Improving the Reach of the National Diabetes Prevention Program Within a Health Disparities Population: A Bronx New York Pilot Project Crossing Health- and Community-Based Sectors.

INTRODUCTION: Diabetes affects upward of 30% of South Bronx residents. The Centers for Disease Control and Prevention's National Diabetes Prevention Program (NDPP) reduces risk of progression to diabetes, yet implementation has been elusive within health disparities populations. METHODS: This community-based, collaborative project piloted the NDPP in the South Bronx and evaluated implementation challenges and enablers. The New York State training group prepared community peer lifestyle coaches recruited by a community organization. A professional society trained academic detailers from local faculty. An interview process evaluated community needs and public health officials' beliefs. A portal managed by the New York State training group collected demographic and biometric data from the community participants and facilitated online registration. Data from interviews and observations were coded systematically using a thematic analysis framework. RESULTS: We were successful at recruiting and training 14 lifestyle coaches and 7 academic detailers, as well as recruiting members of the health disparities population in the South Bronx into the program. Fifty-two individuals completed the first 6 months of the yearlong program, attending an average of 12.7 of 16 sessions. By week 16, weight loss averaged 7.4 lbs and many had doubled their minutes of physical activity. Local electronic referral and feedback systems were developed. DISCUSSION: Health professionals, their teams, public health centers, and communities can work together to prevent diabetes by enhancing the reach of the NDPP to health disparities populations. Peer education using lifestyle coaches can provide a trustworthy process for crossing the boundaries between health teams and community support groups.

Community health worker integration into the health care team accomplishes the triple aim in a patient-centered medical home: a Bronx tale.

Community health workers are ideally suited to the care coordination niche within the patient-centered medical home (PCMH) team, but there are few case studies detailing how to accomplish this integration. This qualitative study documents how community health workers (CHWs) were integrated into a PCMH in South Bronx, New York. Results show that integration was linked to clear definition of their care coordination role within the care team, meticulous recruitment, training and supervision by a senior CHW, shared leadership of the care management team, and documented value for money. By helping the team understand patients' backgrounds, constraints, and preferences, they helped everyone genuinely focus on the patient.

The use of an electronic medical record to improve documentation and treatment of obesity.

BACKGROUND AND OBJECTIVES: Physicians underdocument and undertreat obesity. Electronic medical records (EMR) reminders have improved other preventive services such as cancer screening and immunizations. We explored whether an EMR automatic calculation of body mass index (BMI) improved clinician documentation and treatment of overweight and obesity. METHODS: We conducted a retrospective cross-sectional study of randomly selected patient charts before and after the implementation of an EMR. The primary outcome was documentation of overweight or obesity in the assessment/plan section or problem list section of the record. The secondary outcome was evidence in the medical record of treatment (defined as nutrition or exercise counseling or referral to a nutritionist) of overweight/obese patients. RESULTS: Documentation of obesity (BMI ? 30) improved from 31% to 71% (prevalence ratio [PR]=2.30, 95% confidence interval [CI]=1.44--3.68) of obese patients after the implementation of an EMR calculation of BMI. Documentation of treatment of obese patients also improved, from 35% to 59%, (PR=1.84, 95% CI=1.19--2.86), but documentation and treatment of overweight patients (BMI>25<30) did not significantly improve. CONCLUSIONS: These findings support the effectiveness of an EMR automatic BMI calculation to improve documentation and treatment of obese patients but suggest that software modification and alternative strategies are needed to improve documentation and treatment for overweight patients.

Choroid plexus cysts.

BACKGROUND: Research shows that there is an association between choroid plexus cysts and aneuploidy. Family physicians treating prenatal patients should understand the management of this sonographic finding. OBJECTIVE: To determine the epidemiology, pathophysiology, and management of prenatal choroid plexus cysts. CASE REPORT: A 23-year-old patient, gravida 1, para 0, was seen at an inner city Family Medicine health center for prenatal care. A screening ultrasonogram performed at 16 weeks of gestation showed bilateral choroid plexus cysts approximately 5 mm in diameter. The patient declined amniocentesis. Maternal serum triple screen markers (maternal serum alpha-fetoprotein, human chorionic gonadotropin, and estriol) were all normal, as was the level II sonogram at 20 weeks and the fetal echocardiogram at 28 weeks. At birth the baby was found to be normal after a clinical assessment was performed. METHODS: A review of the literature using MEDLINE with the search strategy of choroid plexus, choroid plexus fetus/fetal, choroid plexus management, choroid plexus treatment, and choroid plexus epidemiology.