is the fastest growing group in the United States. Between 1990 and 2000 this population grew by 48%, from 6.9 million Between 1990 and 2000 this population grew by 48%, from 6.9 million to 10.2 million. Currently, 12 million AAPI live in the USto 10.2 million. Currently, 12 million AAPI live in the US
• AAPI includes Chinese, Japanese, Korean, Vietnamese, Filipino, South AAPI includes Chinese, Japanese, Korean, Vietnamese, Filipino, South Asian, Pacific Islanders, South East Asian, Indonesian, and Malaysian Asian, Pacific Islanders, South East Asian, Indonesian, and Malaysian
In 2025 approximately 50% of the patients with Diabetes 2 will be Asian In 2025 approximately 50% of the patients with Diabetes 2 will be Asian American &Pacific Islander (AAPI)American &Pacific Islander (AAPI)
AAPI members have marked health disparities that exist for each specific AAPI members have marked health disparities that exist for each specific group.group.
page page 2020
Next StepsNext Steps Share effective practices in culturally proficient care Share effective practices in culturally proficient care
with other ethnic groupswith other ethnic groups Assess specific member needs in other ethnic groupsAssess specific member needs in other ethnic groups Implement specific effective practices to address Implement specific effective practices to address
assessed needsassessed needs Monitor specific outcomes to determine effectivenessMonitor specific outcomes to determine effectiveness
