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

Assessment of Health Care Needs of KPSF Chinese Population Patient Survey Results Bilingual Chinese physicians and staff Health Education Materials in Chinese Interpreters Convenience Affordable

The KPSF Bilingual Chinese Module (BCM) 15 Board Certified Primary Care Physicians 1 RN Diabetic Health Educator (DHE) 1 Complex Chronic Condition RN Case manager 1 Behavioral Medicine Specialist (BMS) 1 Clinical Health Educator (CHE) 1 Physical Therapist (PT) 15 Medical Assistants 1 Charge/Triage RN, ½ Unit Manager All physicians, staff, and allied professionals are bilingual The Module takes care of >20,000 Chinese patients Mission: To provide affordable, integrated, culturally appropriate high quality care to our Chinese members

The KPSF Bilingual Chinese Module

Chinese Module Diabetes Care 2010,2011,2012 Diabetes Comprehensive Diabetes Care HgbA1c Screening 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

CHINESE FOOD PYRAMID FOR DIABETIC PATIENTS 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) Butter 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 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) 豆奶 加 鈣 乳酪 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 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) 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

Diabetes Complications 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

CORNERSTONES OF DIABETES CARE 護理糖尿病的四大要點 CORNERSTONES OF DIABETES CARE 健康的飲食習慣 Healthy Eating 自我監察 Self Monitor 運動 Exercise 藥 物 Medications

Chinese Module Hypertension Control 2010,2011,2012 Cardiovascular Diabetes 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 Program Culturally competent integrated care by a team of health professionals Health education in patients’ preferred language Free drop-in with timely intervention and follow up Enlisting patient partnership in their care Chronic condition management program Outcome data feedback to providers and staff Community outreach to promote preventive care

Hypertension Education

健康的外出飲食範例 EXAMPLES OF EATING OUT IN A HEALTHY WAY 麵包/西餅 茶樓點心 中式小菜 中式 種類 較佳選擇 盡少選擇 建議及原因 麵包/西餅 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 茶樓點心 食譜例子: 1碗生菜魚片粥 1小碗菜 2-3件有肉點心 (如蝦鉸) 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 中式小菜 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 中式 快餐 粥粉麵 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 飯盒 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 西餐 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

Colon Cancer Screening 2010,2011,2012 Breast Cancer Screening 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 Screening FIT test packet sent to all patients > age 50 Colon screening reminder on registration slip Staff Reminder to do FIT test Bilingual FIT test instructions FIT test video in Cantonese/Mandarin Community outreach

Bilingual Preventive Care Information on Registration Slip

Bilingual Physician Homepage

Health Education Materials in Chinese [ADVANCE DIRECTIVES] Advance Health Care Directive 醫療護理指示 [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 割傷 Nosebleeds 流鼻血 [DIABETES] Diabetes Self-Care - SC 糖尿病自我護理 What is Type 2 Diabetes - SC 什麼是2型糖尿病 Diabetes Prevention - SC 預防糖尿病 Blood Sugar Control - SC 控制血糖

Key Factors in Health Equity in KPSF Chinese Module Members Culturally competent integrated care by a team of health professionals Health education in patients’ preferred language Timely intervention and follow up Chronic condition management programs Outcome data feedback to providers and staff & follow up Service excellence and easy access Health promotion in communities Encourage member participation in preventive health

Asian American & Pacific Islander (AAPI) Members 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 to 10.2 million. Currently, 12 million AAPI live in the US AAPI includes Chinese, Japanese, Korean, Vietnamese, Filipino, South Asian, Pacific Islanders, South East Asian, Indonesian, and Malaysian In 2025 approximately 50% of the patients with Diabetes 2 will be Asian American &Pacific Islander (AAPI) AAPI members have marked health disparities that exist for each specific group.

Next Steps Share effective practices in culturally proficient care with other ethnic groups Assess specific member needs in other ethnic groups Implement specific effective practices to address assessed needs Monitor specific outcomes to determine effectiveness