Office of Minority Health

Grantee: Delta Regional Institute (DRI), University of Mississippi Medical Center (UMMC)
Jackson, Mississippi 39216
Project: Institute for the Improvement of Minority Health and Health Disparities in the Delta Region
Amount: $5,283,000
Grant Period: 2009-2013
Project Abstract | Key Program Findings | Related Goals

Project Abstract
The focus of the Improvement of Minority Health and Health Disparities in the Delta Regions (DELTA) program was to address significant health disparities that impact rural, underserved and disadvantaged populations living in the Delta region states of Alabama, Louisiana and Mississippi. The Delta Regional Institute (DRI) served as a hub for tri-state activities that focused on the reduction and elimination of health disparities. The institute addressed minority health and health disparities within priority populations and multiple chronic conditions on individual, community and system levels.

The Delta region states of Alabama, Louisiana and Mississippi have some of the least healthy populations in the country, respectively ranking 46th, 49th and 50th in the United States in terms of population health status. With a unique blend of partners—including academic health centers, institutions of higher learning, national associations, state and local health agencies, and faith- and community-based organizations—the DRI integrated evidence-based and practice-based clinical, behavioral, social and environmental interventions across various levels of prevention and care to improve the health of priority populations (racial and ethnic minority and rural populations) and reduce health disparities.

The DRI strategic framework addressed health conditions and disparities focused on priority populations, priority conditions and priority interventions across six core areas. The core areas were:

• Administrative
• Health disparities research 
• Health services 
• Health education and disease intervention 
• Health professional shortage 
• Health information technology 

Each core had its own objectives and intervention activities to work towards the overall goals of the project. The intervention framework was guided by Office of Minority Health's expectations of successful implementation. The intended outcomes of the DRI project included:

• Mobilizing communities and partnerships
• Enhancing positive changes in behavior and utilization
• Increasing access to health care services
• Improving data and evaluation
• Improving access to health information technology

The DRI evaluation was a 360-degree process that utilized both quantitative and qualitative measures. Evaluation efforts monitored partners' advancement towards achieving stated project goals and objectives and ascertained the effectiveness of programmatic activities. A few examples of the performance measures used to monitor the program include:

• The number of new researchers from minority or rural communities
• Quantifying the improvement in health communication, access to care and utilization of care
• Coordination among regional partners
• The volume of services available to the target populations
• The improvement of service delivery

Program staff used a number of activities to evaluate the program, including focus groups and community engagement sessions, survey instruments administered by staff (i.e., patient satisfaction surveys, provider satisfaction surveys, awareness/knowledge surveys), and program records.

Key Program Findings Reported throughout the Grant Period

• The DRI impacted a large number of people throughout the Delta region. Across all intervention activities throughout the four-year program, approximately 105,622 individuals were impacted.

• Administrative core: DRI successfully implemented outreach services, two programs focused on obesity, a geospatial information system, adoption of the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care, and a child heart study. DRI also submitted a manuscript to the Journal of the Mississippi State Medical Association about CLAS. Highlights include:
• 545 women received breast and cervical cancer education from community health workers.
• 76 percent of the participants (n=113) in the Weight Loss Program lost the recommended 20 pounds or more.
• 53 percent of participants in the Childhood Obesity Project showed a reduction in BMI.

• Health disparities research core and chronic kidney disease research: DRI recruited 228 individuals; 105 received educational materials, counseling sessions and telephone follow-up.

• Health services core: DRI conducted the Bayou Outreach and Support Services program, implemented the Diabetes Initiative in African American churches, and implemented the Addressing Health Disparities by Reaching Out program at Tougaloo College.Highlights include:
• 148 mental health referrals were made, and 87 individuals scheduled and kept their appointments at the Bayou Outreach and Support Services.
• On a survey of 40 randomly selected partners, 85.7 percent indicated that Diabetes Foundation of Mississippi participation had been very helpful, and 87.5 percent indicated that they were likely to contact the foundation again for another health fair (n=14 partners).
• 882 activities related to chronic disease management and prevention, health risk factors and physical activity were conducted for 16,669 individuals.

• Health education and disease intervention core: Eight intervention activities were carried out at seven locations. Highlights include:
• 633 cancer patients underwent treatment and received navigation services during 2,525 encounters at the Louisiana Comprehensive Cancer Control Program.
• Five diabetes and four hypertension focus groups with 79 participants were conducted at Tulane University's Improving Care Quality and Access for Asian Americans.
• 17 participants took part in a doula certification class with at Rust College.
• An informational website was developed for the Jackson Family Institute as part of the African American Men's Health Network.

• Health professional shortage core: Nine intervention activities were carried out at eight locations. Highlights include:
  
• 131 students enrolled in the Certified Nursing Assistant program. Of those, 120 students (91.6 percent) completed the program at the Nurse Mentorship Academy housed at the Mississippi Hospital Association.
• 20 high school students completed the five-week program, and 80 percent of those students have entered college and declared a major in a pre-health field at Mississippi State University Rural Health Scholars Program.
• Nine presentations were conducted by the Mississippi Primary Healthcare Association, reaching 949 participants.

• Health information technology core: Carried out a Behavioral and Environmental Health Equity Project and a Mobile Health (mHealth) Pilot Project, the Equity Project administered a tri-state survey (n=411) that revealed the top five health concerns: diabetes, alcohol addiction, cancer, obesity and depression. Preliminary results from the mHealth project yielded an estimated 1.5 percent improvement in A1c levels, and the average improvement was estimated at 0.76 percent.

