Organizational Evaluation

Running head: ORGANIZATIONAL EVALUATION 1

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Organizational Evaluation

Learners Name

Capella University

Health Promotion and Disease Prevention in Vulnerable and Diverse Populations

Organizational Evaluation

May, 2017

ORGANIZATIONAL EVALUATION 2

Organizational Evaluation

East Harlem, an upper Manhattan neighborhood, is home to many immigrant

communities including one of the largest Latino communities in New York City with an overall

population of nearly 120,000. This neighborhood has the largest population of Latinos and

African-Americans with low incomes in New York City. Because of their low socioeconomic

status and low quality of living, the residents of this neighborhood face several health concerns.

Diabetes is a major health concern in the United States, but the residents of East Harlem are

disproportionately affected by it (Fox, Mann, Ramos, Kleinman, & Horowitz, 2012; National

Alliance for Hispanic Health [NAHH], n.d). East Harlem has the highest diabetes mortality rate

(13%) and the highest incidence of obesity (33%) in New York City (New York City Department

of Health and Mental Hygiene [NYCDOHMH], 2015). This disparity exists as Hispanics lack

access to proper nutrition.

The Frequency and Causes of Diabetes among the Vulnerable Population

The high rate of diabetes among the residents of East Harlem can be better understood by

analyzing the factors behind it. There are a number of factors that contribute to higher rates of

diabetes among certain racial or ethnic groups. Lack of access to health care because of language

and financial barriers directly impact the rates of diabetes mortality. According to the Agency for

Healthcare Research and Quality (AHCRQ), the diabetes patients among Hispanics are more

likely than whites to get readmitted to hospitals within a span of six months since the beginning

of the treatment (NAHH, 2010).

A primary reason for the increased occurrence of diabetes among the Hispanic residents

of East Harlem is the lack of resources to cope with their external environment, stress-related

problems, and poor nutrition. A lack of exercise also contributes to the onset of diabetes among

ORGANIZATIONAL EVALUATION 3

Hispanics. The external environment also plays a large role in the onset of diabetes by creating

unequal opportunities for people from different backgrounds to participate in recreational

physical activities. A poor understanding of the disease contributes to higher instances of

diabetes among Hispanics. Finally, because of a combination of genetic, lifestyle, and

environmental factors, Hispanics are more likely to have a family history of diabetes (NAHH,

2010).

Initiatives Implemented to Fight Diabetes in East Harlem

The Center for Chronic Illnesses (CCI) is one of the hospitals in East Harlem that deals

with all major illnesses including diabetes. The CCI can help the vulnerable diabetic population

in East Harlem by implementing appropriate strategies:

 Administrating insulin and glucose injections and prescribing oral medication to control

elevated blood pressure levels;

 Providing practical lifestyle management tips to the Hispanic population in East Harlem by

emphasizing relevant exercise methods and healthy dietary plans;

 Prescribing pills, such as INVOKANA (canagliflozin), to be used once a day, along with

dietary regulations and exercise, to lower blood glucose in adults with type 2 diabetes.

 Using an initiative called the Chronic Care Model. This initiative aims to optimize six

important elements of the health care system in the CCI: organization of health care, decision

support, self-management support, clinical information systems, delivery system design, and

community resources and policies;

 Ensuring the optimization of the health care system by improving the use of existing resources,

creating new resources, and promoting a new policy of interaction between empowered patients

and proactive health teams (Baptista et al., 2016). This sort of interaction encourages the patients

Comment [A1]: Very good! Discusses well.

ORGANIZATIONAL EVALUATION 4

to cope with and manage diabetes independently, which helps them avoid frequent and

preventable hospitalizations; and

 Implementing a major project founded under the Chronic Care Model called Project Dulce.

This project uses a team-based approach where nurse care managers oversee care and peer

educators provide culturally appropriate, group-based diabetes self-management education

(DSME) to patients.

 Health care organizations can communicate these initiatives to the residents of East Harlem

through care coordination. This involves sharing information among all of the participants

concerned with a patient's care and organizing patient care activities, to achieve safer and more

effective care. This means that the patient's preferences and needs are known ahead of time and

communicated to the right people at the right time, and that this information is used to provide

appropriate, safe, and effective care to the patient (Agency for Healthcare Research and Quality

[AHRQ], 2014). treatment of the disease.

Gaps in Health Care for the Treatment of Diabetes

As discussed earlier, a majority of the residents in East Harlem are at a high risk for

diabetes because of a combination of genetic and economic factors. But, many of them are

uninsured and hence medical treatments automatically become more expensive and inaccessible

to them owing to their low socioeconomic status. This neglect can lead to higher rates of

hospitalizations and increased chances of chronic disease and disability (Alliance to Reduce

Disparities in Diabetes [ARDD], n.d.). Some of the gaps in health care organizations for the

treatment of diabetes are as follows:

 A limited capacity to address both the prevention and the treatment of the disease when an

organization works alone to tackle diabetes. In addition, health care organizations may lack staff

Comment [A2]: Nice!

ORGANIZATIONAL EVALUATION 5

member who can speak Spanish. This causes problems in communication between the physicians

and patients (ARDD, n.d.); and

 Ensuring the implementation of healthy eating among individuals. One of the barriers to

implementing these recommendations could be that Hispanics face societal pressure to eat foods

that are high in fats and do not have access to affordable healthy food. To address these gaps in

medical care for diabetic Hispanics, health care organizations should implement interventions

that have a strong clinical and scientific foundation (Hu, Amirehsani, Wallace, & Letvak, 2013).

