Transcript The KPSF Bilingual Chinese Module (BCM)

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
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The KPSF Bilingual Chinese Module
Chinese Module Diabetes Care
Diabetes
Comprehensive Diabetes Care
2010,2011,2012
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
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
奶類
(每日二至三份)
一份=(等於)
(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)
乳酪
豆
奶
加
鈣
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碗=8安士
1杯=8安士
• 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
相等於一安士的肉
page 6
• 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
水果
 1 隻蛋
(每日二至四份)
一份=(等於)
(每日三至五份)
一份=(等於)
• ½ 碗煮熟蔬菜
• 1 碗生蔬菜
肉類
• 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
糖尿病的併發症
Diabetes Complications
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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
• page牙齒(牙周病)
7
Teeth(Gum disease)
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
page 8
藥物
Medications
Chinese Module Hypertension Control
2010,2011,2012
KP SF Chinese Module
Cardiovascular
Diabetes
High Blood Pressure
Control
BP < 139/89
High Blood Pressure
Control
BP < 139/89
82,83,84
79,83,86
KP NCAL
80,82,84
78,82,84
KPSF
79,79,80
78,78,82
page 9
Hypertension Control Program
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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
種類
麵包/西餅
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)
粥粉麵
飯盒
中式
西餐
page 12
盡少選擇
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
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
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、 盡量減低脂肪，所以應選擇清湯，瘦肉
紅豆冰、珍珠奶茶、午餐肉、火腿、
及少油煮的菜色
香腸湯麵/米粉、即食麵
肥，免汁)
中式小菜
中式
快餐
較佳選擇
建議及原因
Cancer Screening
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
2010,2011,2012
Colon Cancer Screening
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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
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[ADVANCE DIRECTIVES]
Advance Health Care Directive 醫療護理指示
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[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
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[CUTS/BLEEDING ]
Cuts 割傷
Nosebleeds 流鼻血
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[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
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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
page 18
Asian American & Pacific Islander (AAPI)
Members
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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
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AAPI includes Chinese, Japanese, Korean, Vietnamese, Filipino, South
Asian, Pacific Islanders, South East Asian, Indonesian, and Malaysian
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In 2025 approximately 50% of the patients with Diabetes 2 will be Asian
American &Pacific Islander (AAPI)
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AAPI members have marked health disparities that exist for each specific
group.
Next Steps
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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
page 20