Identified Best Practices/Promising Approaches

• Leveraged multiple partnerships to implement activities and achieve results. The DRI engaged in multiple partnerships with academic institutes, faith-based organizations and community-based organizations to implement several activities across the six core areas with a focus on their intended outcomes to mobilize communities and partnerships, enhance positive changes in behavior, increase access to health care services, improve data and evaluation, and improve access to health information technology.

• Focused on six core areas to expand reach and address several Delta region health disparities. By selecting six core areas and having each core overseen by a director or co-director and a program manager, the DRI could focus on education outreach, improving health disparities, improving health services, addressing late entry into the health care system, increasing the number of minority populations in the health care field and improving health information technology.

• Used logic models with community partners to express the importance of outcomes. The DRI worked with its community partners to develop and use logic models. The purpose of this exercise was to help the partners think beyond process measures and to teach them to develop and use specific instruments to assess outcomes. This helped increase the evaluation capacity of the community-based organizations.

• Used faith-based/community-based initiatives to combat health disparities. The DRI reached out to minority churches and community centers, inviting these groups to attend health fairs and participate in the Diabetes Foundation of Mississippi screening and educational program. As a result, several churches, corporations and community centers instituted walking programs while others changed foods served at health fairs. By including faith-based community organizations and churches, the DRI was able to increase the number of individuals reached by the program as well as ensure program sustainability.

Related Goals

National Partnership for Action to End Health Disparities

• Awareness: Increase awareness of the significance of health disparities, their impact on the nation, and the actions necessary to improve health outcomes for racial, ethnic and underserved populations
• Cultural and linguistic competency: Improve cultural and linguistic competency and the diversity of the health-related workforce
• Data, research and evaluation: Improve data availability and coordination, utilization and diffusion of research and evaluation outcomes
• Health system and life experience: Improve health and health care outcomes for racial, ethnic and underserved populations
• Leadership: Strengthen and broaden leadership for addressing health disparities at all levels

Healthy People 2020 Objectives and Sub-objectives

• AHS-3: Increase the proportion of persons with a usual primary care provider
• AHS-5.1: Increase the proportion of all ages who have a specific source of ongoing care
• AHS-6.1: Reduce the proportion of individuals who are unable to obtain or face a delay in obtaining necessary medical care, dental care or prescription medicines
• D-1: Reduce the annual number of new cases of diagnosed diabetes in the population
• D-10: Increase the proportion of adults with diabetes who have an annual dilated eye examination
• D-13: Increase the proportion of adults with diabetes who perform blood glucose monitoring at least once daily
• D-14: Increase the proportion of persons with diagnosed diabetes who receive formal diabetes education
• D-15: Increase the proportion of persons with diabetes whose condition has been diagnosed
• D-16.1: Increase the proportion of persons at high risk for diabetes with pre-diabetes who report increasing their levels of physical activity
• D-16.2: Increase the proportion of persons at high risk for diabetes with pre-diabetes who report trying to lose weight
• D-16.3: Increase the proportion of persons at high risk for diabetes with pre-diabetes who report reducing the amount of fat or calories in their diet
• D-3: Reduce the diabetes death rate
• D-4: Reduce the rate of lower extremity amputations in persons with diagnosed diabetes.
• D-5.1: Reduce the proportion of the diabetic population with an A1c value greater than 9 percent
• D-7: Increase the proportion of the population with diagnosed diabetes whose blood pressure is under control
• D-8: Increase the proportion of persons with diagnosed diabetes who have at least an annual dental examination
• D-9: Increase the proportion of adults with diabetes who have at least an annual foot examination
• ECBP-10.7: Increase the number of community-based organizations (including local health departments, tribal health services, nongovernmental organizations and state agencies) providing population-based primary prevention services chronic disease programs
• ECBP-10.8: Increase the number of community-based organizations (including local health departments, tribal health services, nongovernmental organizations and state agencies) providing population-based primary prevention services nutrition
• ECBP-10.9: Increase the number of community-based organizations (including local health departments, tribal health services, nongovernmental organizations and state agencies) providing population-based primary prevention services physical activity
• ECBP–12.1: Increase the inclusion of counseling for health promotion and disease prevention content in M.D.-granting medical schools
• ECBP–12.2: Increase the inclusion of cultural diversity content in M.D.-granting medical schools
• ECBP–12.3: Increase the inclusion of evaluation of health sciences literature content in M.D.-granting medical schools
• ECBP–12.4: Increase the inclusion of environmental health content in M.D.-granting medical schools
• ECBP–12.5: Increase the inclusion of public health systems content in M.D.-granting medical schools
• ECBP-14.1: Increase the inclusion of counseling for health promotion and disease prevention content in undergraduate nursing
• ECBP-14.2: Increase the inclusion of cultural diversity content in undergraduate nursing
• ECBP-14.3: Increase the inclusion of evaluation of health sciences literature content in undergraduate nursing
• ECBP-14.4: Increase the inclusion of environmental health content in undergraduate nursing
• ECBP-14.5: Increase the inclusion of public health systems content in undergraduate nursing
• ECBP-7.2: Increase the proportion of college and university students who receive information from their institution on unintentional injury
• ECBP-7.3: Increase the proportion of college and university students who receive information from their institution on violence
• ECBP-7.4: Increase the proportion of college and university students who receive information from their institution on suicide
• ECBP-7.5: Increase the proportion of college and university students who receive information from their institution on tobacco use and addiction
• ECBP-7.6: Increase the proportion of college and university students who receive information from their institution on alcohol and other drug use
• ECBP-7.7: Increase the proportion of college and university students who receive information from their institution on unintended pregnancy
• ECBP-7.8: Increase the proportion of college and university students who receive information from their institution on HIV, AIDS and STD infection
• ECBP-7.9: Increase the proportion of college and university students who receive information from their institution on unhealthy dietary patterns