Implementation of Evidence-Based Strategies to Reduce Gaps in Medical Care for

Diabetics in East Harlem

One way to address the gaps in health care provided to diabetic Hispanics in East Harlem

is to increase health literacy among the Hispanic residents of this area. Health literacy refers to

the extent to which people have the capability to process, obtain, and understand basic health

information and services needed to make health-related decisions. In February 2016, Carranza

(2016) attempted to carry out a study to see how knowledgeable the Hispanic populations are

about diabetes. Patients were given immediate feedback on their responses to improve their

understanding of diabetes. The results of this study showed that 81.3% of the patients were

unable to accurately read a nutrition label.

To address the gaps in nutritional education or healthy eating it would also be beneficial

for the patients if the CCI could conduct monthly nutritional classes that teach the basic

principles of how to interpret nutritional labels, with a focus on the ideal amount of consumable

carbohydrates. Patients presented with this information will be able to better manage their

diabetes and avoid the negative consequences of an extremely high blood sugar level (Carranza,

2016). Health care organizations should also take collaborative action with other health and

Comment [A3]: Need to be clearer in this area on the causes of the gaps.

Comment [A4]: I am not sure that it is a quick solution to increase the

health literacy. I would change this!

ORGANIZATIONAL EVALUATION 6

community development centers from other neighborhoods in the city. Other community

development centers can also teach the health care organizations to communicate information

about resources to patients in their native language (Philis-Tsimikas & Gallo, 2014).

Barriers to Implementing Evidence-Based Strategies in the Care of Diabetes

While strategies that educate patients about diabetes and assist them to manage their

condition can help bridge gaps in the diabetes health care service, there are further barriers to the

implementation of these strategies. One of the biggest barriers to the prevention and treatment of

diabetes is the lack of general practitioners (GPs) and clinicians in health care centers. Some GPs

are reluctant to collaborate with diabetes educators and dieticians as they feel it diminishes the

value of their role. Because of this attitude, they are effectively depriving their patients of holistic

treatment (Mc Hugh, O’Mullane, Perry, & Bradley, 2013).

Conclusion

Health care providers play an important role in helping diabetic patients overcome the

barriers to self-management of their condition. If patients are aware enough to cope with the

illness on their own, they do not have to spend money on frequent hospitalizations. Health care

providers should actively engage with the patients to ensure the patients’ compliance with the

treatment plan. Cultural competency and language training to overcome communication gaps

will build trust and encourage patients to open up to the health care workers. Additionally,

encouraging family members to attend diabetes education programs provides them the

opportunity to learn more about the disease. However, there are some social and financial

barriers to the effective treatment of diabetes. Further research needs to be done about the

barriers to self-management of diabetes and the effective interventions to overcome these

barriers (Hu et al., 2013).

Comment [A5]: This part is very good!

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References

Agency for Healthcare Research and Quality. (2014). Care Coordination. Retrieved from

https://.ahrq.gov/professionals/prevention-chronic-care/improve/coordination/index.html

Alliance to Reduce Disparities in Diabetes. (n.d.). Disparities in diabetes: Prevention and care.

Retrieved from https://merck.com/corporate-

responsibility/docs/access/DisparitiesFACTSHEET.pdf

Baptisa, D. R., Wiens, A., Pontarolo, R., Regis, L., Reis, W. C., & Correr, C. J. (2016). The

chronic care model for type 2 diabetes: a systematic review. Diabetology & Metabolic

Syndrome, 8(1). https://doi.org/10.1186/s13098-015-0119-z Carranza, E. (2016). Health

literacy in the Hispanic population (Doctoral dissertation). Retrieved from

http://nmfonline.org/wp-content/uploads/2016/02/Carranza-Elizabeth-Paper.pdf

Carranza, E. (2016). Health literacy in the Hispanic population (Doctoral dissertation).

Retrieved from http://nmfonline.org/wp-content/uploads/2016/02/Carranza-Elizabeth-

Paper.pdf Mc Hugh, S., O’Mullane, M., Perry, I. J., & Bradley, C. (2013). Barriers to,

and facilitators in, introducing integrated diabetes care in Ireland: a qualitative study of

views in general practice. BMJ Open, 3(8), e003217. doi:10.1136/bmjopen-2013-003217

Fox, M., Mann, D. M., Ramos, M. A., Kleinman, L. C., & Horowitz, C. R. (2012). Barriers to

physical activity in East Harlem, New York. Journal of Obesity, 2012, 1–8.

https://doi.org/10.1155/2012/719140

Hu, J., Amirehsani, K., Wallace, D. C., & Letvak, S. (2013). Perceptions of barriers in

managing diabetes. The Diabetes Educator, 39(4), 494–503.

https://doi.org/10.1177/0145721713486200

ORGANIZATIONAL EVALUATION 8

Mc Hugh, S., O’Mullane, M., Perry, I. J., & Bradley, C. (2013). Barriers to, and facilitators in,

introducing integrated diabetes care in Ireland: a qualitative study of views in general

practice. BMJ Open, 3(8), e003217. doi:10.1136/bmjopen-2013-003217

National Alliance for Hispanic Health. (2010). The state of diabetes among Hispanics. Retrieved

from http://healthyamericas.org/uploads/2/5/8/7/25879931/stateofdiabetes2010_copy.pdf

New York City Department of Health and Mental Hygiene (2015). Manhattan community

district 11: East Harlem. Retrieved from

https://www1.nyc.gov/assets/doh/downloads/pdf/data/2015chp-mn11.pdf

Philis-Tsimikas, A., & Gallo, L. C. (2014). Implementing community-based diabetes programs:

The Scripps Whittier Diabetes Institute experience. Current Diabetes Reports, 14(2).

https://doi.org/10.1007/s11892-013-0462-0